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Diabetes mellitus 

Diabetes mellitus
Diabetes mellitus

Nigel Unwin

and Jonathan Shaw

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date: 17 September 2019

This chapter discusses diabetes mellitus, a heterogeneous disease characterized by raised blood glucose. The current classification recognizes two main types: type 1, due to destruction of the insulin-producing cells of the pancreas and typically requiring exogenous insulin for survival; and type 2, representing 85–95 per cent of all diabetes, due to a combination of resistance to the action of insulin and diminished insulin production. Currently, over 360 million people worldwide have diabetes, 8 per cent of the adult population, and this figure will increase markedly over the coming years as populations age and become increasingly overweight and sedentary, the result of globally dominant economic and social forces. Contrary to popular perception the overwhelming majority of people with diabetes live in low- or middle-income countries, and most new cases of diabetes over the coming decades will be in such countries in adults of working age. Diabetes reduces life expectancy by around 15 years in type 1 diabetes and 10 years in type 2 and in many populations is the major cause of lower limb amputation, visual loss, and renal failure. Diabetes accounts for between 5% and 15% of health expenditure in over 80% of countries, and impacts upon economic productivity. The prevention of type 1 diabetes remains the subject of research. However, there is convincing evidence from randomized controlled trials that the prevention, or at least delayed onset, of type 2 diabetes through behavioural or pharmacological measures is possible in a substantial proportion of people at high risk. It is currently much less clear how successfully the results of these trials can be translated into everyday healthcare and community settings. Even assuming successful translation of approaches targeting individuals at high risk, preventing the rise in incidence of type 2 diabetes will require measures to reduce risk across whole populations. This will mean policy, including legislative and fiscal, measures designed to promote environments that support healthy diets and physical activity. In those with diabetes, a substantial reduction in the incidence of complications, including reductions in cardiovascular disease events, visual loss, lower limb amputation, and renal failure, is possible. However, achieving these reductions requires well-organized and resourced healthcare, and good education and support to people with diabetes in managing their condition.

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