introduction about diabetes essay

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Diabetes Overview

What Is Diabetes?

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Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Glucose is your body’s main source of energy. Your body can make glucose, but glucose also comes from the food you eat.

Insulin is a hormone made by the pancreas that helps glucose get into your cells to be used for energy. If you have diabetes, your body doesn’t make enough—or any—insulin, or doesn’t use insulin properly. Glucose then stays in your blood and doesn’t reach your cells.

Diabetes raises the risk for damage to the eyes, kidneys, nerves, and heart. Diabetes is also linked to some types of cancer. Taking steps to prevent or manage diabetes may lower your risk of developing diabetes health problems.

On the left, a diagram of a blood vessel that has a normal blood glucose level and contains fewer glucose molecules. On the right, a diagram of a blood vessel that has a high blood glucose level and contains more glucose molecules.

What are the different types of diabetes?

The most common types of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes , your body makes little or no insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes , the cells in your body don’t use insulin properly. The pancreas may be making insulin but is not making enough insulin to keep your blood glucose level in the normal range. Type 2 diabetes is the most common type of diabetes. You are more likely to develop type 2 diabetes if you have risk factors , such as overweight or obesity , and a family history of the disease. You can develop type 2 diabetes at any age, even during childhood.

You can help delay or prevent type 2 diabetes by knowing the risk factors and taking steps toward a healthier lifestyle, such as losing weight or preventing weight gain.

Gestational diabetes

Gestational diabetes is a type of diabetes that develops during pregnancy. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a higher chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is type 2 diabetes.

Prediabetes

People with prediabetes have blood glucose levels that are higher than normal but not high enough to be diagnosed with type 2 diabetes. If you have prediabetes, you have a higher risk of developing type 2 diabetes in the future. You also have a higher risk for heart disease than people with normal glucose levels.

Other types of diabetes

A less common type of diabetes, called monogenic diabetes , is caused by a change in a single gene . Diabetes can also come from having surgery to remove the pancreas, or from damage to the pancreas due to conditions such as cystic fibrosis or pancreatitis .

How common are diabetes and prediabetes?

More than 133 million Americans have diabetes or prediabetes. 1

As of 2019, 37.3 million people—or 11.3% of the U.S. population—had diabetes. 1 More than 1 in 4 people over the age of 65 had diabetes. Nearly 1 in 4 adults with diabetes didn’t know they had the disease. 2

About 90% to 95% of diabetes cases are type 2 diabetes. 3

In 2019, 96 million adults—38% of U.S. adults—had prediabetes. 4

What other health problems can people with diabetes develop?

Over time, high blood glucose can damage your heart , kidneys , feet , and eyes . If you have diabetes, you can take steps to lower your chances of developing diabetes health problems by taking steps to improve your health and learning how to manage the disease . Managing your blood glucose, blood pressure, and cholesterol levels can help prevent future health problems.

Doctor using a special device to check the inside of a patient’s eye.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Daniel Bessesen, M.D., University of Colorado; Domenico Accili, M.D., Columbia University

Essay on Diabetes for Students and Children

500+ words essay on diabetes.

Diabetes is a very common disease in the world. But people may never realize, how did they get diabetes and what will happen to them and what will they go through. It may not be your problem but you have to show respect and care for the one who has diabetes. It can help them and also benefited you to know more about it and have a better understanding of it. Diabetes is a metabolic disorder which is identified by the high blood sugar level. Increased blood glucose level damages the vital organs as well as other organs of the human’s body causing other potential health ailments.

Types of Diabetes

Diabetes Mellitus can be described in two types:

Description of two types of Diabetes Mellitus are as follows

1) Type 1 Diabetes Mellitus is classified by a deficiency of insulin in the blood. The deficiency is caused by the loss of insulin-producing beta cells in the pancreas. This type of diabetes is found more commonly in children. An abnormally high or low blood sugar level is a characteristic of this type of Diabetes.

Most patients of type 1 diabetes require regular administration of insulin. Type 1 diabetes is also hereditary from your parents. You are most likely to have type 1 diabetes if any of your parents had it. Frequent urination, thirst, weight loss, and constant hunger are common symptoms of this.

2) Type 2 Diabetes Mellitus is characterized by the inefficiency of body tissues to effectively respond to insulin because of this it may be combined by insulin deficiency. Type 2 diabetes mellitus is the most common type of diabetes in people.

People with type 2 diabetes mellitus take medicines to improve the body’s responsiveness to insulin or to reduce the glucose produced by the liver. This type of diabetes mellitus is generally attributed to lifestyle factors like – obesity, low physical activity, irregular and unhealthy diet, excess consumption of sugar in the form of sweets, drinks, etc.

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Causes of Diabetes

By the process of digestion, food that we eat is broken down into useful compounds. One of these compounds is glucose, usually referred to as blood sugar. The blood performs the job of carrying glucose to the cells of the body. But mere carrying the glucose to the cells by blood isn’t enough for the cells to absorb glucose.

This is the job of the Insulin hormone. Pancreas supply insulin in the human body. Insulin acts as a bridge for glucose to transit from blood to the body cells. The problem arises when the pancreas fails to produce enough insulin or the body cells for some reason do not receive the glucose. Both the cases result in the excess of glucose in the blood, which is referred to as Diabetes or Diabetes Mellitus.

Symptoms of Diabetes

Most common symptoms of diabetes are fatigue, irritation, stress, tiredness, frequent urination and headache including loss of strength and stamina, weight loss, increase in appetite, etc.

Levels of Diabetes

There are two types of blood sugar levels – fasting blood sugar level and postprandial blood sugar level. The fasting sugar level is the sugar level that we measure after fasting for at least eight hours generally after an overnight fast. Blood sugar level below 100 mg/dL before eating food is considered normal. Postprandial glucose level or PP level is the sugar level which we measure after two hours of eating.

The PP blood sugar level should be below 140 mg/dL, two hours after the meals. Though the maximum limit in both the cases is defined, the permissible levels may vary among individuals. The range of the sugar level varies with people. Different people have different sugar level such as some people may have normal fasting sugar level of 60 mg/dL while some may have a normal value of 90 mg/dL.

Effects of Diabetes

Diabetes causes severe health consequences and it also affects vital body organs. Excessive glucose in blood damages kidneys, blood vessels, skin resulting in various cardiovascular and skin diseases and other ailments. Diabetes damages the kidneys, resulting in the accumulation of impurities in the body.

It also damages the heart’s blood vessels increasing the possibility of a heart attack. Apart from damaging vital organs, diabetes may also cause various skin infections and the infection in other parts of the body. The prime cause of all type of infections is the decreased immunity of body cells due to their inability to absorb glucose.

Diabetes is a serious life-threatening disease and must be constantly monitored and effectively subdued with proper medication and by adapting to a healthy lifestyle. By following a healthy lifestyle, regular checkups, and proper medication we can observe a healthy and long life.

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Essay on Diabetes

Students are often asked to write an essay on Diabetes in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Diabetes

What is diabetes.

Diabetes is a chronic disease where the body can’t control blood sugar levels. This happens because the body either doesn’t make enough insulin or can’t use it properly.

Types of Diabetes

There are two main types: Type 1 and Type 2. Type 1 is when the body doesn’t produce insulin. Type 2 is when the body doesn’t use insulin well.

Managing Diabetes

Diabetes can be managed through a healthy diet, regular exercise, and medication. Regular check-ups are also important to monitor blood sugar levels.

The Impact of Diabetes

If not managed, diabetes can lead to serious health problems like heart disease, kidney disease, and vision loss.

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Speech on Diabetes

250 Words Essay on Diabetes

Introduction.

Diabetes, a chronic metabolic disorder, is characterized by an increased level of glucose in the blood. It arises due to the body’s inability to produce or effectively utilize insulin, a hormone responsible for glucose regulation.

Etiology of Diabetes

Diabetes is classified into two major types: Type 1 and Type 2. Type 1 diabetes, an autoimmune disorder, is a result of the body’s immune system attacking insulin-producing cells in the pancreas. On the other hand, Type 2 diabetes, the more prevalent form, is primarily associated with insulin resistance and often linked to obesity and sedentary lifestyle.

Impact and Management

Diabetes can lead to severe complications like heart disease, kidney failure, and blindness if left unmanaged. Management involves lifestyle modifications, including a healthy diet, regular physical activity, and medication or insulin therapy as needed.

Prevention and Future Research

Prevention strategies for Type 2 diabetes involve promoting healthier lifestyles and early detection. For Type 1 diabetes, research is still ongoing to understand its triggers. Advances in technology and medicine, such as artificial pancreas systems and islet cell transplantation, show promise for future diabetes management.

Diabetes, a global health crisis, requires comprehensive understanding and management strategies. With ongoing research and advancements, the future holds potential for improved diabetes care and prevention.

500 Words Essay on Diabetes

Introduction to diabetes.

Diabetes is a chronic health condition that affects millions of people worldwide. It is characterized by an elevated level of glucose in the blood, which can lead to a variety of health complications if not properly managed. The disease occurs when the body fails to produce enough insulin or is unable to effectively use the insulin it produces, resulting in glucose build-up.

There are primarily two types of diabetes: Type 1 and Type 2. Type 1 diabetes is an autoimmune condition where the body’s immune system attacks the insulin-producing cells in the pancreas. This type is less common and usually develops early in life. Type 2 diabetes, on the other hand, is more prevalent and typically develops in adulthood. It occurs when the body becomes resistant to insulin or doesn’t produce enough to maintain a normal glucose level.

Risk Factors and Symptoms

Several factors increase the risk of developing diabetes, including genetics, obesity, lack of physical activity, and poor diet. Additionally, certain ethnic groups are at a higher risk.

Diabetes often presents with symptoms such as frequent urination, excessive thirst, unexplained weight loss, constant hunger, blurry vision, and fatigue. However, many people with Type 2 diabetes remain undiagnosed as the symptoms can be subtle and develop slowly.

Management and Treatment

While there is currently no cure for diabetes, it can be effectively managed with a combination of lifestyle changes and medication. Regular exercise, a balanced diet, and maintaining a healthy weight are crucial for managing both types of diabetes.

For Type 1 diabetes, insulin injections or use of an insulin pump are necessary. Type 2 diabetes can often be managed with lifestyle changes and oral medication, but insulin may be required as the disease progresses.

Complications and Prevention

If left uncontrolled, diabetes can lead to serious health complications, including heart disease, stroke, kidney disease, and nerve damage. Regular monitoring of blood glucose levels, along with routine medical check-ups, are essential to avoid these complications.

Prevention strategies for Type 2 diabetes include regular physical activity, a healthy diet, maintaining a normal body weight, and avoiding tobacco use. Early detection through regular health screenings is also critical, as early treatment can prevent or delay the onset of complications.

Diabetes is a significant global health concern that requires concerted efforts for effective management and prevention. Understanding the disease, its risk factors, and the importance of early detection can go a long way in reducing the impact of this chronic condition. Through lifestyle changes and medical intervention, individuals with diabetes can lead healthy and fulfilling lives.

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Diabetes mellitus, commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time.

Symptoms often include frequent urination, increased thirst and increased appetite.

There are three main types of diabetes mellitus: Type 1 diabetes, Type 2 diabetes, and Gestational diabetes.

Family history, obesity, lack of exercise, genetics, air pollution, etc.

More than 37 million people in the United States have diabetes, and 1 in 5 of them don’t know they have it. Diabetes is the 7th leading cause of death in the United States. In the last 20 years, the number of adults diagnosed with diabetes has more than doubled as the American population has aged and become more overweight or obese.

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Diabetes - Free Essay Samples And Topic Ideas

Diabetes is a chronic disease characterized by high levels of sugar in the blood due to insulin production issues or the body’s response to insulin. Essays on diabetes could delve into the types of diabetes, its prevalence, management strategies, and the impact on individuals and communities. Discussions might also explore ongoing research and advancements in diabetes care. A substantial compilation of free essay instances related to Diabetes you can find in Papersowl database. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

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King’s Theory and Nursing Process

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General Characteristic of Type II Diabetes

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Keto Diet and Type Diabetes

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Importance of Nursing Theories

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History and Types of Diabetes

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The Basic Problem of Diabetes

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Insulin-Dependent Diabetes Mellitus

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Importance of Speech about Diabetes

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My understanding of diabetes.

For this essay I'll be covering the topic of diabetes. I've always found diabetes as an interesting topic; maybe because it's a huge problem for most people in the United States. you might be wonder what diabetes is, Diabetes is a disease in which the body response to the hormone insulin is impaired or not fully functional, resluting in complications with the metabolism. Having high glucose is also one of the main reasons people get diabetes. Having high glucose in […]

A Process of Teaching Diabetes Self-Management

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Celiac Disease in Type Diabetes Mellitus

Introduction Celiac disease and Type 1 Diabetes Mellitus are both chronic autoimmune diseases exhibiting a steadily increasing prevalence, both in co-occurrence and individually, in the population. The purpose of this review is to outline the literature and studies conducted on Celiac disease in Type 1 diabetes mellitus and the risk factors associated with autoimmune comorbidity. Dietary control is significant to both diseases and plays an essential role in the management of short- and long-term complications. This review will discuss the […]

Essay on Diabetes

Introduction

Diabetes is a healthcare condition that has continued to affect so many people, both young and old. Understanding more about Diabetes will help people live a healthy lifestyle by avoiding all the possible things that might cause it. In this assignment, I will assess why Diabetes is a significant health issue to individuals and the world. I will discuss the background of Diabetes, its definitions, and the types of Diabetes. Besides, I will discuss what is needed to promote individual and group health for people who have Diabetes. By the end of the assignment, one will have better knowledge about Diabetes since I will also discuss the causes and preventive measures that can be undertaken to prevent the disease. Towards the end of the assignment, I will describe three achievable health promotion goals, hence helping fight against Diabetes. I will also describe some of the interventions and roles that different people, groups, and organizations play to reduce the high cases of Diabetes in the world.

