Diabetes

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Not to be confused with Diabetes insipidus. Diabetes_sentence_0

Diabetes_table_infobox_0

Diabetes mellitusDiabetes_header_cell_0_0_0
PronunciationDiabetes_header_cell_0_1_0 Diabetes_cell_0_1_1
SpecialtyDiabetes_header_cell_0_2_0 EndocrinologyDiabetes_cell_0_2_1
SymptomsDiabetes_header_cell_0_3_0 Frequent urination, increased thirst, increased hungerDiabetes_cell_0_3_1
ComplicationsDiabetes_header_cell_0_4_0 Diabetic ketoacidosis, hyperosmolar hyperglycemic state, heart disease, stroke, chronic kidney failure, foot ulcers, cognitive impairment, gastroparesisDiabetes_cell_0_4_1
Risk factorsDiabetes_header_cell_0_5_0 Type 1: Family history

Type 2: Obesity, lack of exercise, geneticsDiabetes_cell_0_5_1

Diagnostic methodDiabetes_header_cell_0_6_0 High blood sugarDiabetes_cell_0_6_1
TreatmentDiabetes_header_cell_0_7_0 Healthy diet, physical exerciseDiabetes_cell_0_7_1
MedicationDiabetes_header_cell_0_8_0 Insulin, anti-diabetic medication like metforminDiabetes_cell_0_8_1
FrequencyDiabetes_header_cell_0_9_0 463 million (8.8%)Diabetes_cell_0_9_1
DeathsDiabetes_header_cell_0_10_0 4.2 million (2019)Diabetes_cell_0_10_1

Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Diabetes_sentence_1

Symptoms often include frequent urination, increased thirst, and increased appetite. Diabetes_sentence_2

If left untreated, diabetes can cause many complications. Diabetes_sentence_3

Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Diabetes_sentence_4

Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves, damage to the eyes and cognitive impairment. Diabetes_sentence_5

Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced. Diabetes_sentence_6

There are three main types of diabetes mellitus: Diabetes_sentence_7

Diabetes_unordered_list_0

  • Type 1 diabetes results from the pancreas's failure to produce enough insulin due to loss of beta cells. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The loss of beta cells is caused by an autoimmune response. The cause of this autoimmune response is unknown.Diabetes_item_0_0
  • Type 2 diabetes begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.Diabetes_item_0_1
  • Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.Diabetes_item_0_2

Type 1 diabetes must be managed with insulin injections. Diabetes_sentence_8

Prevention and treatment of type 2 diabetes involves maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco. Diabetes_sentence_9

Type 2 diabetes may be treated with medications such as insulin sensitizers with or without insulin. Diabetes_sentence_10

Control of blood pressure and maintaining proper foot and eye care are important for people with the disease. Diabetes_sentence_11

Insulin and some oral medications can cause low blood sugar. Diabetes_sentence_12

Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes. Diabetes_sentence_13

Gestational diabetes usually resolves after the birth of the baby. Diabetes_sentence_14

As of 2019, an estimated 463 million people had diabetes worldwide (8.8% of the adult population), with type 2 diabetes making up about 90% of the cases. Diabetes_sentence_15

Rates are similar in women and men. Diabetes_sentence_16

Trends suggest that rates will continue to rise. Diabetes_sentence_17

Diabetes at least doubles a person's risk of early death. Diabetes_sentence_18

In 2019, diabetes resulted in approximately 4.2 million deaths. Diabetes_sentence_19

It is the 7th leading cause of death globally. Diabetes_sentence_20

The global economic cost of diabetes related health expenditure in 2017 was estimated at US$727 billion. Diabetes_sentence_21

In the United States, diabetes cost nearly US$327 billion in 2017. Diabetes_sentence_22

Average medical expenditures among people with diabetes are about 2.3 times higher. Diabetes_sentence_23

Signs and symptoms Diabetes_section_0

The classic symptoms of untreated diabetes are unintended weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Diabetes_sentence_24

Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent in type 2 diabetes. Diabetes_sentence_25

Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. Diabetes_sentence_26

In addition to the known ones above, they include blurred vision, headache, fatigue, slow healing of cuts, and itchy skin. Diabetes_sentence_27

Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. Diabetes_sentence_28

Long-term vision loss can also be caused by diabetic retinopathy. Diabetes_sentence_29

