Diabetes : Disease overview and Indian scenario

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 2 diabetes was previously called non–insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. In adults, type 2 diabetes accounts for about 90 to 95 per cent of all diagnosed cases of diabetes.

Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, medications, infections, pancreatic disease, and other illnesses. Such types of diabetes account for one  to five per cent  of all diagnosed cases.

There were 366 million persons living with diabetes in 2011 and 4.6 million deaths in the world are directly linked to the disease. (IDF data)

Diabetes is most prevalent in ten countries, namely India, China, USA, Indonesia, Japan, Pakistan, Russia, Brazil, Italy, Bangladesh

In the year 2000, there were 171 million diabetics in the world. The number is expected to increase to 366 million by 2030. India, China and United States account for 30 per cent of the world‘s diabetic population

Diabetes drug manufacturers in India

1. Amylin Pharmaceuticals
2. Eli Lilly
3. Merk & Company
4. Novartis Pharmaceuticals Corporation
5. Nova Nordisk
6. Pfizer
7. Sanofi Aventis
8. Takeda Pharmaceuticals
9. Baxter health care
10. Bayer Health care
11. BD Diabetics Care
12. GSK
13. Lifescan
14. Roche

Preventing diabetes complications Glucose control
It has been proved that improved glycemic control benefits people with type 1 and •type 2 diabetes. Every percentage point drop in A1c blood test results (e.g., from 8.0% to 7.0%) can reduce the risk of microvascular complications (eye, kidney, and nerve diseases) by 40 per cent . In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease.

Blood pressure control
Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among people with diabetes by 33•to 50 per cent, and the risk of microvascular complications (eye, kidney, and nerve diseases) by approximately 33 per cent. In general, for every 10 mmHg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced •by 12 per cent. No benefit of reducing systolic blood pressure below 140 mmHg has been demonstrated in randomized clinical trials. Reducing diastolic blood pressure from 90 mmHg to 80 mmHg in people with diabetes reduces the risk of major cardiovascular •events by 50 per cent.

Control of blood lipids
Improved control of LDL cholesterol can reduce cardiovascular complications by 20 to 50 per cent•

Preventive care practices for eyes, feet and kidneys
Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 per cent.

Comprehensive foot care programmes, i.e., that include risk assessment, foot-care education and preventive therapy, treatment of •foot problems, and referral to specialists, can reduce amputation rates by 45 to 85 per cent.

Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 per cent. Treatment with particular medications for hypertension called angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is more effective in reducing the decline in kidney function than is treatment with other blood pressure lowering drugs.

In addition to lowering blood pressure, ARBs and ACEIs reduce proteinuria, a risk factor for developing kidney disease, by about 35 per cent.

Altenative therapies for Type II diabetes
Alternative therapies with anti-diabetic activity have been extensively researched in Different alternative therapies widely practised for treatments of diabetes are, medicinal herbs, nutritional supplementation, acupuncture, and hot tub therapy etc.

Medicinal herbs
Some of the medicinal herbs used in the treatment of diabetes are Trigonella foenum graecum (Fenugreek), Nephoelepsis tuberose, Costus specious, Plantago ovate, Allium sativum, Hemidesmus indicus, Allium cepa, Ginseng Species, Momordica charantia (Bitter Melon), Gymnema sylvestre (Gurmar).

These Herbs have been the reason for deriving many conventional drugs like Metformin. The herbal extracts have proved to have hypoglycemic effect in animal and human models of Type II diabetes.

 Mineral supplementation
Magnesium and Chromium Deficiency in Type 2 diabetes A recent study has shown that many Type 2 diabetics have lower than average blood levels of magnesium and chromium. Chromium is part of glucose tolerance factor and improves glucose utilization. Chromium is also directly involved in carbohydrate, fat and protein metabolism.

Magnesium is used in muscle and nerve functioning and supports immune system and bone health. Magnesium plays a part in protein synthesis and energy metabolism. It also helps in controlling and preventing hypertension, and cardiovascular disease. Its role in Type 2 diabetes is in regulating blood sugar levels.

These trace minerals magnesium and chromium play a part in controlling insulin and glucose, it is necessary for Type 2 diabetics to ensure that they get enough magnesium and chromium.

The dark, green leafy types of vegetables and cruciferous types including broccoli, cauliflower, cabbage, kale and bok choy have long been considered good sources for trace minerals. Other sources include beans and peas, nuts and seeds and whole grains.

Vanadium was used for the control of blood sugar until insulin was discovered. Studies have confirmed the effectiveness of vanadyl sulfate at a dose of 100 mg/day in improving insulin sensitivity.

Acupuncture & hydrotherapy
Acupuncture has been used as an alternative therapy for chronic pain. It has also been effectively used for the treatment of diabetes and related complications.

It has been observed clinically that the effects of acupuncture on diabetes can activate glucose-6-phosphatase (an important enzyme in carbohydrate metabolism), Acupuncture can act on the pancreas to enhance insulin synthesis, increase the number of receptors on target cells, and accelerate the utilization of glucose, resulting in lowering of blood sugar.

Four commonly used points are: (1) Zusanli point, located three inches below the lateral knee depression, one finger width from the lateral side of the anterior crest of the tibia; (2) Sanyinjiao point, located three inches above the tip of the inner ankle, on the posterior margin of the metatarsal bone; (3) Feishu point, located 1.5 inches lateral and inferior to the spinous process of the third thoracic vertebra in a prone position; and (4) Shenshu point, located 1.5 inches lateral to the posterior midline, lateral and inferior to the spinous process of the second lumbar vertebra in a prone position.

Hot-tub therapy increases blood flow to skeletal muscles, recommended for patients with type 2 diabetes who are unable to exercise. In this treatment the patient is asked to sit in a hot tub for 30 minutes daily for three weeks. The water should not be too hot to avoid burning and diabetic patients should be cautious that they do not get their foot heated.

The World Health Organization (WHO) has predicted huge  losses in national income from diabetes and cardiovascular disease for  China,  Russian Federation,  India, Brazil and  Tanzania between 2005 and 2015.

Unless addressed, the mortality and disease burden from diabetes and other NCDs will continue to increase. WHO projects that globally, deaths caused by these health problems will increase by 17 per cent over the next decade, with the greatest increase in low- and middle-income countries, mainly in the African (27 per cent ) and Eastern Mediterranean (25 per cent) regions.