During the medieval ages, being diagnosed with Diabetes was like a death sentence. The pioneers of diabetes treatment were Thomas Willis, Sushruta, and Arataeus (Mandal, 2021). The three were Greek physicians who encouraged people to exercise on horsebacks to prevent excess urination. They also described other therapies like overfeeding and taking wine to reduce starvation and excessive loss of fluids (Mandal, 2021). On the other hand, the ancient Indians would test for Diabetes by taking ants near a person’s urine. If the human urine attracted the ants, then the person would be diagnosed with urine (Mandal, 2021). Diabetes is a disease that is the leading cause of high blood sugar levels. People who have Diabetes have bodies that cannot make enough insulin, or their bodies cannot use the insulin they have effectively (Healthline, 2021). Insulin is the hormone that moves sugars from the blood to the body cells. There are several types of Diabetes, including type 1 diabetes, type 2 diabetes, gestational diabetes, prediabetes, and Diabetes insipidus (Healthine, 2021). All these types affect our bodies differently, and they all have different effects, hence different coping strategies.

The rationale for Choosing Diabetes

Diabetes is among the most severe health issues in the world. This is the reason why I chose to discuss it to create awareness about it. The bad thing with Diabetes is that one can get it and not know that they have it. By the time they realize that they have Diabetes, the condition is worse, and the person is highly affected. According to Genesis Medical Associates (2015), one out of three adults have higher blood sugar levels; a condition referred to as prediabetes. If the persons do not change their lifestyles, the sugar levels increase, leading to other types of Diabetes (Genesis Medical Associates, 2015). Learning about Diabetes will allow people to support each other in the fight against Diabetes. This includes eating healthy meals and maintaining a healthy lifestyle through exercising (Dowshen, 2021). Another reason why I chose to discuss Diabetes is to learn more about the causes and how to manage the disease. Since most people do not know about the condition, it is crucial to educate them so that in case they feel any symptoms, and they can get the treatment as early as possible (Dowshen, 2021). It is easy to deal with Diabetes as long as the signs are detected early enough and the patient follows the given guidelines on healthy living.

Epidemiology

Diabetes is a significant health concern since it affects so many people in the world. Diabetes can affect any person. However, some ethnic groups are affected more than others. The Alaska Natives and the American Indians are more affected by Diabetes as compared to all other ethnic groups. In terms of age, more than sixty-five years are more prone to getting diabetes than young people. According to Shaikh (2021), % of the people who are more than 65 years have diabetes. However, the young people are also affected but at a meager percentage compared to the older people.

The risk factors for Type 1 diabetes are hereditary, hence easily transferred from parents to children. Type 1 diabetes primarily affects young children and teenagers. Also, white Americans are at a higher risk of getting the disease than African Americans and Latino Americans (Shaikh, 2021). Type 2 diabetes affects middle and old age persons. Also, other risk factors for type 2 diabetes include genes, being overweight, a history of gestational pregnancy, and giving birth to a baby that is more than 9lbs (Shaikh, 2021).

It is important to note that diabetes is more prone in rural areas where people do not have access to health services and education. In the United Kingdom, 28% of the people with diabetes have issues obtaining medication due to a lack of health services and knowledge on how to go about diabetes treatment (Whicher et al., 2019 p.243). Besides, most of the people who are in the rural do not go for annual health checkups; hence their conditions get worse daily.

Assessment and assessment tools for Diabetes

Different tools are used during the assessment of diabetes. Assessing diabetes is very important as it helps differentiate between different types of diabetes and the extent of the condition. The Diabetes Prevention Screening Tool helps identify the persons at risk of getting diabetes (Diabetes Education Services, 2021). Such people are encouraged to join the CDC prevention program. There is also the Risk Test for Pre Diabetes patients to understand the risks they face as pre-diabetics (Diabetes Education Services, 2021).

The Diabetes Risk calculator is a tool that is used to detect undiagnosed diabetes and prediabetes. The social Support Assessment Tool helps diabetic patients to have a support system (Diabetes Initiative, 2020). Patients who have Diabetes need a lot of support from family and friends. The support shown will help them adhere to the doctor’s instructions, hence improving the chances of being better. Another assessment is the Mental Health Progress Report. The report is filled up during the patient’s follow-up visits. The assessment involves questions determining if the patient is affected by the condition mentally (Diabetes Initiative, 2020). It helps the doctors to guide the patient on how they can cope mentally with Diabetes.

Health Promotion Goals that you will like to Achieve

One of the goals that I would like to achieve is to reduce the high number of people diagnosed with Diabetes. I will encourage people to ensure they exercise at least thirty minutes a day to become physically fit. To make this goal achievable, I will create small groups that will act as support systems. This will help push people towards healthy living, preventing them from being diagnosed with the condition (Cecelia Health, 2021). My goal is realistic since it is easy to adopt a good eating habit and exercise at least thirty minutes daily. Still, it becomes easier when these activities are done in groups so that members feel motivated. To ensure that the goal is achieved, I will set a time frame of three months. Each member must have dropped at least 10 pounds within three months and managed to exercise at least 30 minutes daily, consistently.

The second goal is to enhance a better diabetes management program. Most people who have diabetes do not know what they should avoid, while others ignore the advice given to them by the doctors. In this case, I will form a group of people of different ages who are diabetic. The group formed will be a support system that will help each other cope with Diabetes. I will encourage the group members to remain healthy by eating the right food and exercising daily (McDermott, 2020). For those that are older, they can do simple exercises like jogging and walking a few kilometers daily. After five months, I will assess each patient’s changes in sugar levels and the general healthcare status (McDermott, 2020). I expect the sugar levels to be expected or close to normal for most patients within this period. Besides, the patients will have adapted to the new lifestyle since they got used to it.

Interventions for your health promotion goals

As indicated above, the first goal is to reduce the high numbers of people diagnosed with diabetes. The first health intervention is by ensuring that people are engaging in vigorous activities and exercises. Before one retires to bed, they must ensure that they have done a bit of practice to increase the metabolic activities of their bodies (Harvard T.H CHAN, 2021). Exercising helps maintain a moderate weight; hence, the high obesity and overweight people will reduce significantly. Besides, exercise helps increase insulin sensitivity in the body. As a result, the body cells can consume the sugars that are in the bloodstream.

For this intervention to work, both individuals and groups work together. A person must know that they have a personal responsibility to ensure that they maintain healthy body weight. Besides, organizations can play a significant role by ensuring that they create team-building activities (Harvard T.H CHAN, 2021). Organizations can set a day or two per month whereby all the employees and employers are involved in various team-building activities. This will help to ensure that at least all members keep fit, even if some of the members might not be keeping fit at a personal level. Since young people are also at a very high risk of getting diabetes, schools should develop a schedule to see all the students engage in exercise activities (John Muir Health, 2021). For example, the school can decide to have a physical exercise lesson after every two days.

Another intervention that will see few people being diagnosed with diabetes is maintaining a healthy eating lifestyle. Most people, especially teenagers, eat food that is full of calories. First, one should ensure they increase the fiber intake (Science Daily, 2018). Fiber is essential as it helps to slow down the digestion of carbs and sugars. Foods that contain more fibers include legumes, vegetables, and whole grains. Too many carbs place a person at a very high risk of getting diabetes. Another healthy eating habit is taking plenty of water to stay hydrated at all times (John Muir Health, 2021). When one takes a lot of water, it also helps the kidney eliminate excess sugars through the urine (Science Daily, 2018). A well-hydrated person is at a lower risk of getting diabetes. However, one should avoid sugar-sweetened drinks as they raise the level of glucose in the blood.

Both individuals and organizations have a role to play when it comes to maintaining a healthy eating lifestyle. Families should ensure that they prepare meals that are balanced diet. As an individual, one has a choice to eat whatever they want. Following this, one should avoid taking foods with high carb content instead of increasing the intake of high fiber meals. Organizations should also participate in this intervention by preparing healthy meals for their employees (Science Daily, 2018). Communities should be encouraged to grow more fibers and take the origin foods rather than rely on ready-made foods with high calories. Also, schools can be involved by ensuring that they have a reasonable timetable for all the meals, and the fiber intake for each student should be higher than the carb intake.

The second goal is enhancing better management for people who are living with diabetes. Individuals have a tremendous responsibility to ensure that they follow the given guidelines to stabilize sugar levels efficiently. As a diabetic patient, one should know the type of diabetes they are suffering from and the measures they are supposed to take to become better (NIH, 2021). The first step that a diabetic person should take is to ensure that they are not stressed. Stress triggers sugar levels, hence raising them. To reduce stress triggers, one can listen to their favorite music, take a walk, breathing in and out, or doing their favorite activities (Diabetes UK, 2021). Also, a person needs to have a support system to reach out in case they feel stressed.

The second step that one can take to deal with diabetes is ensuring that they eat well. After being assessed by the doctor, a health care team should help the sick person come up with a meal plan (Diabetes UK, 2021). The meal plan should contain fewer calories, fewer sugars and salt, and high saturated fats. Also, a diabetic person should eat foods that have high fiber, like rice and bread. Instead of drinking sweetened juices, a diabetic person should ensure that they take plenty of clean drinking water. This helps to keep the body hydrated at all times.

Both individuals and groups have a significant role in ensuring that diabetic persons are taken care of. They have the necessary things needed for them to reduce sugar levels. Health facilities should make sure that they do follow-ups so that if a patient has forgotten to go for checkups, they can go upon being reminded. Besides, other organizations like NGOs should develop fiber for needy people who might not afford such things.

Evaluation of your Health Promotion Care

Maintaining a healthy lifestyle through exercise is not hard to achieve as long as the people involved know the benefits of exercising. Exercising is an effective strategy that will help prevent diabetes and prevent other diseases like heart attack and stroke (Diabetes UK, 2021). However, people should be allowed to choose the kind of exercise that they want to do. Instead of going for a run, one can engage in other activities like playing football, netball, or swimming (Harvard T.H CHAN, 2021). Since people are not the same, one should not be forced to go for a morning jog, yet they like swimming. If this is done, the exercises will be more effective since people will be doing them willingly. I would recommend that the government makes it paramount for organizations to have different days from engaging in other activities like swimming, running, jogging, etc. Also, schools should ensure that there are various exercises for all the students to have one or two activities that they can engage in easily.

The second promotion of care was encouraging people to eat healthy meals. From the above discussion, it is evident that people need to engage in healthy lifestyles. Whether a person has diabetes or not, engaging in a healthy lifestyle is very important (Science Daily, 2018. Following this, one should ensure that they avoid high calories and have high fibers. This healthcare plan can be effective only if the government and other non-governmental organizations are willing to provide the proper meals for the people in need. Some diabetic people do not have access to medical care; hence they cannot do follow-ups about their conditions. As a result, the health care plan will become hard to achieve if the doctors and health care workers do not follow up on their patients to ensure they have taken the right medicines and that the sugar levels are not increasing (John Muir Health, 2021. For this, I would recommend that treatment of diabetes becomes free of charge in all public healthcare institutions. This will make it easy for the poor diabetic people to go for checkups since they know they will not be asked for any money to get the services they need. During the Diabetes Awareness week in the country, the government led by the health care sector should ensure that people are educated about diabetes. This will help people learn more about it and engage in activities that will help reduce diseases.

Tannahill Health Promotion Model

The Tannahill Health Promotion Model helps in the prevention of diabetes and protection of people who have diabetes. As discussed above, diabetes can be prevented through eating the right foods and ensuring that one is physically fit. The Tannahill Health promotion strategy also suggests a good communication flow between the patient and the health care providers (Queens University Belfast, 2021). In this case, the healthcare providers should do the follow up’s for their patients. The third aspect of the Tannahill Health promotion program is that the citizens should be given health protection through the legislature, social measures, and financial measures (Queens University Belfast, 2021). This includes helping needy people eat healthy meals and ensuring that organizations and companies give their employees the proper meals. Besides, Companies, organizations, and schools should set aside specific days where each person is engaged in other activities like swimming, ring, and playing their favorite games.

Diabetes is indeed one of the most severe diseases in the world. Diabetes affects both the young and the old and people of all ages. Although people at the age of 65 and older are more prone to being diagnosed with diabetes, other factors also determine if a person is prone to getting diabetes (Healthline, 2021). For example, a child can get diabetes from their parents; hence they get hereditary diabetes. Women who have experienced gestational diabetes are also at a very high risk of contracting the disease again (Shaikh, 2021). People who are not physically fit are also prone to getting diabetes. Following this, it is evident that although some people are more prone to getting diabetes, several other factors play a significant role.

Although diabetes is a severe condition worldwide, it can be controlled and the high rates reduced. This can be achieved through two maintaining it; exercising and eating suitable meals. Since some people cannot afford the healthy diet recommended for diabetic people, the government and other non-governmental organizations can provide such meals to the people (Whicher et al., 2019 p.243. Also, ensuring that the medication services are accessible at the public hospitals will encourage most people to go for follow-ups. Exercising is easy since there are so many activities that help burn calories (Shaikh, 2021). That is why it is essential to let the person choose activities they are good at and concentrate on them. Generally, although diabetes is a serious condition, it is easy to prevent and manage it if all resources are available.