A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes. Diabetes_sentence_30

Diabetic emergencies Diabetes_section_1

People (usually with type 1 diabetes) may also experience episodes of diabetic ketoacidosis (DKA), a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness. Diabetes_sentence_31

A rare but equally severe possibility is hyperosmolar hyperglycemic state (HHS), which is more common in type 2 diabetes and is mainly the result of dehydration. Diabetes_sentence_32

Treatment-related low blood sugar (hypoglycemia) is common in people with type 1 and also type 2 diabetes depending on the medication being used. Diabetes_sentence_33

Most cases are mild and are not considered medical emergencies. Diabetes_sentence_34

Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases. Diabetes_sentence_35

Rapid breathing, sweating, and cold, pale skin are characteristic of low blood sugar but not definitive. Diabetes_sentence_36

Mild to moderate cases are self-treated by eating or drinking something high in sugar. Diabetes_sentence_37

Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon. Diabetes_sentence_38

Complications Diabetes_section_2

Main article: Complications of diabetes Diabetes_sentence_39

All forms of diabetes increase the risk of long-term complications. Diabetes_sentence_40

These typically develop after many years (10–20) but may be the first symptom in those who have otherwise not received a diagnosis before that time. Diabetes_sentence_41

The major long-term complications relate to damage to blood vessels. Diabetes_sentence_42

Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in people with diabetes are due to coronary artery disease. Diabetes_sentence_43

Other macrovascular diseases include stroke, and peripheral artery disease. Diabetes_sentence_44

The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Diabetes_sentence_45

Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and eventual blindness. Diabetes_sentence_46

Diabetes also increases the risk of having glaucoma, cataracts, and other eye problems. Diabetes_sentence_47

It is recommended that people with diabetes visit an eye doctor once a year. Diabetes_sentence_48

Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplantation. Diabetes_sentence_49

Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. Diabetes_sentence_50

The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes_sentence_51

Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Diabetes_sentence_52

Additionally, proximal diabetic neuropathy causes painful muscle atrophy and weakness. Diabetes_sentence_53

There is a link between cognitive deficit and diabetes. Diabetes_sentence_54

Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function. Diabetes_sentence_55

Having diabetes, especially when on insulin, increases the risk of falls in older people. Diabetes_sentence_56

Causes Diabetes_section_3

Diabetes_table_general_1

Comparison of type 1 and 2 diabetesDiabetes_table_caption_1
FeatureDiabetes_header_cell_1_0_0 Type 1 diabetesDiabetes_header_cell_1_0_1 Type 2 diabetesDiabetes_header_cell_1_0_2
OnsetDiabetes_header_cell_1_1_0 SuddenDiabetes_cell_1_1_1 GradualDiabetes_cell_1_1_2
Age at onsetDiabetes_header_cell_1_2_0 Mostly in childrenDiabetes_cell_1_2_1 Mostly in adultsDiabetes_cell_1_2_2
Body sizeDiabetes_header_cell_1_3_0 Thin or normalDiabetes_cell_1_3_1 Often obeseDiabetes_cell_1_3_2
KetoacidosisDiabetes_header_cell_1_4_0 CommonDiabetes_cell_1_4_1 RareDiabetes_cell_1_4_2
AutoantibodiesDiabetes_header_cell_1_5_0 Usually presentDiabetes_cell_1_5_1 AbsentDiabetes_cell_1_5_2
Endogenous insulinDiabetes_header_cell_1_6_0 Low or absentDiabetes_cell_1_6_1 Normal, decreased
or increasedDiabetes_cell_1_6_2
Concordance

in identical twinsDiabetes_header_cell_1_7_0

50%Diabetes_cell_1_7_1 90%Diabetes_cell_1_7_2
PrevalenceDiabetes_header_cell_1_8_0 ~10%Diabetes_cell_1_8_1 ~90%Diabetes_cell_1_8_2

Diabetes mellitus is classified into six categories: type 1 diabetes, type 2 diabetes, hybrid forms of diabetes, hyperglycemia first detected during pregnancy, "unclassified diabetes", and "other specific types". Diabetes_sentence_57

The "hybrid forms of diabetes" contains slowly evolving, immunemediated diabetes of adults and ketosis-prone type 2 diabetes. Diabetes_sentence_58

The "hyperglycemia first detected during pregnancy" contains gestational diabetes mellitus and diabetes mellitus in pregnancy (type 1 or type 2 diabetes first diagnosed during pregnancy). Diabetes_sentence_59

