Diabetes affects some 400 million people worldwide, half of them undiagnosed. By the year 2040, it is estimated that there will be 640 million people with diabetes worldwide. This 21st century epidemic is due to changes in lifestyle habits, characterized by a sedentary lifestyle and an excess in our diet of foods and beverages rich in sugars and saturated fats.
Increase in diabetes in the Basque Country
Although the increase in diabetes is greater in developing countries where the frequency of the disease will double, Spain and the Basque Country are also suffering from this increase: we have doubled the prevalence of type 2 diabetes from 2000 to 2011.
To this figure we should add the number of people with undiagnosed diabetes, which represents almost half of the total number of people with diabetes. In 2010, total diabetes (known plus unknown) was 10.6% in the Basque Country. There is also a small percentage of people with prediabetes, that is, with a very high risk of developing the disease.
Consequences of diabetes
People with diabetes and prediabetes more frequently have other associated cardiovascular risk factors such as hypertension, and elevated cholesterol and triglyceride levels.
It is important to note that in people with prediabetes (high risk of developing diabetes) the risk of developing diabetes can be reduced in more than half of the cases with lifestyle changes and exercise.
Diabetes is characterized by the development of chronic complications that make it the main cause of cardiovascular disease, blindness, renal failure and lower limb amputation.
In the Basque Country, the main cause of death in people with type 2 diabetes is cardiovascular death, which accounts for about half. 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 type 1 or type 2 diabetes will develop some form of damage to their eyes that can lead to blindness.
Diagnosis of Diabetes
Many people live with type 2 diabetes for a long period of time without being aware of their condition. By the time they are diagnosed, the complications of diabetes may already be present. In the Basque Country, at the time of diagnosis, 14% of people with type 2 diabetes already have cardiovascular disease and 7% have diabetic retinopathy.
It is therefore essential to diagnose people with diabetes as soon as possible in order to modify the course of the disease and reduce the risk of complications. Periodic screening for the possible presence of complications is an essential part of the management of type 1 and type 2 diabetes.
These complications of diabetes can be prevented or delayed by keeping blood glucose, blood pressure and cholesterol levels as normal as possible. Once the complication is detected by periodic screening, which should include screening for diabetic retinopathy, we can treat it to slow progression to more severe stages. Careful management of diabetes and screening for diabetic eye disease can help prevent visual impairment and blindness.
Treatment of diabetes
Diet and exercise are the mainstay of diabetes treatment. Drugs and new technologies have undergone a real 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. Faster-acting insulins are in development 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 also demonstrating cardiovascular safety and some of them reduce the risk of developing cardiovascular disease or death in people with diabetes at very high cardiovascular risk. This is important because cardiovascular disease is the most devastating complication of diabetes.
Advances in the treatment of diabetes
New technologies, such as sensors with flash monitoring that display glucose levels for 24 hours, allow strict monitoring of glycemic levels, which favors disease control and helps to reduce complications and the time patients with type 1 diabetes spend in hypoglycemia.
Continuous insulin infusion pumps are devices that allow better glycemic control for those who cannot achieve it with multidose insulin.
The development of closed loop systems is very advanced: by means of a sensor in the skin, they continuously measure the subcutaneous glucose level and this information is transferred to a terminal worn by the person in which a microchip with a mathematical algorithm orders a continuous insulin infusion pump the amount of this hormone to be dispensed according to the glucose level at each moment. Although these systems are not in general use, they are a great help for some patients and will represent a paradigm shift in the treatment of diabetes in the not too distant future.
In any case, the education of people with diabetes aimed at achieving healthy lifestyle habits, self-measurement and self-control of blood glucose and its associated risk factors, are essential to control the disease and avoid its complications. The management of this epidemic is a multidisciplinary task and requires the intervention of physicians, nurse educators, dieticians, psychologists, podiatrists and health authorities.