Diabetes mellitus is a clinical syndrome characterised by raised blood glucose level due to defects in insulin secretion, insulin action or both. It is identified by documenting fasting blood glucose (≥7.0 mmol/litre) or blood glucose 2 hours after oral standard glucose drink (≥11.1 mmol/litre).

Diabetes mellitus is mainly of two types: Type 1 and Type 2 diabetes mellitus. Other types include gestational diabetes mellitus and other specific types of diabetes mellitus. Type 1 diabetes mellitus is an autoimmune disorder.

It occurs in early ages. Immune system fails to recognize certain cells as body’s own and begins to attack and destroy the insulin producing β-cells of the pancreas. So, there is no insulin secretion from the pancreas. Type 2 diabetes mellitus usually occurs after 30-35 years of age. It is due to insulin resistance or decreased insulin production or both.

The prevalence of both type 1 and Type 2 diabetes mellitus is increasing worldwide. The prevalence of Type 2 diabetes mellitus is expected to rise more rapidly in the future.

More than 85% of diabetic patients in the world are of type 2 diabetes mellitus. Type 2 diabetes mellitus has now a world wide epidemic. Prevalence of diabetes mellitus increases with aging. Both sexes are almost equally affected but slightly greater in men over 60 years of age.

Diabetes in females needs special attention. More than 199 million women are currently living with diabetes mellitus. This figure is projected to increase to about 313 million by the year 2040. Women with type 2 diabetes are almost 10 times more likely to have coronary heart disease than women without the condition.

Diabetes is the ninth leading cause of death in women globally. Two out of every five women with diabetes mellitus are of reproductive age. Approximately one in seven births is affected by gestational diabetes. And about half of the women with gestational diabetes mellitus develop type 2 diabetes within five to ten years after delivery.

Many women with gestational diabetes mellitus experience pregnancy related complications such as hypertension, large birth weight babies and obstructed labour. Women with diabetes have more difficulty in conceiving and may have poor pregnancy outcomes that include increased risk of early miscarriage and congenital malformations. Women, as mothers, have a huge influence over the long term health status of their children.

Risk factors

Family history is a risk factor for developing diabetes mellitus. Diet containing high saturated fat and low dietary fibre, obesity, physical inactivity and sedentary lifestyle are modifiable risk factors for diabetes mellitus. The risk of development of diabetes mellitus increases as age advances. Most patients of Type 2 diabetes mellitus are over 40 years of age. Women who delivered a baby weighing more than 4 kg and women who had excess weight gain during pregnancy are more likely to develop diabetes in the subsequent years.

Symptoms

Diabetes mellitus may remain asymptomatic or it may present with typical features. Type 1 diabetes mellitus is always symptomatic and shows classical features of hyperglycemia. A vast majority of Type 2 diabetes mellitus and other types of diabetes mellitus remain asymptomatic for a prolonged period.

Many patients with type 2 diabetes mellitus have an insidious onset of hyperglycemia and may be relatively asymptomatic initially.

This is particularly true in obese patients. Routine or annual health check-up usually picks up this type of cases.  

Typical features of diabetes mellitus include polyuria, polydipsia, polyphagia, weight loss and general weakness. There may be some non-specific features that include non-healing infection, infertility or repeated pregnancy loss, undue fatigability, pruritus vulvae/ balanitis etc.

Complications

Diabetes mellitus is associated with a range of severe complications. There may be retinopathy (problems in the eyes), nephropathy (problems in the kidneys), neuropathy (problems in the nerves), cerebrovascular problems leading to stroke, cardiovascular problems leading to ischemic heart disease and myocardial infarction, peripheral vascular problems leading to gangrene necessitating amputation.

Diabetes during pregnancy may be associated with pregnancy related complications such as early miscarriage, congenital malformations, hypertension, large birth weight babies and obstructed labour.

Treatment

Three Ds (Discipline, Diet and Drug) are very important aspects in the treatment of diabetes mellitus. Lifestyle modifications including a change in the dietary habit, physical activity, exercise, control of body weight, foot care and foot-wear habit and improvement of monitoring blood glucose as self monitoring of blood glucose, etc. are very much essential. Oral drugs and injectable insulin may be required as per doctor’s prescription.

Prevention

Diabetes mellitus is largely a preventable disease. Upto 70% of type 2 diabetes mellitus can be prevented by through adoption of a healthy lifestyle that includes healthy dietary habit, regular physical activity or exercise, etc. These are very important in the primary prevention of diabetes mellitus.

Even when diabetes mellitus occurs, some measures must be taken to prevent diabetic complications. This is secondary prevention. This includes lifestyle modification in the form of dietary habit, exercise, foot care, eye care and monitoring blood glucose.

Women should have equitable access to knowledge and resources to strengthen their capacity to prevent type 2 diabetes mellitus in them and in their families. All women and girls should have opportunities for physical exercise for prevention of diabetes.

Diabetes prevention strategies must focus on maternal health and nutrition before and during pregnancy. All women with diabetes should have access to pre-conception planning services to reduce risk during pregnancy. Pregnant women require improved access to screening, care and education to achieve positive health outcomes for mother and child.

Antenatal care visits during pregnancy must focus on early detection of gestational diabetes mellitus. Screening facilities for gestational diabetes should be available at primary health care level to ensure early detection and better care for better outcome.