November 14, 2023 - World Diabetes Day

Every year on November 14, World Diabetes Day is celebrated globally. It was established in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to the growing threat of diabetes worldwide.

Diabetes Mellitus (DM) is a serious medical and social problem of the 21st century. The significance of the problem of diabetes morbidity is highlighted by the adoption of the Declaration on Diabetes Mellitus by the United Nations General Assembly in December 2006. The declaration expresses concern about the increasing global incidence of diabetes, a non-communicable disease that has reached epidemic proportions. Since 2007, the Day has been celebrated under the auspices of the UN. A special United Nations resolution proclaimed the need to develop state programs aimed at combating diabetes.

Currently, DM holds a leading position in global health programs, with particular emphasis on the accessibility of essential medicines, and the prevention of obesity and DM.

The goal of World Diabetes Day is to raise awareness about diabetes – not only about the number of people diagnosed with diabetes but also about how the development of this disease can be prevented.

The growing number of people suffering from diabetes places an additional burden on healthcare systems. Healthcare professionals must know how to suspect and diagnose the disease at an early stage and provide quality treatment. At the same time, patients living with diabetes require continuous education to understand their condition and perform the daily self-care necessary to maintain health and prevent complications. However, even now, millions of people with diabetes worldwide lack access to diabetes treatment. In this regard, the theme for World Diabetes Day for the period 2021–2023 was determined as "Diabetes care for all – when not now?".

“Know the risk of diabetes – know how to act” is the motto of the third year of the World Diabetes Day campaign 2021–2023. The events will focus on identifying the risks of developing diabetes and the risks of developing its complications. Patients will be explained not only the basic aspects of diabetes prevention but also the prevention of its complications. In this context, every patient with diabetes should have access not only to diabetes treatment but also to examinations for the timely detection of complications.

Since January 2023, a new procedure for medical examinations of the population has been in effect in the Republic of Belarus, the initial stage of which is a questionnaire aimed at early detection of the risk of developing the most socially significant diseases, including diabetes mellitus. Currently, the number of patients with diabetes mellitus worldwide is about 463 million, and by 2025 their number will increase to 550 million people, with the assumption that every second patient is undiagnosed.

The number of diabetes patients in Belarus has increased more than 2.6 times over the past 15 years. For example, if in 2008 the number of patients with this diagnosis was 150 thousand, now this figure is about 400 thousand. Moreover, the increase in morbidity is due to type 2 diabetes, which accounts for more than 94% of all cases.

Type 1 diabetes mellitus is spreading at a lower rate. There are about 19 thousand patients with type 1 diabetes in the Republic. These people depend on daily insulin injections, including about 2.3 thousand children who need special attention.

As of the beginning of 2023, 48,748 patients were under medical supervision in the Vitebsk region, including 2,008 people with type 1 diabetes, including 333 children. For the 9 months of 2023, the diagnosis of diabetes mellitus was established for the first time in 3,985 people.

What do specialists associate the worldwide increase in the incidence of type 2 diabetes mellitus with?

This is due to the following trends that have become clearly evident in recent decades: a progressive decrease in physical activity and irrational nutrition. The problem of people abandoning traditional culinary traditions for each country, which have developed over centuries, is very relevant. So-called "fast food" and an excess of refined carbohydrates in the diet lead to the development of obesity; impaired lipid metabolism and excess body weight, in turn, lead to insulin resistance, compensatory hyperinsulinism, and exhaustion of the pancreatic islets of Langerhans.

An important factor in the development of diabetes mellitus is psycho-emotional stress, characteristic of modern human lifestyle. The environmental situation is also of great importance. Diabetes mellitus, along with atherosclerosis, hypertension, and obesity, is classified as a disease of civilization. Genetic factors have a significant influence on the development of diabetes mellitus.

Type 2 diabetes mellitus is a disease that affects people in the second half of life, more often after the age of forty. Arising insidiously, it increasingly reminds of its existence each year with the progressive development of complications, which lead first to temporary and then to persistent disability and premature death.