The "other specific types" are a collection of a few dozen individual causes. Diabetes_sentence_60

Diabetes is a more variable disease than once thought and people may have combinations of forms. Diabetes_sentence_61

The term "diabetes", without qualification, refers to diabetes mellitus. Diabetes_sentence_62

Type 1 Diabetes_section_4

Main article: Type 1 diabetes Diabetes_sentence_63

Type 1 diabetes is characterized by loss of the insulin-producing beta cells of the pancreatic islets, leading to insulin deficiency. Diabetes_sentence_64

This type can be further classified as immune-mediated or idiopathic. Diabetes_sentence_65

The majority of type 1 diabetes is of the immune-mediated nature, in which a T cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin. Diabetes_sentence_66

It causes approximately 10% of diabetes mellitus cases in North America and Europe. Diabetes_sentence_67

Most affected people are otherwise healthy and of a healthy weight when onset occurs. Diabetes_sentence_68

Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Diabetes_sentence_69

Although it has been called "juvenile diabetes" due to the frequent onset in children, the majority of individuals living with type 1 diabetes are now adults. Diabetes_sentence_70

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. Diabetes_sentence_71

This term, however, has no biologic basis and should not be used. Diabetes_sentence_72

Still, type 1 diabetes can be accompanied by irregular and unpredictable high blood sugar levels, and the potential for diabetic ketoacidosis or serious low blood sugar levels. Diabetes_sentence_73

Other complications include an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease). Diabetes_sentence_74

These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes. Diabetes_sentence_75

Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. Diabetes_sentence_76

In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors, such as a viral infection or diet. Diabetes_sentence_77

Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans. Diabetes_sentence_78

Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood. Diabetes_sentence_79

Type 1 diabetes can occur at any age, and a significant proportion is diagnosed during adulthood. Diabetes_sentence_80

Latent autoimmune diabetes of adults (LADA) is the diagnostic term applied when type 1 diabetes develops in adults; it has a slower onset than the same condition in children. Diabetes_sentence_81

Given this difference, some use the unofficial term "type 1.5 diabetes" for this condition. Diabetes_sentence_82

Adults with LADA are frequently initially misdiagnosed as having type 2 diabetes, based on age rather than cause Diabetes_sentence_83

Type 2 Diabetes_section_5

Main article: Type 2 diabetes Diabetes_sentence_84

Type 2 diabetes is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. Diabetes_sentence_85

The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. Diabetes_sentence_86

However, the specific defects are not known. Diabetes_sentence_87

Diabetes mellitus cases due to a known defect are classified separately. Diabetes_sentence_88

Type 2 diabetes is the most common type of diabetes mellitus. Diabetes_sentence_89

Many people with type 2 diabetes have evidence of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) before meeting the criteria for type 2 diabetes. Diabetes_sentence_90

The progression of prediabetes to overt type 2 diabetes can be slowed or reversed by lifestyle changes or medications that improve insulin sensitivity or reduce the liver's glucose production. Diabetes_sentence_91

Type 2 diabetes is primarily due to lifestyle factors and genetics. Diabetes_sentence_92

A number of lifestyle factors are known to be important to the development of type 2 diabetes, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization. Diabetes_sentence_93

Excess body fat is associated with 30% of cases in people of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders. Diabetes_sentence_94

Even those who are not obese may have a high waist–hip ratio. Diabetes_sentence_95

Dietary factors such as sugar-sweetened drinks is associated with an increased risk. Diabetes_sentence_96

The type of fats in the diet is also important, with saturated fat and trans fats increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk. Diabetes_sentence_97

Eating white rice excessively may increase the risk of diabetes, especially in Chinese and Japanese people. Diabetes_sentence_98

Lack of physical activity may increase the risk of diabetes in some people. Diabetes_sentence_99

Adverse childhood experiences (ACEs), including abuse, neglect, and household difficulties, increase the likelihood of type 2 diabetes later in life by 32%, with neglect having the strongest effect. Diabetes_sentence_100

Gestational diabetes Diabetes_section_6

Main article: Gestational diabetes Diabetes_sentence_101

Gestational diabetes resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. Diabetes_sentence_102

It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. Diabetes_sentence_103

It is recommended that all pregnant women get tested starting around 24–28 weeks gestation. Diabetes_sentence_104

It is most often diagnosed in the second or third trimester because of the increase in insulin-antagonist hormone levels that occurs at this time. Diabetes_sentence_105

