Diabetes, the silent killer

Diabetes mellitus is a metabolic disease characterised by an abnormal increase in the blood sugar levels. Physiopathologically, there are two main types of diabetes, namely Type 1 and Type 2. The diagnosis can be made by testing the blood glucose levels measuring glycated haemoglobin or proof of oral glucose tolerance.

Based on the data of the 2014 Annual Report of the National Diabetes Observatory, there is a prevalence of 13% diabetic patients aged between 20 and 79, amounting to one million people. With the advance of age, these values worsen. It is estimated that between the ages of 60 and 79, one in four people are diabetic.

Most worrying is that it is estimated that 5.7% of people who are diabetic are not diagnosed and are unaware that they are in fact diabetic. There is also a significant number of patients who, despite not meeting the criteria of diabetes mellitus, have glucose metabolism alterations, either when fasting or after a meal. These people are known as pre-diabetic.

This disease has suffered an unfavourable evolution, the result of a modern lifestyle of overeating and physical inactivity. There is even the possibility, which is increasingly becoming a reality, that diabetes mellitus is the new epidemic of the century.

Diabetes mellitus is a multisystemic disease that ultimately affects a variety of organs. Complications as a consequence of diabetes mellitus are divided into macro-vascular (more prominent examples are Cerebral Vascular Accidents and Acute Myocardial Infarction) and micro-vascular complications (renal failure requiring in some cases dialysis, loss of vision due to diabetic retinopathy as well as micro-vascular abnormalities of the limbs, leading to amputations).

Complications can have devastating consequences for the diabetic patient, some even fatal. It is therefore a disease with significant morbidity and mortality.

Regular monitoring of the diabetic patient includes not only the control of the blood glucose levels, but also control of other cardiovascular risk factors such as ceasing to smoke, dyslipidemia, essential hypertension and control of the various complications associated with diabetes mellitus. A good metabolic control and recognition of complications in the early stages will improve the prognosis of the diabetic, allowing the patient to live longer with a better quality of life.

Early diagnosis and regular monitoring are therefore essential.

The treatment of diabetes mellitus is multi-factorial, involving three essential points: care of the diet in order to optimise the consumption of the correct amount of carbohydrate; regular physical exercise with the object of energy expenditure and maintained weight loss; medication either in oral form or injection form.

There are currently a range of therapeutic options which together and in conjunction with the factors mentioned above allow the patient to maintain normal levels of glycaemia.

Treatment of diabetes mellitus as a disease relies on the patient’s radical change of lifestyle which must be maintained and consistent in order to maintain a good metabolic control.

This type of control requires follow-up by a multidisciplinary team (doctor, nurse, dietician, psychologist and podiatrist). Due to the interaction of these professionals and their various actions, the probability of complications for the diabetic patient is lowered.

Therefore, only a global, comprehensive, interdisciplinary change of lifestyle can change the black course which the last few years have shown us.

By Dr Ricardo Louro
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Dr Ricardo Louro is a specialist in Internal Medicine, working exclusively at the Hospital Particular do Algarve in Alvor.