The concept of "adequate" diabetes control includes not only good well-being with diabetes but also blood glucose levels close to normal. It has been proven that only stable compensation of metabolic disorders in diabetes guarantees a favorable course of the disease. This means that from the moment of diagnosis, it is very important to carefully monitor one's condition to prevent acute critical situations (including hypoglycemia and ketoacidosis) and to block the development of late complications. They develop gradually and imperceptibly, but strike a devastating blow to the eyes, kidneys, legs, and heart. Can their occurrence be prevented? With persistent normalization of blood glucose levels, the occurrence and progression of all specific diabetes complications can be prevented!

Key Facts About Diabetes:

• Studies show that the actual prevalence of diabetes mellitus is 3.1 times higher than registered for the population aged 30-39 years, 4.1 times higher for ages 40-49 years, 2.2 times higher for 50-59-year-olds, and 2.5 times higher for 60-69-year-olds.

• Almost half of patients with diabetes mellitus are in the age group of 40-59 years. Of these, more than 70% are residents of developing countries.
• Every 10 seconds, 2 more patients with diabetes mellitus appear in the world. This amounts to 7 million per year. The highest percentage of morbidity is detected among residents of the USA, where about 20% of the country's entire population suffers from diabetes mellitus.
• Every 10 seconds, 1 person dies from complications of diabetes mellitus, including cardiovascular diseases. This amounts to 4 million per year.
• Diabetes increases mortality by 2-3 times and reduces life expectancy. Almost half of all deaths from diabetes mellitus are usually due to complications and lack of proper treatment, and occur before the age of 70.
• Diabetes is one of the leading causes of blindness, kidney failure, heart attacks, strokes, and amputations of the lower extremities. For example, blindness develops 10 times more often than among the general population; nephropathy - 12-15 times more often; gangrene of the lower extremities - almost 20 times more often.
• The number of patients with type 1 diabetes, which is called "juvenile diabetes," is growing at a rate of 3% per year. However, medical statistics indicate that type 2 diabetes is also becoming more common in younger people.
• The disease can develop unnoticed for many years, without causing any signs or discomfort. For this reason, the disease leads to serious complications, destructively affecting the cardiovascular system, liver, kidneys, and other internal organs, leading to disability.
• It is believed that every kilogram of excess weight increases the risk of developing diabetes by 5%.
• The risk of developing type 2 diabetes mellitus increases by 2 to 6 times if diabetes is present in parents or close relatives. The probability of further inheritance of the disease in this case is 40%.
• Approximately 50% of patients with diabetes are unaware that they are ill. In some countries, this figure reaches 80%.

Diabetes mellitus develops when the body stops producing insulin, or when insufficient insulin is produced, or when its use is ineffective. Without insulin, the human body cannot extract the energy necessary for life from food.

Insulin is a hormone produced by the pancreas. Most food is converted into glucose, which is a form of sugar that our body uses to produce energy. Insulin helps glucose from food get into the body's cells to produce energy. Without insulin, glucose accumulates in the blood instead of entering the cells.

Type 1 diabetes (formerly called insulin-dependent diabetes) requires insulin for survival. In this case, insulin is not produced at all or is produced in small amounts, so the only pathogenetic treatment for this disease is insulin therapy. The ultimate goal of insulin therapy is to prevent late diabetic complications, or at least to reduce the risk and timing of their development.

Various exogenous and endogenous factors influence the development of diabetes mellitus. The link between the manifestation of type 1 diabetes and heredity, and in particular genetic predisposition, has been proven. Among exogenous risk factors, the role of viruses in initiating the autoimmune reaction of type 1 diabetes is considered proven; seasonal fluctuations in the manifestation of the disease have been identified, and differences in morbidity depending on the latitude of the region of residence have been assessed. It has been suggested that the autoimmune reaction and changes at the genetic level can also be initiated by radiation exposure.

Type 1 diabetes mellitus usually begins suddenly and can manifest as:

- frequent urination;

- excessive thirst and dry mouth;

- extreme fatigue / lack of energy;

- constant hunger;

- sudden weight loss;

- blurred vision;

- recurrent infections.

