What is Diabetes (medically known as Diabetes Mellitus)?
In April 2000, the WHO revised its definition of diabetes mellitus as a metabolic disorder of multiple causes, characterized by chronic hyperglycaemia (high blood glucose) with disturbances of: carbohydrate metabolism, fat metabolism, and protein metabolism resulting from defects in: insulin secretion, insulin action, or both
Main differences between type 1 and type 2 diabetes mellitus
Patients with any form of diabetes may require insulin treatment at some stage of their disease. Such use of insulin does not, by itself, classify the patient.
In the last few years, there has been a significant advance in our understanding of type 2 diabetes in particular, and it is no longer regarded as a condition where the blood sugar is high (hyperglycaemia), but more as a "metabolic syndrome" of:
High blood pressure
High total and LDL cholesterol
Low HDL cholesterol
Premature heart disease associated with high blood sugar (hyperglycaemia).
The physician’s emphasis is therefore no longer tailored on just monitoring blood sugar levels, but should crucially address the other aspects of type 2 diabetes, with the aim of preventing or mitigating the high potential for heart disease, stroke, peripheral vascular disease and other complications of the metabolic syndrome. Blood pressure control is paramount for the reduction in these so-called "macrovascular" complications, as proven by the large UKPDS-38 trial (Brit Med J 1998; 317: 703-713). Our goal is to achieve meticulous blood pressure control, regular review and tight control of blood lipids (cholesterol, LDL, HDL, triglycerides), lifestyle changes, and all other means of cardiovascular risk management such as cessation of smoking, low-dose aspirin therapy and regular exercise.
In parallel with these measures, it is still important to control blood sugar levels. With the outcome of large multicentre trials (UKPDS-33 Lancet 1998; 352: 837-53), it is now clear that reducing blood sugar levels towards the normal range minimizes the other complications of diabetes (“microvascular”), namely eye problems (retinopathy), kidney disease (nephropathy) and nerve problems (neuropathy).
The optimal management of diabetes therefore has to be as part of a multi-disciplinary team including diabetes physicians, cardiologists, ophthalmologists, nephrologists, trained nurses, dieticians, podiatrists. Regularly-updated guidelines and protocols for management are critical, and the use of database systems/ registries are widely recommended.
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