Cecelia Health, 2021. How to Set and Achieve SMART Goals — in Life and Diabetes – Cecelia Health . [online] Cecelia Health. Available at: <https://www.ceceliahealth.com/how-to-set-and-achieve-smart-goals-in-life-and-diabetes/> [Accessed 1 June 2021].

Diabetes Education Services, 2021. Screening Tools for Diabetes – Diabetes Education Services . [online] Diabetes Education Services. Available at: <https://diabetesed.net/screening-tools-for-diabetes/> [Accessed 1 June 2021].

Diabetes Initiative, 2020. Tools: Assessment Instruments . [online] Diabetesinitiative.org. Available at: <http://www.diabetesinitiative.org/resources/type/assessmentInstruments.html> [Accessed 1 June 2021].

Diabetes UK, 2021. 10 Tips for Healthy Eating with Diabetes . [online] Diabetes UK. Available at: <https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/10-ways-to-eat-well-with-diabetes> [Accessed 1 June 2021].

Dowshen, S., 2021. Diabetes Control: Why It’s Important (for Teens) – Nemours KidsHealth . [online] Kidshealth.org. Available at: <https://kidshealth.org/en/teens/diabetes-control.html> [Accessed 1 June 2021].

Genesis Medical Associates, 2015. The Importance Of Understanding And Preventing Diabetes – Genesis Medical Associates, Inc . [online] Genesismedical.org. Available at: <https://www.genesismedical.org/blog/the-importance-of-understanding-and-preventing-diabetes> [Accessed 1 June 2021].

Harvard T.H CHAN, 2021. Simple Steps to Preventing Diabetes . [online] The Nutrition Source. Available at: <https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/> [Accessed 1 June 2021].

Healthline, 2021. Everything You Need to Know About Diabetes . [online] Healthline. Available at: <https://www.healthline.com/health/diabetes#:~:text=Diabetes%20mellitus%2C%20commonly% 20known%20as,the%20insulin%20it%20does%20make.> [Accessed 1 June 2021].

John Muir Health, 2021. Preventing Diabetes . [online] Johnmuirhealth.com. Available at: <https://www.johnmuirhealth.com/health-education/conditions-treatments/diabetes-articles/preventing-diabetes.html> [Accessed 1 June 2021].

Mandal, A., 2021. History of Diabetes . [online] News Medical. Available at: <https://www.news-medical.net/health/History-of-Diabetes.aspx#:~:text=The%20term%20diabetes%20was%20probably,sweet%20taste%20of%20the%20urine.> [Accessed 1 June 2021].

McDermott, A., 2020. 7 Long-Term Goals for Better Diabetes Management . [online] Healthline. Available at: <https://www.healthline.com/health/type-2-diabetes/living-better-with-type-2-diabetes/long-term-goals-everyone-with-type-2-diabetes-should-make> [Accessed 1 June 2021].

NIH, 2021. 4 Steps to Manage Your Diabetes for Life | NIDDK . [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: <https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/4-steps> [Accessed 1 June 2021].

Queens University Belfast, 2021. Health Promotion. [online] Queens University Belfast. Available at https://www.qub.ac.uk/elearning/public/HealthyEating/HealthPromotion/ [Accessed 1 June 2021]

Science Daily, 2018. Physical exercise reduces the risk of developing diabetes, study shows . [online] ScienceDaily. Available at: <https://www.sciencedaily.com/releases/2018/02/180220102420.htm> [Accessed 1 June 2021].

Shaikh, J., 2021. What Population Is Most Affected by Diabetes? . [online] MedicineNet. Available at: <https://www.medicinenet.com/what_population_is_most_affected_by_diabetes/article.htm> [Accessed 1 June 2021].

Whicher, C., O’Neill, S., and Holt, R., 2019. Diabetes in the UK: 2019. Diabetic Medicine , [online] 37(2), pp.242-247. Available at: <https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.14225> [Accessed 1 June 2021].

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World J Diabetes
v.6(6); 2015 Jun 25

Diabetes mellitus: The epidemic of the century

Correspondence to: Akram T Kharroubi, PhD, Associate Professor of Biochemistry and Endocrinology, Dean of Faculty of Health Professions, Department of Medical Laboratory Sciences, Faculty of Health Professions, Al-Quds University, P.O. Box 51000, Abed Elhamaid Shoman Street, Beit Hanina-Jerusalem, Jerusalem 91000, Palestine. [email protected]

Telephone: +972-2-2791243 Fax: +972-2-2791243

The epidemic nature of diabetes mellitus in different regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in adults (10.9%) whereas, the Western Pacific region has the highest number of adults diagnosed with diabetes and has countries with the highest prevalence of diabetes (37.5%). Different classes of diabetes mellitus, type 1, type 2, gestational diabetes and other types of diabetes mellitus are compared in terms of diagnostic criteria, etiology and genetics. The molecular genetics of diabetes received extensive attention in recent years by many prominent investigators and research groups in the biomedical field. A large array of mutations and single nucleotide polymorphisms in genes that play a role in the various steps and pathways involved in glucose metabolism and the development, control and function of pancreatic cells at various levels are reviewed. The major advances in the molecular understanding of diabetes in relation to the different types of diabetes in comparison to the previous understanding in this field are briefly reviewed here. Despite the accumulation of extensive data at the molecular and cellular levels, the mechanism of diabetes development and complications are still not fully understood. Definitely, more extensive research is needed in this field that will eventually reflect on the ultimate objective to improve diagnoses, therapy and minimize the chance of chronic complications development.

Core tip: Diabetes mellitus is rising to an alarming epidemic level. Early diagnosis of diabetes and prediabetes is essential using recommended hemoglobin A1c criteria for different types except for gestational diabetes. Screening for diabetes especially in underdeveloped countries is essential to reduce late diagnosis. Diabetes development involves the interaction between genetic and non-genetic factors. Biomedical research continues to provide new insights in our understanding of the mechanism of diabetes development that is reviewed here. Recent studies may provide tools for the use of several genes as targets for risk assessment, therapeutic strategies and prediction of complications.

DEFINITION OF DIABETES MELLITUS

Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Metabolic abnormalities in carbohydrates, lipids, and proteins result from the importance of insulin as an anabolic hormone. Low levels of insulin to achieve adequate response and/or insulin resistance of target tissues, mainly skeletal muscles, adipose tissue, and to a lesser extent, liver, at the level of insulin receptors, signal transduction system, and/or effector enzymes or genes are responsible for these metabolic abnormalities. The severity of symptoms is due to the type and duration of diabetes. Some of the diabetes patients are asymptomatic especially those with type 2 diabetes during the early years of the disease, others with marked hyperglycemia and especially in children with absolute insulin deficiency may suffer from polyuria, polydipsia, polyphagia, weight loss, and blurred vision. Uncontrolled diabetes may lead to stupor, coma and if not treated death, due to ketoacidosis or rare from nonketotic hyperosmolar syndrome[ 1 - 3 ].

CLASSIFICATION OF DIABETES MELLITUS

Although classification of diabetes is important and has implications for the treatment strategies, this is not an easy task and many patients do not easily fit into a single class especially younger adults[ 1 , 4 - 6 ] and 10% of those initially classified may require revision[ 7 ]. The classical classification of diabetes as proposed by the American Diabetes Association (ADA) in 1997 as type 1, type 2, other types, and gestational diabetes mellitus (GDM) is still the most accepted classification and adopted by ADA[ 1 ]. Wilkin[ 8 ] proposed the accelerator hypothesis that argues “type 1 and type 2 diabetes are the same disorder of insulin resistance set against different genetic backgrounds”[ 9 ]. The difference between the two types relies on the tempo, the faster tempo reflecting the more susceptible genotype and earlier presentation in which obesity, and therefore, insulin resistance, is the center of the hypothesis. Other predictors of type 1 diabetes include increased height growth velocity[ 10 , 11 ] and impaired glucose sensitivity of β cells[ 12 ]. The implications of increased free radicals, oxidative stress, and many metabolic stressors in the development, pathogenesis and complications of diabetes mellitus[ 13 - 18 ] are very strong and well documented despite the inconsistency of the clinical trials using antioxidants in the treatment regimens of diabetes[ 19 - 21 ]. The female hormone 17-β estradiol acting through the estrogen receptor-α (ER-α) is essential for the development and preservation of pancreatic β cell function since it was clearly demonstrated that induced oxidative stress leads to β-cell destruction in ER-α knockout mouse. The ER-α receptor activity protects pancreatic islets against glucolipotoxicity and therefore prevents β-cell dysfunction[ 22 ].

TYPE 1 DIABETES MELLITUS

Autoimmune type 1 diabetes.

This type of diabetes constitutes 5%-10% of subjects diagnosed with diabetes[ 23 ] and is due to destruction of β cells of the pancreas[ 24 , 25 ]. Type 1 diabetes accounts for 80%-90% of diabetes in children and adolescents[ 2 , 26 ]. According to International Diabetes Federation (IDF), the number of youth (0-14 years) diagnosed with type 1 diabetes worldwide in 2013 was 497100 (Table (Table1) 1 ) and the number of newly diagnosed cases per year was 78900[ 27 ]. These figures do not represent the total number of type 1 diabetes patients because of the high prevalence of type 1 diabetes in adolescence and adults above 14 years of age. One reported estimate of type 1 diabetes in the United States in 2010 was 3 million[ 28 , 29 ]. The number of youth in the United States younger than 20 years with type 1 diabetes was estimated to be 166984 in the year 2009[ 30 ]. The prevalence of type 1 diabetes in the world is not known but in the United States in youth younger than 20 years was 1.93 per 1000 in 2009 (0.35-2.55 in different ethnic groups) with 2.6%-2.7% relative annual increase[ 26 , 31 ]. Type 1 diabetes is mainly due to an autoimmune destruction of the pancreatic β cells through T-cell mediated inflammatory response (insulitis) as well as a humoral (B cell) response[ 25 ]. The presence of autoantibodies against the pancreatic islet cells is the hallmark of type 1 diabetes, even though the role of these antibodies in the pathogenesis of the disease is not clear. These autoantibodies include islet cell autoantibodies, and autoantibodies to insulin (IAA), glutamic acid decarboxylase (GAD, GAD65), protein tyrosine phosphatase (IA2 and IA2β) and zinc transporter protein (ZnT8A)[ 32 ]. These pancreatic autoantibodies are characteristics of type 1 diabetes and could be detected in the serum of these patients months or years before the onset of the disease[ 33 ]. Autoimmune type 1 diabetes has strong HLA associations, with linkage to DR and DQ genes. HLA-DR/DQ alleles can be either predisposing or protective[ 1 ]. This autoimmune type 1 diabetes is characterized by the absence of insulin secretion and is more dominant in children and adolescents.

Number of subjects with type 1 diabetes in children (0-14 years), with diabetes in adults (20-79 years) and with hyperglycemia (type 2 or gestational diabetes) in pregnancy (20-49 years)

Data extracted from International Diabetes Federation Diabetes Atlas, 6th ed, 2013.

In addition to the importance of genetic predisposition in type 1 diabetes, several environmental factors have been implicated in the etiology of the disease[ 9 , 33 ]. Viral factors include congenital rubella[ 34 , 35 ], viral infection with enterovirus, rotavirus, herpes virus, cytomegalovirus, endogenous retrovirus[ 36 , 37 ] and Ljungan virus. Other factors include low vitamin D levels[ 38 ], prenatal exposure to pollutants, improved hygiene and living conditions decreased childhood infections in countries with high socioeconomic status leading to increased autoimmune diseases (hygiene hypothesis), early infant nutrition such as using cow’s milk formula instead of breast feeding[ 39 ] in addition to insulin resistance in early childhood due to obesity or increased height growth velocity. The role of environmental factors remains controversial[ 40 ]. Recent evidence supported the causative effect of viral infections in diabetes[ 41 - 43 ].

Type 1 diabetes often develops suddenly and can produce symptoms such as polydipsia, polyuria, enuresis, lack of energy, extreme tiredness, polyphagia, sudden weight loss, slow-healing wounds, recurrent infections and blurred vision[ 27 ] with severe dehydration and diabetic ketoacidosis in children and adolescents. The symptoms are more severe in children compared to adults. These autoimmune type 1 diabetes patients are also prone to other autoimmune disorders such as Graves’ disease, Hashimoto’s thyroiditis, Addison’s disease, vitiligo, celiac sprue, autoimmune hepatitis, myasthenia gravis, and pernicious anemia[ 1 ]. The complete dependence on insulin of type 1 diabetes patients may be interrupted by a honeymoon phase which lasts weeks to months or in some cases 2-3 years. In some children, the requirement for insulin therapy may drop to a point where insulin therapy could be withdrawn temporarily without detectable hyperglycemia[ 44 ].

Idiopathic type 1 diabetes

A rare form of type 1 diabetes of unknown origin (idiopathic), less severe than autoimmune type 1 diabetes and is not due to autoimmunity has been reported. Most patients with this type are of African or Asian descent and suffer from varying degrees of insulin deficiency and episodic ketoacidosis[ 45 ].

