Diabetes continues to be a growing public-health issue associated with substantial morbidity and mortality, as well as economic burdens for affected patients and the healthcare system. The CDC indicates that diabetes is the seventh leading cause of death and the leading cause of kidney failure, lower-limb amputations, and adult blindness in the United States. Moreover, in the past 2 decades, the incidence of diabetes in adults has more than doubled.
Diabetes is associated with significant morbidity and mortality, and its prevalence continues to escalate, even among pediatric patients, despite advances in our understanding of its complex pathogenesis, risk factors, and optimal treatment strategies, including an expanding number of therapies.
The American Diabetes Association (ADA) defines diabetes mellitus as a complex, chronic metabolic condition requiring continuous medical care and self-care with multifactorial risk-reduction strategies beyond glycemic control. The ADA indicates that diabetes can be further classified as type 1; type 2; specific types due to other causes, such as monogenic diabetes syndromes (e.g., neonatal diabetes and maturity-onset diabetes of the young), diseases of the exocrine pancreas (e.g., cystic fibrosis and pancreatitis), and drug- or chemical-induced diabetes (as associated with the use of glucocorticoids, in the treatment of HIV/AIDS, or after organ transplantation); and gestational diabetes mellitus (GDM).
The two major subtypes of diabetes are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). T1DM and T2DM are heterogeneous medical conditions, and the pathophysiology of each type is different; therefore, each type will vary with regard to etiology, progression, clinical presentation, and therapies. In both T1DM and T2DM, several genetic and environmental factors can contribute to the progressive loss of Beta-cell mass and/or function that manifests clinically as hyperglycemia.
T1DM (previously referred to as juvenile-onset or insulin-dependent) is the result of autoimmune Beta-cell destruction that usually progresses to complete insulin deficiency. The pathogenesis of T1DM has been associated with both a genetic predisposition and environmental components. Typically, the onset of T1DM occurs during childhood or adolescence, but it may also manifest in adults in their late 30s and early 40s (latent autoimmune diabetes of adulthood, which frequently initially appears to be T2DM). Some cases of T1DM do not seem to be autoimmune in nature and are therefore considered idiopathic. The rate of progression depends on several factors, including age of first antibody detection, number of antibodies, antibody specificity, and antibody titers.
T2DM (previously referred to as adult-onset or non–insulin-dependent) is the result of a progressive loss of adequate Beta-cell insulin secretion, frequently due to the development of insulin resistance. The majority of diabetes cases are diagnosed as T2DM, and more healthcare resources are spent on diabetes care than on any other medical condition. While T2DM typically occurs in adults and the incidence increases with age, with more than one-third of those aged 65 years and older presenting with impaired glucose tolerance, the soaring rate of obesity, especially among pediatric patients, is fueling the increasing rates of T2DM among younger individuals.
The ADA states, “The traditional paradigms of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in both age-groups.”
GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy, and it does not include women who had diabetes prior to conception. In the U.S., GDM occurs in an estimated 10% of pregnancies.
An alarming number of individuals are considered to be prediabetic. The ADA defines prediabetes as the state in which blood glucose levels are greater than normal but not elevated enough to be diagnosed as diabetes. The ADA adds that if this condition goes undiagnosed and unmanaged, individuals with prediabetes will eventually progress to diabetes.
Undiagnosed and uncontrolled diabetes is associated with a number of serious health complications, including microvascular complications (nephropathy, neuropathy, and retinopathy) and macrovascular complications (coronary artery disease, myocardial infarction, transient ischemic attack/stroke, congestive heart failure, and peripheral arterial insufficiency).
To reduce and/or prevent the risk of serious diabetes-related complications, early diagnosis, aggressive treatment, and effective ongoing support and management are essential, and a multidisciplinary approach to care is warranted to maintain tight glycemic control, minimize risks of hyperglycemia and hypoglycemia, and reduce the risk of microvascular and macrovascular complications.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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