Diabetes is a modern Epidemic. With more than 300 million people suffering from Diabetes globally this entity cannot be considered anything less than an epidemic. With the current trend of increasing incidence the total number of people with diabetes is going to touch more than 500 million by 2025.
For a matter of understanding Diabetes may be considered as body's inability to utilize blood sugar and hence facing the consequences of high blood sugar levels (glucotoxicity).
Diabetes should not be considered as a single clinical entity. With the spectrum of Metabolic, Biochemical , Endocrine and other systemic involvement Diabetes needs to be taken as a " Spectrum of Diseases".
The metabolic effect of Diabetes does not restrict to only at Glucose regulation abnormalities. It causes adverse Fat (lipids) and Proteins metabolism leading to deleterious effects of the body by lipotoxicity and proteins loss.
Broadly there are 2 groups of Diabetes Mellitus
- Insulin Dependent Diabetes (Diabetes type 1)
- Non Insulin Dependent Diabetes (Type 2 Diabetes)
Ultimately all diabetics lead to the state of Insulin dependence.
Conventionally Type 1 diabetics are lean and Type 2 diabetics were obese. But now a big group of lean Diabetes type 2 group is identified.
The causes of Diabetes are multifactorial
- Genetic/ Hereditary
- Life Style
- Drug induced ( Oral Contraceptive pills)
Sedentary life style with/without high sugar/fat diet increases the potential of developing Diabetes multifold in both genetic vulnerable and non vulnerable population.
Conventionally Diabetes pathology is related with hyperglycemia because of Insulin deficiency/Insulin Resistance. But now other hormones are also implicated in the pathogenesis of Diabetes and its complications.
Important extra insulin hormones implicated in Diabetes are Glucagon, Cortisol, DHEA, Testosterone, Growth Hormone, Estrogen, Progesterone , Thyroid, Catecholamines are directly or indirectly associated with Diabetes outcomes.
High testosterone levels in women and low testosterone levels in men are associated with adverse outcomes in Diabetes Mellitus and Metabolic Syndrome. Similarly low estradiol level in women and high estradiol levels in men are associated with adverse outcomes.
The other modern day epidemic "Obesity" is also associated as bidirectional with Diabetes Mellitus type 2. Obesity increases the risk of Insulin Resistance/Type 2 Diabtes Mellitus and vice versa. More importantly the "Obese Type 2 Diabetes Mellitus" patients have more complications in terms of Cardiac and Endocrine health.