Fulminant type 1 diabetes

This is a distinct form of type 1 diabetes, first described in the year 2000, and has some common features with idiopathic type 1 diabetes being non-immune mediated[ 46 , 47 ]. It is characterized by ketoacidosis soon after the onset of hyperglycemia, high glucose levels (≥ 288 mg/dL) with undetectable levels of serum C-peptide, an indicator of endogenous insulin secretion[ 48 ]. It has been described mainly in East Asian countries and accounted for approximately 20% of acute-onset type 1 diabetes patients in Japan (5000-7000 cases) with an extremely rapid and almost complete beta-cell destruction resulting in nearly no residual insulin secretion[ 48 , 49 ]. Both genetic and environmental factors, especially viral infection, have been implicated in the disease. Anti-viral immune response may trigger the destruction of pancreatic beta cells through the accelerated immune reaction with no detectable autoantibodies against pancreatic beta cells[ 48 , 50 ]. Association of fulminant type 1 diabetes with pregnancy has also been reported[ 51 ].

TYPE 2 DIABETES MELLITUS

The global prevalence of diabetes in adults (20-79 years old) according to a report published in 2013 by the IDF was 8.3% (382 million people), with 14 million more men than women (198 million men vs 184 million women), the majority between the ages 40 and 59 years and the number is expected to rise beyond 592 million by 2035 with a 10.1% global prevalence. With 175 million cases still undiagnosed, the number of people currently suffering from diabetes exceeds half a billion. An additional 21 million women are diagnosed with hyperglycemia during pregnancy. The Middle East and North Africa region has the highest prevalence of diabetes (10.9%), however, Western Pacific region has the highest number of adults diagnosed with diabetes (138.2 millions) and has also countries with the highest prevalence (Figure (Figure1 1 )[ 27 ]. Low- and middle-income countries encompass 80% of the cases, “where the epidemic is gathering pace at alarming rates”[ 27 ]. Despite the fact that adult diabetes patients are mainly type 2 patients, it is not clear whether the reported 382 million adults diagnosed with diabetes also include type 1 diabetes patients.

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Comparative prevalence of diabetes in adults (20-79 years) in countries with high prevalence (≥ 10%). Data extracted from International Diabetes Federation Diabetes Atlas, 6th ed, 2013.

More than 90%-95% of diabetes patients belong to this type and most of these patients are adults. The number of youth (less than 20 years) with type 2 diabetes in the United States in the year 2009 was 0.46 in 1000 and accounted for approximately 20% of type 2 diabetes in youth[ 26 ]. The increased incidence of type 2 diabetes in youth is mainly due to the change in the lifestyle of the children in terms of more sedentary life and less healthy food. Obesity is the major reason behind insulin resistance which is mainly responsible for type 2 diabetes[ 52 - 54 ]. The ADA recommends screening of overweight children and adolescence to detect type 2 diabetes[ 55 , 56 ]. The prevalence of obesity in children in on the rise[ 6 ] which is probably the main reason for the increased incidence of type 2 diabetes in the young (30.3% overall increase in type 2 diabetes in children and adolescence between 2001 and 2009)[ 26 ].

Insulin resistance in type 2 diabetes patients increases the demand for insulin in insulin-target tissues. In addition to insulin resistance, the increased demand for insulin could not be met by the pancreatic β cells due to defects in the function of these cells[ 18 ]. On the contrary, insulin secretion decreases with the increased demand for insulin by time due to the gradual destruction of β cells[ 57 ] that could transform some of type 2 diabetes patients from being independent to become dependent on insulin. Most type 2 diabetes patients are not dependent on insulin where insulin secretion continues and insulin depletion rarely occurs. Dependence on insulin is one of the major differences from type 1 diabetes. Other differences include the absence of ketoacidosis in most patients of type 2 diabetes and autoimmune destruction of β cells does not occur. Both type 1 and type 2 diabetes have genetic predisposition, however, it is stronger in type 2 but the genes are more characterized in type 1 (the TCF7L2 gene is strongly associated with type 2 diabetes)[ 58 ]. Due to the mild symptoms of type 2 diabetes in the beginning, its diagnosis is usually delayed for years especially in countries where regular checkup without symptoms is not part of the culture. This delay in diagnosis could increase the incidence of long-term complications in type 2 diabetes patients since hyperglycemia is not treated during this undiagnosed period.

In addition to diabetes, insulin resistance has many manifestations that include obesity, nephropathy, essential hypertension, dyslipidemia (hypertriglyceridemia, low HDL, decreased LDL particle diameter, enhanced postprandial lipemia and remnant lipoprotein accumulation), ovarian hyperandrogenism and premature adrenarche, non-alcoholic fatty liver disease and systemic inflammation[ 6 , 54 ]. The presence of type 2 diabetes in children and adolescence who are not obese[ 59 - 61 ], the occasional severe dehydration and the presence of ketoacidosis in some pediatric patients with type 2 diabetes[ 55 ] had led to the misclassification of type 2 to type 1 diabetes.

Some patients with many features of type 2 diabetes have some type 1 characteristics including the presence of islet cell autoantibodies or autoantibodies to GAD65 are classified as a distinct type of diabetes called latent autoimmune diabetes in adults (LADA)[ 62 ]. People diagnosed with LADA do not require insulin treatment. In a recent study, Hawa et al[ 63 ] reported 7.1% of European patients with type 2 diabetes with a mean age of 62 years, tested positive for GAD autoantibodies and the prevalence of LADA was higher in patients diagnosed with diabetes at a younger age. This classification of LADA as a distinct type of diabetes is still controversial[ 6 , 64 - 66 ].

Insulin resistance and signaling

Defects in the insulin-dependent substrate proteins IRS-1 and IRS-2 mediated signaling pathway are implicated in the development of metabolic disorders, mainly diabetes. This pathway mediates the cellular response to insulin and involves a large array of insulin-stimulated protein kinases including the serine/threonine kinase AKT and protein kinase C (PKC) that phosphorylate a large number of Ser/Thr residues in the insulin receptor substrate (IRS) proteins involved in the metabolic response to insulin[ 67 ]. In addition, other non-insulin dependent kinases including the AMP-activated protein kinase, c-Jun N-terminal protein kinase and G protein-coupled receptor kinase 2 that are activated under various conditions can phosphorylate the two insulin responsive substrates[ 67 - 71 ]. Disruption in the AKT and PKC kinases is central to the development of diabetes[ 72 ] and is associated with all major features of the disease including hyperinsulinemia, dyslipidemia and insulin resistance[ 73 ]. Replacing the wild type IRS-1 with a mutant version of the protein having alanine instead of tyrosine in three locations using genetic knock-in approach provided evidence to the central role of IRS-1 phosphorylation in the development of insulin resistance[ 74 ]. Using a similar approach to generate IRS-1 mutant with a single mutation involving a specific tyrosine residue, confirmed the role of IRS-1 phosphorylation in the development of insulin resistance pathogenesis[ 75 ]. The large cumulative evidence indicates a complex array of factors including environmental factors[ 76 ] and a wide range of cellular disturbances in glucose and lipid metabolism in various tissues[ 77 ] contribute to the development of insulin resistance. This condition generates complex cellular metabolic changes in a variety of tissues, mainly liver and muscles, that include the inability of the liver to transport and dispose glucose, control glucose production via gluconeogenesis, impaired storage of glucose as glycogen, de novo lipogenesis and hypertriglyceridemia[ 77 ]. Among the factors implicated in the development of insulin resistance, obesity is the most predominant risk factor leading to insulin insensitivity and diabetes which involves several mechanisms that participate in the pathogenesis of the disease[ 78 ]. Obesity-induced insulin resistance is directly linked to increased nutrient flux and energy accumulation in tissues that directly affect cell responsiveness to insulin[ 77 ]. However, it seems that other insulin-independent mechanisms are involved in the overall metabolic disturbances of glucose homeostasis and diabetes including activities in extra-hepatic tissues in addition to the central role of liver.

OTHER TYPES OF DIABETES MELLITUS

Monogenic diabetes.

Characterization of the genetic etiology of diabetes enables more appropriate treatment, better prognosis, and counseling[ 79 ]. Monogenic diabetes is due to a genetic defect in single genes in pancreatic β cells which results in disruption of β cell function or a reduction in the number of β cells. Conventionally, monogenic diabetes is classified according to the age of onset as neonatal diabetes before the age of six months or Maturity Onset Diabetes of the Young (MODY) before the age of 25 years. However, certain familial defects are manifested in neonatal diabetes, MODY or adult onset diabetes[ 2 , 9 , 80 ]. Others believe that classification of diabetes as MODY and neonatal diabetes is obsolete and monogenic diabetes is currently used relating specific genetic etiologies with their specific treatment implications[ 79 ]. Beta cell differentiation depends on the expression of the homeodomain transcription factor PDX1 where mutation in the gene results in early onset diabetes (MODY) and its expression decreases before the onset of diabetes[ 81 ]. The angiopoietin-like protein 8 (ANGPTL8) may represent a potential “betatrophin” that acts to promote the proliferation of beta cells, however, studies using mice lacking the ANGPTL8 active gene or overexpressed protein indicated that it did not seem to play a role in beta cells proliferation[ 82 ].

Mitochondrial diabetes is due to a point mutation in the mitochondrial DNA associated with deafness and maternal transmission of the mutant DNA can result in maternally-inherited diabetes[ 1 , 83 ].

Mutations that result in mutant insulin or the inability to convert proinsulin to insulin result in glucose intolerance in some of these cases. Genetic defects in the insulin receptor or in the signal transduction pathway of insulin have been demonstrated to result in hyperinsulinemia and modest hyperglycemia to severe diabetes[ 1 ].

Disease of the exocrine pancreas

Damage of the β cells of the pancreas due to diffused injury of the pancreas can cause diabetes. This damage could be due to pancreatic carcinoma, pancreatitis, infection, pancreatectomy, and trauma[ 1 ]. Atrophy of the exocrine pancreas leads to progressive loss of the β cells[ 84 ]. Accumulation of fat in the pancreas or pancreatic steatosis could lead to diabetes due to decreased insulin secretion but may require a long time before the damage to β cells occurs[ 85 ]. In most cases, extensive damage of the pancreas is required before diabetes occurs and the exocrine function of the pancreas is decreased in these patients[ 86 ]. Cirrhosis in cystic fibrosis may contribute to insulin resistance and diabetes[ 2 ].

Hormones and drugs

Diabetes has been found in patients with endocrine diseases that secrete excess hormones like growth hormone, glucocorticoids, glucagon and epinephrine in certain endocrinopathies like acromegaly, Cushing’s syndrome, glucagonoma, and pheochromocytoma, respectively[ 1 ]. Some of these hormones are used as drugs such as glucocorticoids to suppress the immune system and in chemotherapy and growth hormone to treat children with stunted growth.

Genetic syndromes

Diabetes has been detected in patients with various genetic syndromes such as Down syndrome, Klinefelter syndrome, Turner syndrome and Wolfram syndrome[ 1 ].

PREDIABETES

Individuals with prediabetes do not meet the criteria of having diabetes but are at high risk to develop type 2 diabetes in the future. According to the ADA Expert Committee, individuals are defined to have prediabetes if they have either impaired fasting plasma glucose (IFG) levels between 100-125 mg/dL (5.6-6.9 mmol/L) or impaired glucose tolerance test (IGT) with 2-h plasma glucose levels in the oral glucose tolerance test (OGTT) of 140-199 mg/dL (7.8-11.0 mmol/L). The World Health Organization (WHO) still adopts the range for IFG from 110-125 mg/dL (6.1-6.9 mmol/L). Prediabetes has been shown to correlate with increased cardiovascular mortality[ 87 , 88 ] and cancer[ 89 ]. The definition of prediabetes with the indicated cut off values is misleading since lower levels of glucose in the normal range are still correlated with cardiovascular disease in a continuous glycemic risk perspective[ 90 ]. In accordance with the recommendation of the ADA in 2009 to use hemoglobin A1c (HbA1c) to diagnose diabetes, ADA also recommended the use of an HbA1c (5.7%-6.4%) to diagnose prediabetes[ 91 ]. The number of people with IGT according to IDF was 316 million in 2013 (global prevalence 6.9% in adults) and is expected to rise to 471 million in 2030[ 27 ]. According to a report in 2014 by the Center for Disease Control and Prevention, 86 million Americans (1 out of 3) have prediabetes[ 92 ]. Four of the top ten countries with the highest prevalence of prediabetes are in the Middle East Arab States of the Gulf (Kuwait, Qatar, UAE and Bahrin with prevalence of 17.9%, 17.1%, 16.6% and 16.3%, respectively)[ 27 ]. The number of people diagnosed with prediabetes is different according to the method and criteria used to diagnose prediabetes. The number of people with prediabetes defined by IFG 100-125 mg/dL is 4-5 folds higher than those diagnosed using the WHO criteria of 110-125 mg/dL[ 93 ]. Diabetes and prediabetes diagnosed using an HbA1c criteria give different estimates compared to methods using FPG or OGTT. Higher percentages of prediabetes were diagnosed using HbA1c compared to FPG[ 94 - 96 ]. Prediabetes is associated with metabolic syndrome and obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension[ 97 ]. Not all individuals with prediabetes develop diabetes in the future, exercise with a reduction of weight 5%-10% reduces the risk of developing diabetes considerably (40%-70%)[ 98 ]. Individuals with an HbA1c of 6.0%-6.5% have twice the risk of developing diabetes (25%-50%) in five years compared to those with an HbA1c of 5.5%-6.0%[ 99 ].

DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS

Diabetes mellitus is diagnosed using either the estimation of plasma glucose (FPG or OGTT) or HbA1c. Estimation of the cut off values for glucose and HbA1c is based on the association of FPG or HbA1c with retinopathy. Fasting plasma glucose of ≥ 126 mg/dL (7.0 mmol/L), plasma glucose after 2-h OGTT ≥ 200 mg/dL (11.1 mmol/L), HbA1c ≥ 6.5% (48 mmol/mol) or a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) along with symptoms of hyperglycemia is diagnostic of diabetes mellitus. In addition to monitor the treatment of diabetes, HbA1c has been recommended to diagnose diabetes by the International Expert Committee in 2009[ 100 ] and endorsed by ADA[ 101 ], the Endocrine Society, the WHO[ 102 ] and many scientists and related organizations all over the world. The advantages and disadvantages of the different tests used to diagnose diabetes have been reviewed by Sacks et al[ 103 ]. The advantages of using HbA1c over FPG to diagnose diabetes include greater convenience and preanalytical stability, lower CV (3.6%) compared to FPG (5.7%) and 2h OGTT (16.6%), stronger correlation with microvascular complications especially retinopathy, and a marker for glycemic control and glycation of proteins which is the direct link between diagnosis of diabetes and its complications[ 104 - 109 ]. It is recommended to repeat the HbA1c test in asymptomatic patients within two weeks to reaffirm a single apparently diagnostic result[ 110 ].

A cut off value for HbA1c of ≥ 6.5% (48 mmol/mol) has been endorsed by many countries and different ethnic groups, yet ethnicity seems to affect the cut off values to diagnose diabetes[ 111 , 112 ]. Cut-off values of 5.5% (37 mmol/mol)[ 113 ] and 6.5% (48 mmol/mol)[ 114 ] have been reported in a Japanese study, 6.0% (42 mmol/mol) in the National Health and Nutrition Examination Survey (NHANES III), 6.2% (44 mmol/mol) in a Pima Indian study, 6.3% (45 mmol/mol) in an Egyptian study as reported by Davidson[ 105 ]; and three cut-off values for Chinese[ 112 ]. The Australians recommended the use of two cut-off values: ≤ 5.5% to “rule-out” and ≥ 7.0% to “rule-in” diabetes[ 115 ]. Variations in the prevalence of diabetes[ 94 , 116 - 119 ] and prediabetes[ 120 ] due to ethnicity have been documented. Most studies diagnosed less subjects with diabetes using HbA1c compared to FPG or OGTT[ 121 - 123 ]. Yet, other studies reported more subjects diagnosed with diabetes using HbA1c[ 96 , 124 - 126 ].

GESTATIONAL DIABETES

Hyperglycemia in pregnancy whether in the form of type 2 diabetes diagnosed before or during pregnancy or in the form gestational diabetes has an increased risk of adverse maternal, fetal and neonatal outcome. Mothers with gestational diabetes and babies born to such mothers have increased risk of developing diabetes later in life. Hyperglycemia in pregnancy is responsible for the increased risk for macrosomia (birth weight ≥ 4.5 kg), large for gestational age births, preeclampsia, preterm birth and cesarean delivery due to large babies[ 127 ]. Risk factors for gestational diabetes include obesity, personal history of gestational diabetes, family history of diabetes, maternal age, polycystic ovary syndrome, sedentary life, and exposure to toxic factors[ 3 ].

Diagnosis of type 2 diabetes before or during pregnancy is based on criteria mentioned before. Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L) or 2-h plasma glucose ≥ 200 mg/dL (11.1 mmol/L) after a 75 g oral glucose load. However, gestational diabetes has been diagnosed at 24-28 wk of gestation in women not previously diagnosed with diabetes using two approaches: the first approach is based on the “one-step” International Association of the Diabetes and Pregnancy Study Groups (IADPSG) consensus[ 128 ] and recently adopted by WHO[ 129 ]. Gestational diabetes is diagnosed using this method by FPG ≥ 92 mg/dL (5.1 mmol/L), 1-h plasma glucose after a 75 g glucose load ≥ 180 mg/dL (10.0 mmol/L) or 2-h plasma glucose after a 75 g glucose load ≥ 153 mg/dL (8.5 mmol/L). This criteria is derived from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study[ 127 ] even though the HAPO study showed a continuous relationship between hyperglycemia and adverse short-term pregnancy outcome with no threshold reported[ 130 ]. The second approach is used in the United States and is based on the “two-step” NIH consensus[ 131 ]. In the first step 1-h plasma glucose after a 50 g glucose load under nonfasting state ≥ 140 mg/dL (7.8 mmol/L) is followed by a second step under fasting conditions after a 100 g glucose load for those who screened abnormal in the first step. The diagnosis of gestational diabetes is made when at least two of the four plasma glucose levels are met. The four plasma glucose levels according to Carpenter/Coustan criteria are: FPG ≥ 95 mg/dL (5.3 mmol/L); 1-h ≥ 180 mg/dL (10.0 mmol/L); 2-h ≥ 155 mg/dL (8.6 mmol/L); and 3-h ≥ 140 mg/dL (7.8 mmol/L)[ 1 ].

The use IADPSC criteria in comparison with the Carpenter/Coustan criteria was associated with a 3.5-fold increase in GDM prevalence as well as significant improvements in pregnancy outcomes, and was cost-effective[ 132 ]. In another retrospective cohort study of women diagnosed with gestational diabetes, Ethridge et al[ 133 ] have shown that newborns of women diagnosed with gestational diabetes by IADPSG approach have greater measures of fetal overgrowth compared with Carpenter-Coustan “two-step” approach neonates. A strategy of using fasting plasma glucose as a screening test and to determine the need for OGTT is valid[ 134 , 135 ]. According to Sacks[ 136 ], correlation of glucose concentrations and the risk of subsequent complications will eventually lead to universal guidelines.

The use of ADA/WHO cut off value of HbA1c ≥ 6.5% (48 mmol/mol) to diagnose gestational diabetes is not recommended by the “one step” IADPSC criteria or the “two-step” NIH criteria. Further investigation is required in light of recent reports on HbA1c in combination with OGTT and its usefulness to predict adverse effect of gestational diabetes or obviate the use OGTT in all women with gestational diabetes[ 137 - 141 ].

DIABETES AND GENETICS

Diabetes is a complex disease that involves a wide range of genetic and environmental factors. Over the past several years, many studies have focused on the elucidation of the wide spectrum of genes that played a role in the molecular mechanism of diabetes development[ 142 - 144 ]. However, despite the vast flow of genetic information including the identification of many gene mutations and a large array of single nucleotide polymorphisms (SNPs) in many genes involved in the metabolic pathways that affect blood glucose levels, the exact genetic mechanism of diabetes remains elusive[ 145 , 146 ]. Evidently, a major complication is the fact that a single gene mutation or polymorphism will not impose the same effect among different individuals within a population or different populations. This variation is directly or indirectly affected by the overall genetic background at the individual, family or population levels that are potentially further complicated by interaction with highly variable environmental modifier factors[ 147 , 148 ].

Molecular genetics and type 2 diabetes

One of the major focuses of biomedical research is to delineate the collective and broad genetic variants in the human genome that are involved in the development of diabetes. This major effort will potentially provide the necessary information to understand the molecular genetics of the different forms of diabetes including type 1, type 2 and monogenic neonatal diabetes among individuals of all populations and ethnic groups. Despite the fact that linkage and association studies allowed the identification and characterization of many candidate genes that are associated with type 2 diabetes[ 144 , 149 , 150 ], however, not all of these genes showed consistent and reproducible association with the disease[ 151 ]. Genome wide association studies (GWAS) in various populations identified 70 loci associated with type 2 diabetes and revealed positive linkage of many mutations and SNPs that influence the expression and physiological impact of the related proteins and risk to develop type 2 diabetes. One study involved several thousand type 2 diabetes patients and control subjects from the United Kingdom allowed the identification of several diabetes putative loci positioned in and around the CDKAL1 , CDKN2A/B , HHEX/IDE and SLC30A8 genes in addition to the contribution of a large number of other genetic variants that are involved in the development of the disease[ 152 ]. Two similar studies from the Finns and Swedish populations and the United States resulted in the identification of similar single nucleotide variants[ 153 ] that are linked to the risk of acquiring type 2 diabetes[ 154 , 155 ]. The study in the United States population included in addition to type 2 diabetes, the association of the identified SNPs with the level of triglycerides in the tested subjects[ 155 ]. These SNPs are located near several candidate genes including IGFBP2 and CDKAL1 and other genes in addition to several other variants that are located near or in genes firmly associated with the risk of acquiring type 2 diabetes. Other GWAS analysis studies were performed in the Chinese, Malays, and Asian-Indian populations which are distinct from the European and United States populations in addition to meta-analysis of data from other populations in the region revealed relevant findings among patients with European ancestry[ 156 ]. The results of the combined analysis showed significant association of SNPs in the CDKAL1 , CDKN2A/B , HHEX , KCNQ1 and SLC30A8 genes after adjustment with gender and body mass index. More recently, meta-analysis of GWAS data involving African American type 2 diabetes patients identified similar loci to the previous studies with the addition of two novel loci, HLA-B and INS-IGF[ 157 ]. These results provide strong evidence of common genetic determinants including common specific genes that are linked to diabetes. A small list of specific genetic markers seem strongly associated with the risk of developing type 2 diabetes including the TCF7L2 [ 158 ] and CAPN10 [ 159 , 160 ] genes which also play a significant role in the risk and pathogenesis of the disease[ 158 , 159 ]. The association of TCF7L2 gene variants with type 2 diabetes and its mechanism of action received special attention by several investigators[ 161 , 162 ]. Over expression of the protein was shown to decrease the sensitivity of beta islet cells to secrete insulin[ 163 , 164 ] and was more precisely involved in the regulation of secretary granule fusion that constitute a late event in insulin secretion pathway[ 165 ]. The role of TCF7L2 in insulin secretion was partially clarified[ 166 ] that involves modifying the effect of incretins on insulin secretion by lowering the sensitivity of beta cells to incretins. Several other genes have been found to be significantly associated with the risk of developing type 2 diabetes including a specific SNP in a hematopoietically-expressed homeobox ( HHEX ) gene[ 167 ]. The islet zinc transporter protein (SLC30A8)[ 168 ] showed positive correlation with the risk of developing type 2 diabetes where variant mutations in this gene seem protective against the disease which provides a potential tool for therapy[ 169 ]. More recently, a low frequency variant of the HNF1A identified by whole exome sequencing was associated with the risk of developing type 2 diabetes among the Latino population and potentially may serve as a screening tool[ 170 ]. Genetic variants and specific combined polymorphisms in the interleukin and related genes including interlukin-6 ( IL-6 ), tumor necrosis factor-α and IL-10 genes were found to be associated with greater risk of developing type 2 diabetes[ 171 ], in addition to genetic variants in the genes for IL12B , IL23R and IL23A genes[ 172 ]. In a study involving the hormone sensitive lipase responsible for lipolysis in adipose tissues, a deletion null mutation, which resulted in the absence of the protein from adipocytes, was reported to be associated with diabetes[ 173 ]. Nine specific rare variants in the peroxisome proliferator-activated receptor gamma ( PPARG ) gene that resulted in loss of the function of the protein in adipocytes differentiation, were significantly associated with the risk of developing type 2 diabetes[ 174 ]. In addition, certain SNPs in the alpha 2A adrenergic receptor ( ADRA2A ) gene, involved in the sympathetic nervous system control of insulin secretion and lipolysis, were found to be associated with obesity and type 2 diabetes[ 175 ]. Link analysis between the melatonin MT2 receptor ( MTNR1B ) gene, a G-protein coupled receptor, identified 14 mutant variants from 40 known variants revealed by exome sequencing, to be positively linked with type 2 diabetes[ 176 ]. The authors suggested that mutations in the MT2 gene could provide a tool with other related genes in modifying therapy for type 2 diabetes patients based on their specific genetic background to formulate personalized therapies which potentially may ensures the optimum response. Interestingly, mutations in the clock[ 177 , 178 ] and Bmal1 [ 179 ] transcription factor genes which are involved in beta cells biological clock affecting growth, survival and synaptic vesicle assembly in these cells, resulted in reduced insulin secretion and diabetes. Evidently, prominent metabolic functions involve the production of specific reactive metabolites, leading to oxidative stress, which affect lipids, proteins and other biological compounds leading to serious damage in various tissues and organs. Mutations and SNPs in the antioxidant genes, including superoxide dismutase, catalase and glutathione peroxidase, that decrease their activity are implicated in the risk and pathogenesis of type 2 diabetes[ 180 ]. The metabolic syndrome was shown to be associated with the development of type 2 diabetes in a population that is described as highly endogenous especially in individuals over 45 years of age[ 181 ]. Since consanguinity marriages is high in this population, screening for this syndrome among families could provide an informative marker on the risk of developing type 2 diabetes[ 181 ].