However, after pregnancy approximately 5–10% of women with gestational diabetes are found to have another form of diabetes, most commonly type 2. Diabetes_sentence_106

Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Diabetes_sentence_107

Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required Diabetes_sentence_108

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Diabetes_sentence_109

Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Diabetes_sentence_110

Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause infant respiratory distress syndrome. Diabetes_sentence_111

A high blood bilirubin level may result from red blood cell destruction. Diabetes_sentence_112

In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Diabetes_sentence_113

Labor induction may be indicated with decreased placental function. Diabetes_sentence_114

A caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia. Diabetes_sentence_115

Other types Diabetes_section_7

Maturity onset diabetes of the young (MODY) is a rare autosomal dominant inherited form of diabetes, due to one of several single-gene mutations causing defects in insulin production. Diabetes_sentence_116

It is significantly less common than the three main types, constituting 1–2% of all cases. Diabetes_sentence_117

The name of this disease refers to early hypotheses as to its nature. Diabetes_sentence_118

Being due to a defective gene, this disease varies in age at presentation and in severity according to the specific gene defect; thus there are at least 13 subtypes of MODY. Diabetes_sentence_119

People with MODY often can control it without using insulin. Diabetes_sentence_120

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Diabetes_sentence_121

Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Diabetes_sentence_122

Abnormal insulin action may also have been genetically determined in some cases. Diabetes_sentence_123

Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diabetes_sentence_124

Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Diabetes_sentence_125

Many drugs impair insulin secretion and some toxins damage pancreatic beta cells, whereas others increase insulin resistance (especially glucocorticoids which can provoke "steroid diabetes"). Diabetes_sentence_126

The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999. Diabetes_sentence_127

The following is a list of disorders that may increase the risk of diabetes: Diabetes_sentence_128

New-onset diabetes has been observed in patients with Covid-19. Diabetes_sentence_129

Pathophysiology Diabetes_section_8

Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, adipose tissue and muscle, except smooth muscle, in which insulin acts via the IGF-1. Diabetes_sentence_130

Therefore, deficiency of insulin or the insensitivity of its receptors play a central role in all forms of diabetes mellitus. Diabetes_sentence_131

The body obtains glucose from three main sources: the intestinal absorption of food; the breakdown of glycogen (glycogenolysis), the storage form of glucose found in the liver; and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body. Diabetes_sentence_132

Insulin plays a critical role in regulating glucose levels in the body. Diabetes_sentence_133

Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen. Diabetes_sentence_134

Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Diabetes_sentence_135

Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Diabetes_sentence_136

Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. Diabetes_sentence_137

This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin. Diabetes_sentence_138

If the amount of insulin available is insufficient, or if cells respond poorly to the effects of insulin (insulin resistance), or if the insulin itself is defective, then glucose is not absorbed properly by the body cells that require it, and is not stored appropriately in the liver and muscles. Diabetes_sentence_139

The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as metabolic acidosis in cases of complete insulin deficiency. Diabetes_sentence_140

When glucose concentration in the blood remains high over time, the kidneys reach a threshold of reabsorption, and the body excretes glucose in the urine (glycosuria). Diabetes_sentence_141

This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Diabetes_sentence_142

Lost blood volume is replaced osmotically from water in body cells and other body compartments, causing dehydration and increased thirst (polydipsia). Diabetes_sentence_143

In addition, intracellular glucose deficiency stimulates appetite leading to excessive food intake (polyphagia). Diabetes_sentence_144