Type 2 diabetes, previously known as non-insulin-dependent diabetes, is usually found in older people, especially those who are overweight. However, due to obesity and a sedentary lifestyle, which are increasingly observed among young people, type 2 diabetes is now also occurring in children and young adults. Recent data indicate that 5 to 30% of newly diagnosed diabetes cases in children may be attributed to type 2 diabetes. Unfortunately, this also implies the possibility of early development of diabetes complications. Insulin secretion is preserved for a long time in type 2 diabetes, with insulin resistance (decreased sensitivity to insulin) being typical. Patients with type 2 diabetes do not always require insulin injections. Often, they can manage the disease through diet, weight loss (if necessary), and regular physical exercise. Additionally, treatment with oral medications is possible. Patients with type 2 diabetes account for 90-95% of all diabetes patients worldwide.

Type 2 diabetes usually develops gradually, making it difficult to detect. However, patients with type 2 diabetes may experience symptoms characteristic of type 1 diabetes, but in a less severe form.

Type 2 diabetes is characterized by an asymptomatic course or non-specific clinical signs (itching of the skin and genital area, pustular skin lesions and fungal nail infections, skin peeling and excessive keratinization of the feet, recurrent conjunctivitis, styes, poor wound healing, cuts, dental problems – gingivitis, stomatitis, periodontitis (loose teeth), disorders of the central or peripheral nervous system).

As practice shows, the disease is often detected with significant delay, 5-7 years after its onset, when it already manifests with complications. Diabetes is often diagnosed by ophthalmologists, surgeons, and neurologists, not just by general practitioners and endocrinologists. The main task of doctors is the timely diagnosis of diabetes. In this regard, screening individuals from risk groups is very important: patients with atherosclerosis, ischemic heart disease, hypertension, obesity, and the elderly.

Everyone should know and remember the following:

- if during a medical examination your blood glucose level is incidentally found to be above 6.1 mmol/L, you must immediately consult your general practitioner; individuals under 40 years of age should consult an endocrinologist;

- If your blood glucose level is between 5.0 and 6.1 mmol/L, you should undergo an OGTT (Oral Glucose Tolerance Test). The term "tolerance" itself means "patience" or "endurance"; glucose tolerance is the body's ability to handle glucose loads. OGTT is a more objective criterion for determining the presence of diabetes or a pre-diabetic state;

If you belong to a risk group for developing diabetes mellitus, or if you have arterial hypertension, a BMI > 30 kg/m², chronic cholecystitis, obesity, slow wound healing, vision impairment, or a sedentary lifestyle, it is advisable to consult a doctor to determine your blood glucose level and, if indicated, prescribe an OGTT.

The most optimal approach is to identify patients at the stage of impaired glucose tolerance, i.e., when fasting blood glucose levels are between 5.6 and 6.1 mmol/L, and postprandial levels are between 7.8 and 11 mmol/L. Impaired glucose tolerance is the very first objective sign of carbohydrate metabolism disorder and indicates a high risk of developing diabetes mellitus. Studies have shown that the risk of developing diabetes mellitus in individuals with impaired glucose tolerance is 11-19% per year.

Who belongs to the risk group for developing diabetes mellitus?

Close relatives of patients with diabetes mellitus (parents, children, siblings, especially twins);

- Obese individuals;

- Women with a history of miscarriages, premature births, stillbirths, or delivery of a large baby (over 4 - 4.5 kg); gestational glucosuria;

- Individuals with renal and alimentary glucosuria;

- Individuals with episodic glucosuria and hyperglycemia detected during stressful situations (surgery, trauma, heart attack, stroke, infections);

- Patients with chronic liver, kidney, or cardiovascular diseases, especially ischemic heart disease, persistent periodontitis, furunculosis, neuropathies of unclear etiology;

- Individuals with spontaneous hypoglycemia and a family history of diabetes;

- Elderly and senile individuals.

Diseases that are accompanied by reduced insulin action (polycystic ovary syndrome, arterial hypertension, dyslipidemia) also indicate a high risk of developing diabetes.

Skin signs of insulin resistance, such as "acanthosis nigricans": dark, thickened patches of skin in the armpits, on the neck, and elbows may indicate impaired insulin sensitivity.

How to avoid developing late complications?

