Dr. Jose Antonio Pinies, renowned specialist in Endocrinology and Nutrition, talks about the most important characteristics of diabetes, its complications and treatment. Dr. Piniés recognizes that the two most common types of diabetes are DM1 and DM2. DM1 accounts for 10% of cases and affects young people. It is characterized by an autoimmune destruction of the insulin-producing beta cells of the pancreas. DM2 accounts for 90% and occurs in adulthood; it can occur for two reasons, resistance to insulin in its mission of introducing glucose into the cells and the inability of the pancreas to secrete sufficient insulin to overcome the resistance to its action. This resistance is mainly caused by an increase in body fat.
Symptoms and diagnosis
Regarding the signs that can give us the alarm, in DM1 the presentation can be very abrupt, with intense symptoms of polyuria (urinating a lot), polydipsia (thirst), nocturia (urinating at night) and weight loss and tiredness. As for DM2 the symptoms are similar, although with varying degrees of intensity, and it can be more ‘larval’ in time and in many occasions it is diagnosed when elevated glycemia (blood glucose) is detected in a routine blood test.
Complications
Diabetes is characterized by the development of chronic complications, making it the leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation.
People with diabetes and prediabetes also more frequently have other associated cardiovascular risk factors such as hypertension, and elevated cholesterol and triglyceride levels.
In a recent study carried out in the Basque Country, the main cause of death in people with type 2 diabetes is cardiovascular death, which accounts for around 50%. The risk of cardiovascular mortality is multiplied by 3 in people with diabetes compared to the general population of our country.
More than one-third of people currently living with DM1 or DM2 will develop some form of damage to their eyes that can lead to blindness.
These complications of diabetes can be prevented or delayed by keeping blood glucose, blood pressure and cholesterol levels as close to normal as possible. Once the complication is detected (through periodic examinations including screening for diabetic retinopathy, foot examination, electrocardiogram and urine albumin), it can be treated to slow progression to more severe stages.
Management of diabetes
Glycosylated hemoglobin (average glucose over the last 3 months) is an analytical parameter of glycemic control and figures of 7% or lower indicate that the person is well controlled and at low risk of developing chronic complications of the disease.
Control of other risk factors such as hypertension, cholesterol or smoking are essential.
Treatment
The treatment of diabetes has evolved towards a care focused on the characteristics of each person. The most important thing is to follow a diet free of carbohydrates of rapid absorption (sweets), balanced, Mediterranean and adjusted to the energy needs of the person. Regular aerobic and/or strength training, according to one’s capacity, is essential to combat obesity whenever it is present. Likewise, oral antidiabetics and insulin are the drugs we use to reduce glucose levels.
To prevent cardiovascular disease we need intensive control of all these risk factors (glucose, cholesterol, blood pressure and smoking), which also improve with changes in lifestyle habits (diet, exercise and abstinence from smoking).
Drugs and new technologies have undergone a true revolution in the last decade that is transforming and improving the management of this disease. New slow-acting insulins have been developed with a flatter and longer-lasting action profile that allow less glycemic variability and lower risk of hypoglycemia. We have “faster” rapid-acting insulins that will allow, when administered before meals, better glucose control with lower post-meal glucose elevations.
Likewise, for the treatment of type 2 diabetes, we have new oral antidiabetic and injectable drugs that improve glycemic control with a lower risk of hypoglycemia, promote weight loss and reduce other associated cardiovascular risk factors such as blood pressure.
These new treatments are demonstrating cardiovascular safety and some of them reduce the risk of developing cardiovascular disease or death and diabetic kidney disease in people with diabetes at very high cardiovascular risk. This is important since cardiovascular disease is the most devastating complication of diabetes.