Diagnosis Diabetes_section_9

See also: Glycated hemoglobin and Glucose tolerance test Diabetes_sentence_145

Diabetes_table_general_2

WHO diabetes diagnostic criteriaDiabetes_table_caption_2
ConditionDiabetes_header_cell_2_0_0 2-hour glucoseDiabetes_header_cell_2_0_1 Fasting glucoseDiabetes_header_cell_2_0_3 HbA1cDiabetes_header_cell_2_0_5
UnitDiabetes_cell_2_1_0 mmol/LDiabetes_cell_2_1_1 mg/dLDiabetes_cell_2_1_2 mmol/LDiabetes_cell_2_1_3 mg/dLDiabetes_cell_2_1_4 mmol/molDiabetes_cell_2_1_5 DCCT %Diabetes_cell_2_1_6
NormalDiabetes_cell_2_2_0 < 7.8Diabetes_cell_2_2_1 < 140Diabetes_cell_2_2_2 < 6.1Diabetes_cell_2_2_3 < 110Diabetes_cell_2_2_4 < 42Diabetes_cell_2_2_5 < 6.0Diabetes_cell_2_2_6
Impaired fasting glycaemiaDiabetes_cell_2_3_0 < 7.8Diabetes_cell_2_3_1 < 140Diabetes_cell_2_3_2 6.1–7.0Diabetes_cell_2_3_3 110–125Diabetes_cell_2_3_4 42–46Diabetes_cell_2_3_5 6.0–6.4Diabetes_cell_2_3_6
Impaired glucose toleranceDiabetes_cell_2_4_0 ≥ 7.8Diabetes_cell_2_4_1 ≥ 140Diabetes_cell_2_4_2 < 7.0Diabetes_cell_2_4_3 < 126Diabetes_cell_2_4_4 42–46Diabetes_cell_2_4_5 6.0–6.4Diabetes_cell_2_4_6
Diabetes mellitusDiabetes_cell_2_5_0 ≥ 11.1Diabetes_cell_2_5_1 ≥ 200Diabetes_cell_2_5_2 ≥ 7.0Diabetes_cell_2_5_3 ≥ 126Diabetes_cell_2_5_4 ≥ 48Diabetes_cell_2_5_5 ≥ 6.5Diabetes_cell_2_5_6

Diabetes mellitus is characterized by recurrent or persistent high blood sugar, and is diagnosed by demonstrating any one of the following: Diabetes_sentence_146

Diabetes_unordered_list_1

A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. Diabetes_sentence_147

It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test. Diabetes_sentence_148

According to the current definition, two fasting glucose measurements above 7.0 mmol/L (126 mg/dL) is considered diagnostic for diabetes mellitus. Diabetes_sentence_149

Per the WHO, people with fasting glucose levels from 6.1 to 6.9 mmol/L (110 to 125 mg/dL) are considered to have impaired fasting glucose. Diabetes_sentence_150

People with plasma glucose at or above 7.8 mmol/L (140 mg/dL), but not over 11.1 mmol/L (200 mg/dL), two hours after a 75 gram oral glucose load are considered to have impaired glucose tolerance. Diabetes_sentence_151

Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease. Diabetes_sentence_152

The American Diabetes Association (ADA) since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/L (100 to 125 mg/dL). Diabetes_sentence_153

Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause. Diabetes_sentence_154

Prevention Diabetes_section_10

See also: Prevention of type 2 diabetes Diabetes_sentence_155

There is no known preventive measure for type 1 diabetes. Diabetes_sentence_156

Type 2 diabetes—which accounts for 85–90% of all cases worldwide—can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and eating a healthy diet. Diabetes_sentence_157

Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Diabetes_sentence_158

Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish. Diabetes_sentence_159

Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes. Diabetes_sentence_160

Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well. Diabetes_sentence_161

The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. Diabetes_sentence_162

There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment. Diabetes_sentence_163

Management Diabetes_section_11

Main article: Diabetes management Diabetes_sentence_164

Diabetes management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. Diabetes_sentence_165

This can usually be accomplished with dietary changes, exercise, weight loss, and use of appropriate medications (insulin, oral medications). Diabetes_sentence_166

Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels. Diabetes_sentence_167

Per the American College of Physicians, the goal of treatment is an HbA1C level of 7-8%. Diabetes_sentence_168

Attention is also paid to other health problems that may accelerate the negative effects of diabetes. Diabetes_sentence_169

These include smoking, high blood pressure, metabolic syndrome obesity, and lack of regular exercise. Diabetes_sentence_170

Specialized footwear is widely used to reduce the risk of ulcers in at-risk diabetic feet although evidence for the efficacy of this remains equivocal. Diabetes_sentence_171

Lifestyle Diabetes_section_12

See also: Diabetic diet Diabetes_sentence_172

People with diabetes can benefit from education about the disease and treatment, dietary changes, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. Diabetes_sentence_173

In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure. Diabetes_sentence_174

Weight loss can prevent progression from prediabetes to diabetes type 2, decrease the risk of cardiovascular disease, or result in a partial remission in people with diabetes. Diabetes_sentence_175

No single dietary pattern is best for all people with diabetes. Diabetes_sentence_176

Healthy dietary patterns, such as the Mediterranean diet, low-carbohydrate diet, or DASH diet, are often recommended, although evidence does not support one over the others. Diabetes_sentence_177