Molecular genetics of type 1 diabetes

Even though type 1 diabetes is basically described as an autoimmune disease that results in the destruction of pancreatic beta cells, however, single gene mutations and SNPs have been found to be associated with the susceptibility to this type of diabetes. Initially, two gene mutations were linked to the development of type 1 diabetes including the autoimmune regulator ( AIRE ) gene which affect the immune tolerance to self antigens leading to autoimmunity[ 182 ] and the FOXP3 gene which results in defective regulatory T cells[ 183 ]. In addition, a mutation in the histone deacetylase SIRTI gene predominantly expressed in beta cells involved in the regulation of insulin secretion[ 184 ] and played a role in modulating the sensitivity of peripheral tissues to insulin[ 185 ] was detected in type 1 diabetes patients[ 186 ]. Recently, additional mutations and SNPs in the CTLA-4 +49A/G and HLA-DQB1 and INS gene VNTR alleles were found to be associated with type 1 diabetes, which have the advantage of differentiating between Latent autoimmune type 1 diabetes and type 2 diabetes[ 187 ]. The HLA-DQB1, in combination with HLA-DR alleles and a polymorphism in PTPN22 gene seem to be associated with the age onset of late type 1 diabetes[ 188 , 189 ]. Two specific polymorphisms in the promoter region of a transmembrane protein (DC-SIGN) gene expressed in macrophages and played an important role of T- cell activation and inflammation were found to be protective against type 1 diabetes[ 190 ]. An innovative non-parametric SNP enrichment tool using summary GWAS DATA allowed the identification of association between several transcription factors and type 1 diabetes and are located in a type 1 diabetes susceptibility region[ 191 ]. Nine SNP variants in several genes associated with type 1 diabetes, not including the major histocompatibility gene region, were identified using extensive GWAS analysis[ 192 ]. Furthermore, several novel SNPs in a region in chromosome 16 located in the CLEC16A gene were shown to be associated with type 1 diabetes and seem to function through the reduced expression of DEX1 in B lymphoblastoid cells[ 193 ]. Since more than 40 regions in the human genome were identified to be associated with the susceptibility to type 1 diabetes[ 194 - 196 ], a weighted risk model was developed utilizing selected genes SNPs could be used for testing infants for these genetic markers that could provide insights in the susceptibility to type 1 diabetes development or safe prevention of the disease among young children[ 197 ].

Molecular genetics of monogenic diabetes

A large array of genes were identified to be involved in the development of monogenic diabetes[ 80 ] which represent about 2%-5% of diabetes patients. Monogenic diabetes results primarily from gene defects that lead to a decrease in beta cell number or function. Monogenic diabetes genes were identified using linkage studies or code for proteins that directly affected glucose homeostasis. The majority of genes responsible for monogenetic diabetes code for either transcription factors that participate in the control of nuclear gene expression or proteins that are located on the cell membrane, cytoplasm and endoplasmic reticulum, proteins involved in insulin synthesis and secretion, exocrine pancreatic proteins and autoimmune diabetes proteins[ 80 ]. The collective function of these proteins is their participation in glucose metabolism at different levels. Evidently, the hierarchy of a specific gene in the overall glucose metabolism pathway determines the onset of diabetes in the patient and whether it is neonataly expressed or have late onset expression (adulthood). Consequently, molecular defects in the structure and function of these genes lead to the disturbance of plasma glucose level, the primary pathological sign of diabetes. The molecular mechanism of permanent neonatal diabetes mellitus (PNDP) in addition to MODY explains the observed phenotype of monogenetic diabetes that involves loss of function of the expressed mutant protein. The first gene implicated in monogenic diabetes was the glucokinase ( GCK ) gene[ 198 ] which functions as a pancreatic sensor for blood glucose where more than 70 mutations in the gene were identified that affected its activity[ 199 ]. A recent study on GCK gene mutations causing neonatal and childhood diabetes showed that the majority of mutations resulted in the loss of the enzyme function primarily due to protein instability[ 148 , 150 ]. Two hepatocytes nuclear factor genes that code for the HNF4A and HNF1A transcription factors were closely associated with MODY1 and MODY2[ 148 , 149 ]. Definitely, a whole list of other genes involved in monogenic diabetes are either overlooked or included in the genetic determinants of type 1 and type 2 diabetes which will be identified and clarified through more careful future studies.

MOLECULAR GENETICS OF DIABETES COMPLICATIONS

In addition to the genetic determinants of diabetes, several gene mutations and polymorphisms have been associated with the clinical complications of diabetes. The cumulative data on diabetes patients with a variety of micro- and macrovascular complications support the presence of strong genetic factors involved in the development of various complications[ 200 ]. A list of genes have been reported that are associated with diabetes complications including ACE and AKR1B1 in nephropathy, VEGF and AKRB1 in retinopathy and ADIPOQ and GLUL in cardiovascular diseases[ 200 ]. A study on Chinese patients revealed a single SNP in the promoter region of the smooth muscle actin ( ACTA2 ) gene correlates with the degree of coronary artery stenosis in type 2 diabetes patients[ 201 ]. Furthermore, the alpha kinase 1 gene ( ALPK1 ) identified as a susceptibility gene for chronic kidney disease by GWAS[ 202 ], was demonstrated in type 2 diabetes patients[ 203 ]. Three additional genes have been strongly correlated with this risk of diabetic retinopathy (DR) including the vascular endothelial growth receptor, aldose reductase and the receptor for advanced glycation products genes[ 204 ] where specific polymorphisms in these genes seem to increase the risk of DR development in diabetes patients[ 204 ]. A significant differential proteome (involving 56 out of 252 proteins) is evident that characterizes vitreous samples obtained from diabetes patients with the complication in comparison to diabetes patients without the complication and control individuals[ 205 ]. Interestingly, a large portion of these proteins (30 proteins) belong to the kallikrein-kinin, coagulation and complement systems including complement C3, complement factor 1, prothrombin, alpha-1-antitrypsin and antithrombin III that are elevated in diabetic patients with retinopathy[ 205 ]. In addition, 2 single nucleotides polymorphisms in the human related B7-I gene seem to mediate podocyte injury in diabetic nephropathy[ 206 ]. Furthermore, increased concentration of the ligand of B7-1 correlates with the progression of end-stage renal disease (ESRD) in diabetes patients[ 206 ]. These results indicate that B7-I inhibition may serve as a potential target for diabetes nephropathy prevention and/or treatment. Recently, it was shown that direct correlation is evident between circulating levels of tumor necrosis factors 1 and 2 and increased risk of ESRD in American Indian patients[ 207 ]. The link between diabetes and proper bone development and health is evident. Studies using animal models with major significant reduction in insulin receptor (IR) in osteoprogenitor cells resulted in thin and rod-like weak bones with high risk of fractures[ 208 ]. Similar findings were observed in animal models with bone-specific IR knockdown animals which points to the central role of IR in the proper development of bones[ 208 ]. Type 2 diabetes is also associated with mitochondrial dysfunction in adipose tissues. Using knockout animal models of specific mitochondrial genes led to significant reduction in key electron transport complexes expression and eventually adipocytes death[ 209 ]. These animals exhibited Insulin resistance in addition to other complications that can potentially lead to cardiovascular disease[ 209 ].

Diabetes mellitus is the epidemic of the century and without effective diagnostic methods at an early stage, diabetes will continue to rise. This review focuses on the types of diabetes and the effective diagnostic methods and criteria to be used for diagnosis of diabetes and prediabetes. Evidently, diabetes is a complex disease with a large pool of genes that are involved in its development. The precise identification of the genetic bases of diabetes potentially provides an essential tool to improve diagnoses, therapy (more towards individualized patient targeted therapy) and better effective genetic counseling. Furthermore, our advanced knowledge of the association between medical genetics and the chronic complications of diabetes, will provide an additional advantage to delay or eradicate these complications that impose an immense pressure on patient’s quality of life and the significantly rising cost of health-care services.

Conflict-of-interest: The authors declare that there is no conflict of interest associated with this manuscript.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Peer-review started: November 23, 2014

First decision: February 7, 2015

Article in press: April 14, 2015

P- Reviewer: Hegardt FG, Surani S, Traub M S- Editor: Gong XM L- Editor: A E- Editor: Wang CH

Introduction to Diabetes Mellitus

First Online: 30 December 2012

Cite this chapter

Kirti Kaul 2 ,
Joanna M. Tarr 2 ,
Shamim I. Ahmad 3 ,
Eva M. Kohner 2 &
Rakesh Chibber 2

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 771))

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The chronic metabolic disorder diabetes mellitus is a fast-growing global problem with huge social, health, and economic consequences. It is estimated that in 2010 there were globally 285 millionpeople (approximately 6.4% of the adult population) suffering from this disease. This number is estimated to increase to 430 million in the absence of better control or cure. An ageing population and obesity are two main reasons for the increase. Furthermore it has been shown that almost 50% of the putative diabetics are not diagnosed until 10 years after onset of the disease, hence the real prevalence of global diabetes must be astronomically high.

This chapter introduces the types of diabetes and diabetic complications such as impairment of immune system, periodontal disease, retinopathy, nephropathy, somatic and autonomic neuropathy, cardiovascular diseases and diabetic foot. Also included are the current management and treatments, and emerging therapies.

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Diabetes Mellitus

Introduction to Type 2 Diabetes Mellitus

Type 1 Diabetes Mellitus

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Kaul, K., Tarr, J.M., Ahmad, S.I., Kohner, E.M., Chibber, R. (2013). Introduction to Diabetes Mellitus. In: Ahmad, S.I. (eds) Diabetes. Advances in Experimental Medicine and Biology, vol 771. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5441-0_1

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Essay on Diabetes in English for Children and Students

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Table of Contents

Essay on Diabetes: Diabetes is a metabolic disease, in which the human body fails to utilize the sugar (glucose) content in blood, thus resulting in high blood sugar levels over a prolonged period of time. Sugar present in our blood is a carried by a hormone called Insulin, to the cells and stored or used as a source of energy. Diabetes occurs when the body doesn’t produce enough insulin or the insulin is unable to effectively transfer the produced glucose to the body tissues.

Diabetes is a serious health concern and requires regular medical care. Most common symptoms of diabetes include – frequent urination, unusual weight loss, increased appetite and a desire to consume sweets.

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Long and Short Essay on Diabetes in English

Below we have provided long and short essay on diabetes of varying length on various aspects of diabetes. After going through the essay you will be able to speak or write on various issues like – causes, symptoms, types, levels and effects of diabetes.

It will also focus on diet that should be taken by a diabetic person and its effects on other vital organs of human body.

Also, you will know about the global spread of diabetes and its preventive measures as well as the significance of the World Diabetes Day.

You can choose any Diabetes essay of your choice from the essays given below and use the information in competitions, debates, class tests etc.

Short Essay on Diabetes –200 words

A Silent Threat to Humanity

Diabetes is a metabolic disease which is caused due to the excess of sugar (glucose) in human blood. It is also called as Diabetes Mellitus (DM). Our body produces a hormone – Insulin, which is primarily responsible for carrying glucose present in our blood to the cells to be stored and used as energy source. Problem occurs when either the pancreas doesn’t produce enough insulin, or the insulin produced is somehow unable to effectively transfer the glucose from blood to the cells.

A persistent increased blood sugar level is a potential threat to the vital organs and other parts of human body. Initial symptoms of diabetes are frequent urination, dizziness, weight loss, increased hunger etc. Diabetes may cause severe complications like – consciousness loss, kidney failure, brain stroke, foot ulcers and damage to the eyes.

Diabetes Mellitus has become the most common disease and around 425 million people globally are suffering from diabetes; out of which 82 million belong to the south-east Asian region. India, which is also a part of south-east Asia, has over seven crores cases of diabetes recorded annually.

With lifestyle changes and less physical exercise, more and more people are getting affected by diabetes. It is estimated that given to the present state of affairs, total number of diabetes patients in south-east Asia alone, will rise to 151 million.

Essay on Diabetes – 300 Words

Effects of Diabetes and Diabetes Day

Diabetes or Diabetes Mellitus is a metabolic disease caused due to the excess of blood sugar level in human body. An excessive quantity of sugar in blood, damages other vital organs like – kidney, heart and brain. Though, it is caused by the under production of insulin hormone by the pancreas, it is also a life style disease, caused due to unhealthy dietary habits and lack of physical exercise.

Effects of Diabetes on Health

Diabetes has wide range of effects on human body and health. It is the condition in which the glucose present in the human blood is somehow fails to be utilized as the source of energy. It could be either due to under production of insulin hormone, which carries sugar from blood to the cells, or it could be due to the unresponsiveness of cells to receive the sugar.

Whatever the reason may be, it results in excess blood sugar (glucose) content. Diabetes may potentially affect the vital organs like heart, kidney, brain and eyes. It may cause cardiovascular diseases, heart attack, kidney failure, hearing loss, bacterial and fungal skin infections and brain stroke.

World Diabetes Day and its Significance

Globally, around 425 million people are suffering from diabetes and the number is about to increase significantly in coming years if the preventive measures are not taken. Therefore, to raise awareness of people about diabetes, International Diabetes Federation (IDF) observes World Diabetes Day every year on 14 th November.

World Diabetes Day was first launched in 1991, as a counter measure to the increasing number of diabetes patients around the world.

Diabetes Mellitus is a global threat, with billions affected globally by it, it becomes imperative to raise public awareness about the causes, symptoms and effects of diabetes in order to effectively reduce the number of patients globally. Global events like World Diabetes Day play a significant role in freeing the world from Diabetes Mellitus.

Essay on Diabetes – 400 Words

Diabetes Mellitus and Kidney Problems

Diabetes Mellitus is a condition when human body is unable to effectively utilize the sugar (glucose) present in its blood ultimately leading to high blood glucose level. Blood is a vital body fluid that reaches all the body parts, and an abnormally high glucose level in blood could potentially damage the vital body organs and other body parts.

