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Our efforts in meeting the treatment goals are to prevent the onset or the progression of diabetic complications. These complications are categorized into microvascular and macrovascular problems. Microvascular complications result from poor glycemic control over a long period of time, and they are more commonly observed in patients with type 1 disease. According to the landmark study Diabetes Control and Complications Trial (DCCT) , intensive control with multiple insulin shots or insulin given via a pump into the body and self-blood glucose monitoring can reduce the onset of microvascular complications by about 60%.
Macrovascular complications may also present in patients with type 1 disease, but they are more common in patients with type 2 disease, who may have high blood pressure, high cholesterol / triglycerides, and / or overweight problems. The combination of these problems has been called a variety of names such as "Syndrome X," "Cardiac Dysmetabolic Syndrome," "Hyperinsulinemic Syndrome," and "Insulin Resistance Syndrome." Researchers believe that these metabolic problems stem from resistance to insulin and a state of hyperinsulinemia (when too much insulin is secreted and the cells are resistant to the available insulin). It is also believed that the syndrome as a whole is responsible for the macrovascular complications that are common in patients with type 2 disease. According to the United Kingdom Prospective Diabetes Study (UKPDS), achieving an HbA1c of 7% compared to 7.9% was associated with a 25% reduction of overall microvascular diseases. In addition, for every percentage point reduction in HbA1c achieved, there was a 25% decrease in diabetes-related mortality due to macrovascular complications, and an 18% reduction in combined fatal and nonfatal heart attacks.
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Screening markers can help diagnosis |
Because type 1 diabetes is of autoimmune nature, it is almost inconceivable to think it can be prevented. However, there are markers that can accurately identify first-degree relatives of those already diagnosed with the disease. Therefore, it is possible to screen these people by the HLA (genetic) type and potential interventions explored. In contrast, type 2 diabetes is caused by a variety of metabolic defects and it is possible that with healthy diet and behavior that its onset can be prevented or delayed. The prevalence of type 2 diabetes has increased significantly over the last 10 years or so. Some researches say this may be due to the growth of the aging population and people living longer. However, the incidence of diabetes has also been growing in the younger population, particularly in the teens. Factors responsible for this are probably many and include better diagnostic tools, and lower diagnostic criteria, as well as a tremendous increase in the prevalence of obesity. With better-designed public education programs targeted to the younger population regarding proper nutrition in diet, it is believed that the control of obesity will prevent the alarming increase of diabetes cases.
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Public education programs |
In addition to finding more effective ways to prevent or treat the symptoms and complications from diabetes, continuous research efforts in the areas of identifying physiological, genetic, and metabolic abnormalities associated with diabetes is necessary to conquer the disease and to avoid its worldwide increase. Although therapies for diabetes have been more specifically targeted to particular causative factors in recent years, focus on individual patients and personal treatment plans as well as intensive self-care should be emphasized in the next millennium. This will help control this disease, which has devastating implications in terms of morbidity, mortality, and healthcare dollars. |
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