According to the ADA, "reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia", and for individuals with type 2 diabetes who cannot meet the glycemic targets or where reducing anti-glycemic medications is a priority, low or very-low carbohydrate diets are a viable approach. Diabetes_sentence_178

For overweight people with type 2 diabetes, any diet that achieves weight loss is effective. Diabetes_sentence_179

Implementing a plant-based diet may help manage or prevent type-2 diabetes by lowering glycated hemoglobin levels. Diabetes_sentence_180

In addition, improvement in health may reduce the need for or number of medications needed by people who adopt a plant-based diet. Diabetes_sentence_181

Medications Diabetes_section_13

Glucose control Diabetes_section_14

See also: Anti-diabetic medication Diabetes_sentence_182

Most medications used to treat diabetes act by lowering blood sugar levels through different mechanisms. Diabetes_sentence_183

There is broad consensus that when people with diabetes maintain tight glucose control – keeping the glucose levels in their blood within normal ranges – they experience fewer complications, such as kidney problems or eye problems. Diabetes_sentence_184

There is however debate as to whether this is appropriate and cost effective for people later in life in whom the risk of hypoglycemia may be more significant. Diabetes_sentence_185

There are a number of different classes of anti-diabetic medications. Diabetes_sentence_186

Type 1 diabetes requires treatment with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs. Diabetes_sentence_187

Type 2 diabetes may also be treated with insulin at later stages. Diabetes_sentence_188

Some medications for type 2 diabetes are taken by mouth, such as metformin, while others are only administered by injection, such as GLP-1 agonists. Diabetes_sentence_189

Metformin is generally recommended as a first-line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. Diabetes_sentence_190

It works by decreasing the liver's production of glucose. Diabetes_sentence_191

Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type 2 diabetes. Diabetes_sentence_192

These include agents that increase insulin release (sulfonylureas), agents that decrease absorption of sugar from the intestines (acarbose), agents that inhibit the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretins such as GLP-1 and GIP (sitagliptin), agents that make the body more sensitive to insulin (thiazolidinedione) and agents that increase the excretion of glucose in the urine (SGLT2 inhibitors). Diabetes_sentence_193

When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Diabetes_sentence_194

Doses of insulin are then increased until glucose targets are reached. Diabetes_sentence_195

). Diabetes_sentence_196

Berberine hydrochloride has shown not only to lower blood glucose levels under a fasting state, but hemoglobin A1c and insulin levels as well: having an effect similar to that of metformin. Diabetes_sentence_197

Blood pressure lowering Diabetes_section_15

Cardiovascular disease is a serious complication associated with diabetes, and many international guidelines recommend blood pressure treatment targets that are lower than 140/90 mmHg for people with diabetes. Diabetes_sentence_198

However, there is only limited evidence regarding what the lower targets should be. Diabetes_sentence_199

A 2016 systematic review found potential harm to treating to targets lower than 140 mmHg, and a subsequent systematic review in 2019 found no evidence of additional benefit from blood pressure lowering to between 130 - 140mmHg, although there was an increased risk of adverse events. Diabetes_sentence_200

2015 American Diabetes Association recommendations are that people with diabetes and albuminuria should receive an inhibitor of the renin-angiotensin system to reduce the risks of progression to end-stage renal disease, cardiovascular events, and death. Diabetes_sentence_201

There is some evidence that angiotensin converting enzyme inhibitors (ACEIs) are superior to other inhibitors of the renin-angiotensin system such as angiotensin receptor blockers (ARBs), or aliskiren in preventing cardiovascular disease. Diabetes_sentence_202

Although a more recent review found similar effects of ACEIs and ARBs on major cardiovascular and renal outcomes. Diabetes_sentence_203

There is no evidence that combining ACEIs and ARBs provides additional benefits. Diabetes_sentence_204

Aspirin Diabetes_section_16

The use of aspirin to prevent cardiovascular disease in diabetes is controversial. Diabetes_sentence_205

Aspirin is recommended in people at high risk of cardiovascular disease, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes. Diabetes_sentence_206

2015 American Diabetes Association recommendations for aspirin use (based on expert consensus or clinical experience) are that low-dose aspirin use is reasonable in adults with diabetes who are at intermediate risk of cardiovascular disease (10-year cardiovascular disease risk, 5–10%). Diabetes_sentence_207