Causes and Symptoms of Diabetes Mellitus

Diabetes is identified by high sugar (glucose) content in human blood. Glucose is a source of energy for the body and is normally present in blood which supplies glucose to other parts of body. The body parts that receive glucose do so with help of a hormone called Insulin. As long as the pancreas normally produces insulin, the blood glucose level is maintained. But, an abnormality in insulin production or its inefficiency to effectively transfer the glucose to the body tissues, leads to excess of glucose in blood. This metabolic condition is identified as Diabetes or Diabetes Mellitus.

Common symptoms of diabetes mellitus include tiredness, loss of stamina, sweating, persistent hunger, loss of weight and frequent urination. Any such symptoms must not be neglected and proper medical advice must be sought.

How Diabetes is Related to the Health of Kidney

Diabetes is one of the most common causes of kidney failure. Kidneys are the vital body organ which cleans the blood. A high content of glucose in blood damages the blood vessels of kidney, resulting in a medical condition called Diabetic Nephropathy.

With damaged blood vessels, your kidneys will not be able to effectively clean the blood, resulting in waste accumulation in your blood and body as well. This cycle continues, further damaging the kidneys and also other body parts. If the damage continues, it might result in serious complications including kidney failure.

The damage to the kidneys begins long before the other symptoms of diabetes actually appear. Patients suffering from diabetes should get their kidneys examined from time to time. Retention of urine in the bladder caused due to diabetes might also result in pressure on kidneys, further damaging them.

It is recorded that around 30 to 40% of diabetes patients will eventually face kidney failure. The number is disturbing given the billions of diabetes patients worldwide. Apart from raising people’s awareness on diabetes, there is also a need to make the tests of kidneys affordable for a common man. Diabetes patients must be regularly tested for the health of their kidneys and other vital organs.

Essay on Diabetes – 500 Words

Diabetes Mellitus and Heart Attack

Diabetes is a metabolic condition in which the blood retains more glucose, than it should under normal conditions. A high blood glucose level may damage the vital organs of human body like kidney, eyes, ear, heart and brain. Diabetes is caused due to under production of insulin hormone by the pancreas, which acts as a bridge for blood sugar (glucose), to move from blood to the other cells of the body.

Signs of Diabetes Mellitus

Some of the typical symptoms of Diabetes include anxiety, tiredness, blurred vision, headache, irritation, weakness, loss of stamina and faster heartbeat. These are only initial symptoms of diabetes and indicate the forthcoming severe consequences. Every sign of diabetes speaks volumes about the effects of the disease. For example, tiredness, dizziness is caused due to the inability of one’s body cells to successfully convert blood glucose into energy. Increased blood sugar levels in the blood damages the vital organs including heart.

Person suffering from diabetes is more likely to have cardiovascular complications including heart attack. Diabetes leads to high blood pressure and high cholesterol levels, escalating the possibility of a heart attack.

High glucose content in the blood damages the blood vessels of heart. Damaged blood vessels are unable to pump the required blood at the required rate, ultimately causing heart attack and other heart diseases. People suffering from diabetes are more likely to have cardiovascular disorders from a very early age, than the people who are not suffering from diabetes.

There are also certain factors which might increase one’s chance of heart attack, like smoking, drinking liquor, obesity, high cholesterol level and unhealthy lifestyle. The given factors, if present with diabetes, substantially increase the chances of a heart attack.

Prevention is Better than Cure

The best way for a diabetic person to stop a heart attack from occurring is by keeping a check on his/her blood sugar level. A diabetic person should always take necessary precautions to keep his/her blood sugar level under control. The precautions include – routine checkup of sugar level and heart, avoiding unhealthy and oily food, quit smoking, adapting to healthy lifestyle, regular exercise, and early morning walks etc.

The blood vessels of a diabetic patient are already weaker as compared to that of a normal human being. If a diabetic patient consumes unhealthy or junk food, he/she increases his/her cholesterol level, which together with the damaged blood vessels makes a heart attack most likely possibility. Activities like exercising and walking keep one’s cholesterol level under control, hence decreasing the chances of a heart attack.

A diabetic person must also take precautionary measures to keep his/her high blood pressure under control. Such patients are more likely to get a heart attack when compared to any normal patient of high blood pressure.

Diabetes is a silent killer; when unchecked, it slowly damages the vital organs resulting in their malfunction and severe health complications. Necessary precautionary measures should be taken, especially by a diabetic person to keep his/her heart and other vital organs in a healthy condition. Diabetes damages the heart’s blood vessels increasing the possibility of a heart attack.

Long Essay on Diabetes – 600 Words

This one is a complete essay providing information about “Meaning, Types, Causes, Symptoms, Effects and Levels of Diabetes.”

Diabetes is a metabolic disorder which is identified by the high blood sugar (glucose) level. An increased blood glucose level damages the vital organs as well as other organs of the human’s body causing other potential health ailments.

Types of Diabetes

Diabetes Mellitus could be further classified into the following two types –

1) Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus is classified by deficiency of insulin in blood. The deficiency is caused by the loss of insulin producing beta cells in pancreas. This type of diabetes is found more common in children. It is characterized by an abnormally high or low blood sugar levels.

The patients of type 1 diabetes require regular administration of insulin. The type 1 diabetes is hereditary i.e. you are most likely to have type 1 diabetes if any of your parents had it. Symptoms of Type 1 diabetes include frequent urination, thirst, weight loss and constant hunger.

2) Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus is characterized by the inefficiency of body tissues to effectively respond to insulin, which may be combined by insulin deficiency. Type 2 diabetes mellitus is the most common type of diabetes.

Causes of Diabetes

The food that we eat is broken down into useful compounds through the process of digestion. One of these compounds is glucose, usually referred to as blood sugar. Glucose is food for the cells of human body i.e. body cells rely on the availability of glucose for further using it as a source of energy. The job of carrying glucose to the cells of the body is done by the blood.

But mere carrying the glucose to the cells by blood isn’t enough for the cells to absorb glucose, a job which is done by hormone insulin, supplied by the pancreas. Insulin acts as a bridge for glucose to transit from blood to the body cells. Problem arises when the pancreas fails to produce enough insulin or the body cells for some reason doesn’t respond to receive the glucose; both the cases result in the excess of glucose in blood, which is referred as Diabetes or Diabetes Mellitus.

Symptoms of Diabetes

Most common symptoms of diabetes are fatigue, irritation, stress, tiredness, frequent urination and headache including loss of strength and stamina, weight loss, increase in appetite etc.

Levels of Diabetes

There are two types of blood sugar levels – fasting blood sugar level (blood sugar test before food) and postprandial blood sugar level (blood sugar test two hours after having meal). Sugar level measured after fasting for at least eight hours generally after an overnight fast is called fasting sugar level. Blood sugar level below 100 mg/dL (milligrams per deciliter) before eating food is considered normal.

Sugar level measured after two hours of eating is called postprandial glucose level or PP level. The PP blood sugar level should be below 140 mg/dL, two hours after the meals.

Though, the maximum limit in both the cases is defined, the permissible levels may vary among individuals. Some people may have normal fasting sugar level of 60 mg/dL while some may have the normal value of 90 mg/dL.

Effects of Diabetes

Diabetes may have severe health consequences and it affects vital body organs. Excessive glucose in blood damages kidneys, blood vessels, skin resulting in various cardiovascular and skin diseases and other ailments. Diabetes damages the kidneys, resulting in accumulation of impurities in body. It also damages the heart’s blood vessels increasing the possibility of a heart attack.

Apart from damaging vital organs, diabetes may cause various skin infections and the infection in other parts of the body. The prime cause of all type of infections is the decreased immunity of body cells due to their inability to absorb glucose.

Diabetes is a serious life threatening disease and must be constantly monitored and effectively subdued with proper medication and by adapting to a healthy life style. By following a healthy lifestyle, regular checkups and proper medication one can observe a healthy and long life.

Essay on Diabetes FAQs

Can eating too much sugar cause diabetes.

No, eating too much sugar doesn't directly cause diabetes, but it can increase the risk of developing type 2 diabetes over time.

What are the 3 main symptoms of diabetes?

The 3 main symptoms of diabetes are frequent urination, excessive thirst, and unexplained weight loss.

Who gets diabetes and why?

Anyone can get diabetes, but it's more common in those with a family history, poor diet, or lack of physical activity.

How can I prevent diabetes naturally?

You can prevent diabetes naturally by maintaining a healthy weight, eating a balanced diet, and staying physically active.

What is the main prevention of diabetes?

The main prevention of diabetes involves lifestyle changes, like eating well and exercising regularly.

The Treatment and Management of Diabetes Essay

Introduction, diabetes control and complication trial, diabetes prevention program, look ahead trial.

For centuries, medical scientists have been developing various interventions in a bid to treat and manage diabetes among the population. Nutrition and lifestyle interventions are part of interventions that have proved to be effective in the treatment and management of diabetes. According to Delahanty (2010), nutrition and lifestyle interventions are current therapies for diabetes because they “have been a critical component in three of the four largest clinical trials that focused on diabetes in the past two decades” (p. 360).

The three major clinical trials involving diabetes are Diabetes Control and Complications Trial 1983-1993 (DCCT), Diabetes Prevention Program 1996-2001 (DPP), and Action for Health in Diabetes 2001-2012 (Look AHEAD Trial). These clinical trials confirmed that nutrition and lifestyle interventions play a central role in the treatment and management of diabetes; type I and type II diabetes mellitus. Therefore, this essay examines the findings of the three clinical trials that are relevant in the treatment and management of diabetes, as nursing practice.

The DCCT trial entailed diabetic patients with type I diabetes who volunteered for the study. The clinical trial randomly assigned participants who volunteered for the study to conventional and intensive therapies. Conventional therapy is aimed at helping diabetic patients to measure their glucose levels in blood and urine while attending their clinics after every three months. Comparatively, the intensive therapy required the diabetic patients to measure their glucose levels in the blood and urine regularly while attending their clinics monthly. Both patients under conventional and intensive therapies received similar dietary counseling.

When planning a diet for diabetic patients, “insulin doses were first matched with a consistent diet, and the dieticians taught participants how to adjust insulin for variations in food intake and activity level” (Delahanty, 2010, p. 362). During the progress of the clinical trial, it was evident that intensive therapy with nutrition has a significant impact on the treatment and management of diabetes.

The findings of the DCCT show that there is a marked difference between conventional and intensive therapy. Delahanty (2010) states that “intensive therapy achieved a stable HbA1c by approximately 7.2% versus 9.1% with conventional treatment” (p. 362). Such reduction in HbA1c has significant benefits because it reduced the risk of developing retinopathy by 76% and progression of diabetes by 54%. Moreover, the reduction in HbA1c decreased the risk of developing microalbuminuria by about 30-60%. In this view, the DCCT proved that medical nutrition therapy is important in maintaining blood glucose levels, achieving HbA1c targets, and minimizing weight gain.

DPP intervention focused on patients with diabetes type II. The clinical trial aimed at determining whether 150 minutes of physical activity would help diabetic patients reduce their weights by 7%, and thus prevent or delay the occurrence of type II diabetes (Delahanty, 2010). To achieve this, DPP randomly assigned 3000 patients to three groups, namely, metformin, placebo, and lifestyle intervention groups.

Patients in the three groups underwent regular assessment after every three months, where they received their respective counseling about treatments. As case managers, the dietitians “scheduled quarterly outcome assessment visits within the appropriate time windows, reported and documented adverse events, reviewed their participants’ progress with lifestyle goals at weekly team meetings” (Delahanty, 2010, p.366). Throughout the clinical trial, dietitians assessed the impact of physical activity on the prevention, treatment, and management of diabetes type II.

The findings of DPP intervention indicate that modification of diet and physical activity are critical in preventing the development of type II diabetes among the predisposed population, or in delaying its progression among the diabetic population. According to Delahanty (2010), “the lifestyle intervention decreased the development of diabetes by 58% compared to placebo,” while metformin decreased its development by 31% (p. 366).

Moreover, the findings indicate that lifestyle intervention is very effective among older patients and the ones with low body mass index when compared to metformin intervention. Overall, lifestyle intervention of physical activity led to weight reduction, which ultimately reduced the risk of diabetes by 71% among older patients.

Look AHEAD trial focused on the impact of intensive lifestyle intervention on patients with diabetes type II. The objective of the Look AHEAD was to “determine the long-term effects of a lifestyle intervention compared to conventional ‘diabetes support and education’ treatment” (Delahanty, 2010, p. 367). The Look AHEAD intervention entailed modification of diet and incorporation of physical exercise in the management of diabetes among patients.

The evidence obtained indicates that the Look AHEAD intervention is the most effective intervention when compared to the DCCT and DPP interventions. The Look AHEAD intervention has a two-fold effect in the treatment and management of diabetes because it reduced HbA1c levels and enhances weight loss. The findings of the study are relevant in nursing, because, nurses can utilize them in aiding diabetic patients to make informed decisions regarding the nature of the diet and physical activity, which are appropriate in the management of diabetes.

The DCCT, the DPP, and the Look AHEAD are three interventions, which have proved that nutrition and physical activity are central in the treatment and management of diabetes among the population. The DCCT intervention aims at aiding a diabetic patient to understand how to manage body weight and blood glucose levels. Moreover, the aim of DPP and Look AHEAD interventions is to help a diabetic patient manage own body weight and maintain normal glucose levels in the blood. Overall, the three interventions show that dietitians have a noble role in offering lifestyle and nutritional interventions, which prevent the development and progression of diabetes in the population.

Delahanty, L. M. (2010). Research charting a course for evidence-based clinical diabetic practice in diabetes. Journal of Human Nutrition and Dietetics, 23 (4), 360-370.