Firstly, if you have diabetes, there's nothing you can do about it – you must agree to the doctor's main requirement: accept the lifestyle changes dictated by the disease. Now you need to pay more attention to your diet, following the dietary recommendations given to you by your doctor. Patients with diabetes mellitus need to minimize their sugar intake and reduce the amount of animal fats. You should increase your consumption of healthy foods, especially fresh vegetables and whole grains. For patients with excess body weight, the daily calorie intake should be around 1200-1500 calories. It is important to remember that you should never starve yourself. It is important to follow the so-called "plate rule." Try to mentally divide your plate in half. Divide one half again in half – we have created three zones that we will fill with food. Half of the plate should be fresh vegetables, a quarter – whole grains – buckwheat, rice, cereals, porridges, and a quarter – protein-rich foods – lean fish, meat, legumes. Such a diet will benefit not only the patient with diabetes but also all members of their family. Moderate, strictly individualized physical activity has a beneficial effect on the condition of a person with diabetes. During physical exercise, glucose from the blood is intensely oxidized in muscle tissue, and consequently, blood glucose levels decrease. This is why people with diabetes of all ages need physical activity. And there is no need to buy exercise equipment or gym memberships. You just need to slightly change your daily habits. Good ways to keep your body in shape include:

• walking up stairs instead of using the elevator;
• walking in the park with friends instead of an evening at a cafe;
• active games with children instead of using a computer;
• avoiding stress. Relevant advice for maintaining health is to quit smoking, which only creates an illusion of calmness. At the same time, nerve cells and hormonal balance still suffer, and nicotine enters the body, contributing to the development of diabetes and its subsequent complications.

By overcoming the desire to "eat well and lie down more," you are already halfway to success. Special attention should be paid to the prescribed treatment. Diabetes treatment also includes smoking cessation, glucose-lowering therapy, treatment of arterial hypertension (if blood pressure is elevated), and normalization of blood lipid levels. Today, the principle of successful diabetes therapy is the immediate initiation of drug therapy if non-drug methods prove to be ineffective. Is it possible to achieve and maintain target blood glucose levels with diet and glucose-lowering pills? Scientific research has shown that 10 years after the onset of type 2 diabetes, the secretion of endogenous insulin decreases to 25%, and then approaches almost zero. Therefore, in theory, 10 years after the onset of the disease, up to 80% of patients with type 2 diabetes should receive insulin.

Insulin can be successfully combined with glucose-lowering pills even in the early stages, with just one daily injection of long-acting insulin. This type of therapy is convenient for the patient and will allow for good diabetes compensation for a long time.

Thus, insulin is an essential drug in the treatment of type 2 diabetes not compensated by oral glucose-lowering drugs, and it helps to quickly establish proper metabolism in the body. Insulin therapy should "play" the role of absent or insufficient secretion of the body's own hormone. If the injection regimen and insulin dose correspond to the meal plan and blood glucose levels are close to normal, then good compensation of metabolic processes in the body can be achieved.

How to maintain stable diabetes compensation?

Long-term observation of diabetic patients has convincingly proven that maximum and stable metabolic compensation significantly reduces the risk of diabetic complications. However, medical supervision must be active, and patients need to strictly follow all self-monitoring rules.

Self-monitoring of diabetes includes:

• regular measurement of blood glucose levels;
• competent assessment of the obtained results;
• the ability to adjust one's treatment according to the obtained results.

To be confident in the correct self-monitoring of diabetes, one must understand the meaning of their actions, go through a difficult path of mistakes, and be persistent in achieving the set goal – to have a good quality of life despite the illness. Unfortunately, this is not achieved by all people with diabetes, but one must strive for it. It is known that eternal life does not exist, and happiness and luck do not smile on everyone. But if you have contracted diabetes, do not despair – you can live successfully for many, many years with this disease.

The problem of prevention and treatment of diabetes mellitus concerns not only endocrinologists. Lifestyle modification, assessment of diabetes risk, patient education – all these tasks fall on the shoulders of the therapeutic service. Observation of patients with type 2 diabetes mellitus before insulin therapy is currently also carried out by general practitioners (family doctors). At the same time, patients with type 1 diabetes mellitus constitute one of the most complex subpopulations of patients requiring regular observation by an endocrinologist, systematic training in self-monitoring skills, assessment of risk factors and progression of chronic diabetes complications.

A decisive factor determining the quality of life of patients with diabetes mellitus is the