Surgery Diabetes_section_17

Weight loss surgery in those with obesity and type 2 diabetes is often an effective measure. Diabetes_sentence_208

Many are able to maintain normal blood sugar levels with little or no medications following surgery and long-term mortality is decreased. Diabetes_sentence_209

There is, however, a short-term mortality risk of less than 1% from the surgery. Diabetes_sentence_210

The body mass index cutoffs for when surgery is appropriate are not yet clear. Diabetes_sentence_211

It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control. Diabetes_sentence_212

A pancreas transplant is occasionally considered for people with type 1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation. Diabetes_sentence_213

Support Diabetes_section_18

In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. Diabetes_sentence_214

In other circumstances, general practitioners and specialists share care in a team approach. Diabetes_sentence_215

Home telehealth support can be an effective management technique. Diabetes_sentence_216

Epidemiology Diabetes_section_19

Main article: Epidemiology of diabetes Diabetes_sentence_217

In 2017, 425 million people had diabetes worldwide, up from an estimated 382 million people in 2013 and from 108 million in 1980. Diabetes_sentence_218

Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.8% among adults, nearly double the rate of 4.7% in 1980. Diabetes_sentence_219

Type 2 makes up about 90% of the cases. Diabetes_sentence_220

Some data indicate rates are roughly equal in women and men, but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake. Diabetes_sentence_221

The WHO estimates that diabetes resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death. Diabetes_sentence_222

However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes. Diabetes_sentence_223

For example, in 2017, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.0 million deaths worldwide, using modeling to estimate the total number of deaths that could be directly or indirectly attributed to diabetes. Diabetes_sentence_224

Diabetes occurs throughout the world but is more common (especially type 2) in more developed countries. Diabetes_sentence_225

The greatest increase in rates has however been seen in low- and middle-income countries, where more than 80% of diabetic deaths occur. Diabetes_sentence_226

The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030. Diabetes_sentence_227

The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet). Diabetes_sentence_228

The global number of diabetes cases might increase by 48% between 2017 and 2045. Diabetes_sentence_229

History Diabetes_section_20

Main article: History of diabetes Diabetes_sentence_230

Diabetes was one of the first diseases described, with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine." Diabetes_sentence_231

The Ebers papyrus includes a recommendation for a drink to take in such cases. Diabetes_sentence_232

The first described cases are believed to have been type 1 diabetes. Diabetes_sentence_233

Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants. Diabetes_sentence_234

The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Apollonius of Memphis. Diabetes_sentence_235

The disease was considered rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career. Diabetes_sentence_236

This is possibly due to the diet and lifestyle of the ancients, or because the clinical symptoms were observed during the advanced stage of the disease. Diabetes_sentence_237

Galen named the disease "diarrhea of the urine" (diarrhea urinosa). Diabetes_sentence_238

The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). Diabetes_sentence_239

He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". Diabetes_sentence_240

He hypothesized a correlation between diabetes and other diseases, and he discussed differential diagnosis from the snakebite, which also provokes excessive thirst. Diabetes_sentence_241

His work remained unknown in the West until 1552, when the first Latin edition was published in Venice. Diabetes_sentence_242

Two types of diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 CE with one type being associated with youth and another type with being overweight. Diabetes_sentence_243

Effective treatment was not developed until the early part of the 20th century when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922. Diabetes_sentence_244

This was followed by the development of the long-acting insulin NPH in the 1940s. Diabetes_sentence_245

Etymology Diabetes_section_21

The word diabetes (/ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtɪs/) comes from Latin diabētēs, which in turn comes from Ancient Greek διαβήτης (diabētēs), which literally means "a passer through; a siphon". Diabetes_sentence_246

Ancient Greek physician Aretaeus of Cappadocia (fl. Diabetes_sentence_247

1st century CE) used that word, with the intended meaning "excessive discharge of urine", as the name for the disease. Diabetes_sentence_248

Ultimately, the word comes from Greek διαβαίνειν (diabainein), meaning "to pass through," which is composed of δια- (dia-), meaning "through" and βαίνειν (bainein), meaning "to go". Diabetes_sentence_249

The word "diabetes" is first recorded in English, in the form diabete, in a medical text written around 1425. Diabetes_sentence_250

The word (/məˈlaɪtəs/ or /ˈmɛlɪtəs/) comes from the classical Latin word mellītus, meaning "mellite" (i.e. sweetened with honey; honey-sweet). Diabetes_sentence_251