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At The Brink

An Introduction: It’s Time to Protest Nuclear War Again

Kathleen Kingsbury, Opinion Editor

The threat of nuclear war has dangled over humankind for much too long. We have survived so far through luck and brinkmanship. But the old, limited safeguards that kept the Cold War cold are long gone. Nuclear powers are getting more numerous and less cautious. We’ve condemned another generation to live on a planet that is one grave act of hubris or human error away from destruction without demanding any action from our leaders. That must change.

In New York Times Opinion’s latest series, At the Brink, we’re looking at the reality of nuclear weapons today. It’s the culmination of nearly a year of reporting and research. We plan to explore where the present dangers lie in the next arms race and what can be done to make the world safer again.

W.J. Hennigan, the project's lead writer, begins that discussion today by laying out what’s at stake if a single nuclear weapon were used, as well as revealing for the first time details about how close U.S. officials thought the world came to breaking the decades-long nuclear taboo.

Russia’s president, Vladimir Putin, threatened in his 2024 annual speech that more direct Western intervention in Ukraine could lead to nuclear conflict. Yet an American intelligence assessment suggests the world may have wandered far closer to the brink of a nuclear launch more than a year earlier, during the first year of Mr. Putin's invasion.

This is the first telling of the Biden administration’s efforts to avoid that fate, and had they failed, how they hoped to contain the catastrophic aftermath. Mr. Hennigan explores what happened during that tense time, what officials were thinking, what they did and how they’re approaching a volatile future.

In the first essay of the series, W.J. Hennigan lays out the risks of the new nuclear era and how we got here. You can listen to an adaptation of the piece here .

Within two years, the last major remaining arms treaty between the United States and Russia is to expire. Yet amid mounting global instability and shifting geopolitics, world leaders aren’t turning to diplomacy. Instead, they have responded by building more technologically advanced weapons. The recent intelligence on Russia’s development of a space-based nuclear weapon is the latest reminder of the enormous power these weapons continue to wield over our lives.

There is no precedent for the complexity of today’s nuclear era. The bipolarity of the Cold War has given way to a great-power competition with far more emerging players. With the possibility of Donald Trump returning as president, Iran advancing its nuclear development and China on track to stock its arsenal with 1,000 warheads by 2030, German and South Korean officials have wondered aloud if they should have their own nuclear weapons, as have important voices in Poland, Japan and Saudi Arabia.

The latest generation of nuclear technology can still inflict unspeakable devastation. Artificial intelligence could someday automate war without human intervention. No one can confidently predict how and if deterrence will work under these dynamics or even what strategic stability will look like. A new commitment to what could be years of diplomatic talks will be needed to establish new terms of engagement.

Over the past several months, I’ve been asked, including by colleagues, why I want to raise awareness on nuclear arms control when the world faces so many other challenges — climate change, rising authoritarianism and economic inequality, as well as the ongoing wars in Ukraine and the Middle East.

Part of the answer is that both of those active conflicts would be far more catastrophic if nuclear weapons were introduced into them. Consider Mr. Putin’s threat at the end of February: “We also have weapons that can strike targets on their territory,” the Russian leader said during his annual address. “Do they not understand this?”

The other answer lies in our recent history. When people around the world in the 1960s, ’70s, ’80s and early ’90s began to understand the nuclear peril of that era, a vocal constituency demanded — and achieved — change.

Fear of mutual annihilation last century spurred governments to work together to create a set of global agreements to lower the risk. Their efforts helped to end atmospheric testing of nuclear weapons, which, in certain cases, had poisoned people and the environment. Adversarial nations started talking to each other and, by doing so, helped avoid accidental use. Stockpiles were reduced. A vast majority of nations agreed to never build these weapons in the first place if the nations that had them worked in good faith toward their abolishment. That promise was not kept.

In 1982 as many as a million people descended on Central Park calling for the elimination of nuclear arms in the world. More recently, some isolated voices have tried to raise the alarm — Jamie Dimon, the chief executive of JPMorgan Chase, said last year that “the most serious thing facing mankind is nuclear proliferation” — but mostly such activism is inconceivable now. The once again growing threat of nuclear weapons is simply not part of the public conversation. And the world is less secure.

Today the nuclear safety net is threadbare. The good news is that it can be restitched. American leadership requires that Washington marshal international support for this mission — but it also requires leading by example. There are several actions that the U.S. president could take without buy-in from a Congress unlikely to cooperate.

As a first step, the United States could push to reinvigorate and establish with Russia and China, respectively, joint information and crisis control centers to ensure that misunderstandings and escalation don’t spiral. Such hotlines have all but gone dormant. The United States could also renounce the strategy of launching its nuclear weapons based only on a warning of an adversary’s launch, reducing the chance America could begin a nuclear war because of an accident, a human or mechanical failure or a simple misunderstanding. The United States could insist on robust controls for artificial intelligence in the launch processes of nuclear weapons.

Democracy rarely prevents war, but it can eventually serve as a check on it. Nuclear use has always been the exception: No scenario offers enough time for voters to weigh in on whether to deploy a nuclear weapon. Citizens, therefore, need to exert their influence well before the country finds itself in such a situation.

We should not allow the next generation to inherit a world more dangerous than the one we were given.

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What Is Diabetes?
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Glucose is your body's main source of energy. Your body can make glucose, but glucose also comes from the food you eat. Insulin is a hormone made by the pancreas that helps glucose get into your cells to be used for energy.
Essay on Diabetes for Students and Children
Diabetes Mellitus can be described in two types: 1) Type 1. 2) Type 2. Description of two types of Diabetes Mellitus are as follows. 1) Type 1 Diabetes Mellitus is classified by a deficiency of insulin in the blood. The deficiency is caused by the loss of insulin-producing beta cells in the pancreas. This type of diabetes is found more commonly ...
Diabetes Essay
Good Essays. 997 Words. 4 Pages. Open Document. Diabetes. Diabetes is a lifelong disease that can affect both children and adults. This disease is the sixth leading cause of death in the United States. It claims about 178,000 lives each year. Type one diabetes, also known as insulin dependent diabetes mellitus, usually occurs in people less ...
Introduction to Diabetes
Chapter 1. Introduction to Diabetes. Created: July 7, 2004. Diabetes mellitus is characterized by abnormally high levels of sugar (glucose) in the blood. When the amount of glucose in the blood increases, e.g., after a meal, it triggers the release of the hormone insulin from the pancreas.
Type 2 Diabetes
Introduction. Diabetes is a health condition that is developed when sugar level in the blood increases above normal levels. The two major types of diabetes are type 1 diabetes and type 2 diabetes. ... Type 2 diabetes is more prevalent than type 1 diabetes. This essay discusses some of the most frequently asked questions about type 2 diabetes ...
Diabetes Mellitus: Symptoms, Types, Effects Essay
Diabetes mellitus is a disease caused by high blood sugar levels, which result in defective releases of insulin in the body (Mathur, R. 2008). Initially this disease was associated with "sweet urine" and excessive loss of muscles (Mathur, R. 2008). In Diabetic patients, the glucose levels in the blood are increased, a condition known as ...
Type 2 Diabetes as a Public Health Issue Essay
High mortality rates are caused by the disease complications that gradually progress, significantly reducing the quality and duration of one's life. This paper aims to examine type 2 diabetes, including the related problems, potential solutions, and recommendations. We will write a custom essay on your topic. 809 writers online.
Essay on Diabetes
Diabetes, a global health crisis, requires comprehensive understanding and management strategies. With ongoing research and advancements, the future holds potential for improved diabetes care and prevention. 500 Words Essay on Diabetes Introduction to Diabetes. Diabetes is a chronic health condition that affects millions of people worldwide.
Essay on Diabetes for Students and Children in English
10 Lines on Diabetes Essay in English. 1. Diabetes is a severe metabolic disorder mainly caused due to obesity. 2. Type 2 diabetes is a lifestyle disorder, while Type 1 diabetes is genetic. 3. 1 out of every five people above the age of 65 has Diabetes.
Essays About Diabetes
6 pages / 2744 words. Introduction Diabetes is a chronic disease that affects the body's mechanism of converting food into energy. A substantial amount of food that we consume is metabolized into glucose and transported into the bloodstream. When the sugar content in the blood spikes up, the pancreas receives...
Diabetes Free Essay Examples And Topic Ideas
Free essay examples about Diabetes ️ Proficient writing team ️ High-quality of every essay ️ Largest database of free samples on PapersOwl. ... Introduction Diabetes mellitus is a global problem facing various populations. As such, many victims tend to appreciate the underlying treatment prescribed by doctors to reduce its effects. ...
Diabetes Essays: Examples, Topics, & Outlines
Diabetes Evidence-Based Practice Diabetes Diabetes is a disease which stays with the patient life-long except in some cases where the diabetes is gestational which occurs during pregnancy and often goes back to normal after the delivery. Typically there are two types of diabetes which are type 1 and type 2 diabetes but less common are gestational diabetes and other types which contain features ...
(PDF) DIABETES: CAUSES, SYMPTOMS AND TREATMENTS
INTRODUCTION: Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin ...
Essay on Diabetes
Essay on Diabetes. Published: 2021/11/09 ... Introduction. Diabetes is a healthcare condition that has continued to affect so many people, both young and old. Understanding more about Diabetes will help people live a healthy lifestyle by avoiding all the possible things that might cause it. In this assignment, I will assess why Diabetes is a ...
An Introduction To Diabetes Mellitus
In 1674 a physician named Willis coined the term "Diabetes Mellitus" (from the Greek word for Honey).1, 2. Diabetes mellitus is a complex syndrome that affects multiple organ systems. It is now clear that diabetes is a heterogeneous group of disorders that are elicited secondary to various genetic predispositions and precipitating factors.3.
Diabetes mellitus: The epidemic of the century
Duran A, Sáenz S, Torrejón MJ, Bordiú E, Del Valle L, Galindo M, Perez N, Herraiz MA, Izquierdo N, Rubio MA, et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study.
357 Diabetes Essay Topics & Examples
357 Diabetes Essay Topics & Examples. Updated: Feb 25th, 2024. 25 min. When you write about the science behind nutrition, heart diseases, and alternative medicine, checking titles for diabetes research papers can be quite beneficial. Below, our experts have gathered original ideas and examples for the task. We will write.
Introduction to Diabetes Mellitus
The chronic metabolic disorder diabetes mellitus is a fast-growing global problem with huge social, health, and economic consequences. It is estimated that in 2010 there were globally 285 millionpeople (approximately 6.4% of the adult population) suffering from this disease. This number is estimated to increase to 430 million in the absence of ...
Public Health Issue: Diabetes Mellitus
Diabetes patients who are unable to attend the surgery are being overlooked and missed out on screening and reviews of their diabetes, consequently receiving a lower standard of care despite the NSF for Diabetes stating inequalities in provision of services should be addressed to ensure a high standard of care which meets individual patient ...
Essay on Diabetes in English for Children and Students
Essay on Diabetes: Diabetes is a metabolic disease, in which the human body fails to utilize the sugar (glucose) content in blood, thus resulting in high blood sugar levels over a prolonged period of time. Sugar present in our blood is a carried by a hormone called Insulin, to the cells and stored or used as a source of energy. Diabetes occurs when the body doesn't produce enough insulin or ...
Type 2 diabetes mellitus
The aim of this essay is to explore the psychological implications for a person suffering from type 2 diabetes and others involved in the experience of that illness. Type 2 diabetes, is caused as the result of reduced secretion of insulin and to peripheral resistance to the action of insulin; that is, the insulin in the body does not have its ...
Quality of Life in Patients Diagnosed with Type 2 Diabetes
Introduction: Since the beginning of the new millennium, type 2 diabetes (T2D) in Mexico is the first cause of death in women and the second cause of mortality among men.1 The T2D is a chronic degenerative disease in which blood glucose is elevated2 and that over time; this excess causes a state known as glucotoxicity, which is the pathophysiological basis of diabetes and its complications.3,4 ...
The Treatment and Management of Diabetes Essay
Conclusion. The DCCT, the DPP, and the Look AHEAD are three interventions, which have proved that nutrition and physical activity are central in the treatment and management of diabetes among the population. The DCCT intervention aims at aiding a diabetic patient to understand how to manage body weight and blood glucose levels.
Association of type 2 diabetes with family history of diabetes
This study aimed to determine the degree of family relations and associated socio-demographics characteristics, clinical/physical and mental disorders in type 2 diabetes mellitus in a Kenyan diabetes clinic. This study was part of a large multicentre study whose protocol and results had been published. It took place at the outpatient diabetes clinic at a County Teaching and Referral Hospital ...
At The Brink
In the first essay of the series, W.J. Hennigan lays out the risks of the new nuclear era and how we got here. You can listen to an adaptation of the piece here.. In the first essay of the series ...

What Is Diabetes?

What are the different types of diabetes?

Type 1 diabetes

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Gestational diabetes

Prediabetes

Other types of diabetes

How common are diabetes and prediabetes?

What other health problems can people with diabetes develop?

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Diabetes mellitus: The epidemic of the century

DEFINITION OF DIABETES MELLITUS

CLASSIFICATION OF DIABETES MELLITUS

TYPE 1 DIABETES MELLITUS

Idiopathic type 1 diabetes

Fulminant type 1 diabetes

TYPE 2 DIABETES MELLITUS

Insulin resistance and signaling

OTHER TYPES OF DIABETES MELLITUS

Disease of the exocrine pancreas