The Latin word comes from mell-, which comes from mel, meaning "honey"; sweetness; pleasant thing, and the suffix -ītus, whose meaning is the same as that of the English suffix "-ite". Diabetes_sentence_252

It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a person with diabetes had a sweet taste (glycosuria). Diabetes_sentence_253

This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. Diabetes_sentence_254

Society and culture Diabetes_section_22

Further information: List of films featuring diabetes Diabetes_sentence_255

The 1989 "St. Diabetes_sentence_256 Vincent Declaration" was the result of international efforts to improve the care accorded to those with diabetes. Diabetes_sentence_257

Doing so is important not only in terms of quality of life and life expectancy but also economically – expenses due to diabetes have been shown to be a major drain on health – and productivity-related resources for healthcare systems and governments. Diabetes_sentence_258

Several countries established more and less successful national diabetes programmes to improve treatment of the disease. Diabetes_sentence_259

People with diabetes who have neuropathic symptoms such as numbness or tingling in feet or hands are twice as likely to be unemployed as those without the symptoms. Diabetes_sentence_260

In 2010, diabetes-related emergency room (ER) visit rates in the United States were higher among people from the lowest income communities (526 per 10,000 population) than from the highest income communities (236 per 10,000 population). Diabetes_sentence_261

Approximately 9.4% of diabetes-related ER visits were for the uninsured. Diabetes_sentence_262

Naming Diabetes_section_23

The term "type 1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Diabetes_sentence_263

Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Diabetes_sentence_264

Beyond these two types, there is no agreed-upon standard nomenclature. Diabetes_sentence_265

Diabetes mellitus is also occasionally known as "sugar diabetes" to differentiate it from diabetes insipidus. Diabetes_sentence_266

Other animals Diabetes_section_24

Main articles: Diabetes in dogs and Diabetes in cats Diabetes_sentence_267

In animals, diabetes is most commonly encountered in dogs and cats. Diabetes_sentence_268

Middle-aged animals are most commonly affected. Diabetes_sentence_269

Female dogs are twice as likely to be affected as males, while according to some sources, male cats are more prone than females. Diabetes_sentence_270

In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles. Diabetes_sentence_271

Feline diabetes is strikingly similar to human type 2 diabetes. Diabetes_sentence_272

The Burmese, Russian Blue, Abyssinian, and Norwegian Forest cat breeds are at higher risk than other breeds. Diabetes_sentence_273

Overweight cats are also at higher risk. Diabetes_sentence_274

The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetes_sentence_275

Diabetic animals are more prone to infections. Diabetes_sentence_276

The long-term complications recognized in humans are much rarer in animals. Diabetes_sentence_277

The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans. Diabetes_sentence_278

Research Diabetes_section_25

See also: Diabetes (journal) Diabetes_sentence_279

Inhalable insulin has been developed. Diabetes_sentence_280

The original products were withdrawn due to side effects. Diabetes_sentence_281

Afrezza, under development by the pharmaceuticals company MannKind Corporation, was approved by the United States Food and Drug Administration (FDA) for general sale in June 2014. Diabetes_sentence_282

An advantage to inhaled insulin is that it may be more convenient and easy to use. Diabetes_sentence_283

Transdermal insulin in the form of a cream has been developed and trials are being conducted on people with type 2 diabetes. Diabetes_sentence_284

Major clinical trials Diabetes_section_26

The Diabetes Control and Complications Trial (DCCT) was a clinical study conducted by the United States National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that was published in the New England Journal of Medicine in 1993. Diabetes_sentence_285

Test subjects all had type 1 diabetes and were randomized to a tight glycemic arm and a control arm with the standard of care at the time; people were followed for an average of seven years, and people in the treatment had dramatically lower rates of diabetic complications. Diabetes_sentence_286

It was as a landmark study at the time, and significantly changed the management of all forms of diabetes. Diabetes_sentence_287

The United Kingdom Prospective Diabetes Study (UKPDS) was a clinical study conducted by Z that was published in The Lancet in 1998. Diabetes_sentence_288

Around 3,800 people with type 2 diabetes were followed for an average of ten years, and were treated with tight glucose control or the standard of care, and again the treatment arm had far better outcomes. Diabetes_sentence_289

This confirmed the importance of tight glucose control, as well as blood pressure control, for people with this condition. Diabetes_sentence_290


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Diabetes.