2^nd Annual Congress on Diabetes and its Complications March 25-26, 2019 Hong Kong

Diabetes is mainly of three types however, research has shown that a variety of other rare types of diabetes also exists. While insulin deficiency or resistance is the chief causative factor for the three main types of diabetes, there are a host of other factors which are responsible for the rare types of diabetes. Diabetes pathophysiology seeks to highlight the functional changes in an organism brought about due to the occurrence of diabetes.

Complications associated with diabetes are often acute or chronic. Acute complications, though short-termed, can often present immediate danger and thus needs to be treated at the earliest possible. These short term complications are mainly characterised by the hypoglycaemic or hyperglycaemic state of the body in which it is unable to function properly. Acute complications mainly include diabetic ketoacidosis, diabetic coma and so on. These complications if promptly treated, usually results in full recovery, however might prove fatal in case of delayed treatment.

Diabetics are more prone to developing dental complications than those who have a proper control over their blood glucose level. There are a host of dental and gum diseases associated with diabetes including gingivitis, periodontitis (mild and severe), fungal infections, dry mouth, loose teeth and so on. Prolonged levels of blood glucose can lead to developing or worsening of dental infections. Keeping a check on the blood glucose level, maintaining proper oral and dental hygiene can help mitigate such complications.

Diabetic neuropathy or nerve damage which is brought about by diabetes is a severe form of the diabetic complications. High blood glucose levels often damage the small blood vessels which supplies essential nutrients thereby causing neuropathy. Diabetic neuropathy mostly affects the nerves in legs and feet. Apart from neuropathy, diabetes has also been linked to various other disorders of the brain including Alzheimer's disease, Memory loss, Gastric Problem, Mental Health, etc. Though a serious complication, progress of diabetic neuropathy can be slowed down with tight blood sugar control and a healthy lifestyle.

Also known as diabetic kidney disease (DKD), diabetic nephropathy is the chronic loss of kidney function primarily because of high blood glucose level. About 40% of the individuals affected with Diabetes Mellitus, eventually develops DKD. Diabetic Nephropathy is characterised by the loss of protein in the urine (proteinuria or albuminuria) and also by a decline in the estimated Glomerular Filtration Rate of the kidneys. It is one of the most common causes of End-Stage Kidney Disease (ESKD) which can ultimately lead to kidney failure. A proper diet, healthy lifestyle, regular checking of blood glucose and lowering blood pressure can help prevent diabetic nephropathy and protect kidney function.

Diabetes can also cause a group of eye conditions which are collectively called Diabetic eye disease. The most common form of the disease is diabetic retinopathy which is associated with damage to the tiny blood vessels in the retina. This condition can progress through four stages and eventually result in retinal detachment or permanent vision loss. Other forms of the diabetic eye disease include Glaucoma, Cataracts, Blindness, etc. For early detection and treatment of such disease, it is necessary for affected individuals to undergo retinopathy screening and taking proper care of oneself.

Having diabetes greatly enhances the risk of developing a heart disease and having a greater chance of a heart attack or a stroke. High blood pressure or high cholesterol which is often associated with diabetes is the main causative factors of cardiovascular diseases. Apart from these, several other serious vascular complications also arise because of diabetes viz. Angina, Deep vein thrombosis, endothelial dysfunction, Peripheral arterial disease, etc.  Identifying symptoms, maintaining a healthy weight, proper diet and medications and cutting down on smoking can help keep these otherwise serious complications under control.

Glaucoma is generally defined as a disease affecting peripheral vision. Ageing patients are more prone to glaucoma but it can develop at any age. Optic nerve damage can lead to severe vision loss. The damage of the optic nerve is due to high intraocular pressure and if it is untreated then it will progress to vision loss with the initiation of unobserved blind spots at the edges of the visual field followed by tunnel vision and finally to blindness. 

People with diabetes are more likely to develop skin problems which include bacterial and fungal infections, diabetic dermopathy, diabetic blisters, eruptive xanthomatosis, etc. Generally because of high glucose levels they tend to have dry skin and less ability to ward off harmful bacteria. In both the conditions, risk of infection predominantly increases. Fortunately, majority of the skin conditions can be prevented or easily treated if diagnosed early. Good skin care is essential. However, keeping diabetes well managed is the key to avoiding skin complications.

Often, raised blood glucose is capable of damaging the sensation in the feet, affecting blood circulation to the area without which there usually tends to be delay in healing of the cuts and sores. When these symptoms are kept untreated, various complications are likely to arise like foot ulcers, foot infections and foot deformation and might also lead to amputation. Therefore it is extremely necessary to take proper care of the foot, undergo regular foot examinations and keep diabetes under control.

Research has shown that diabetes is linked to an increased risk for different forms of cancer. Cancers of the liver, pancreas, and endometrium are twice as likely to occur in diabetic people as those in non-diabetic people. Studies have focussed more on the relationship between Type 2 Diabetes and Cancer, some of which have suggested that hyperinsulinemia might possibly promote the growth of tumours. Also, leading harmful lifestyles can also be attributed to the development of both diabetes and cancer. Making lifestyle changes and increasing awareness are some of the ways of reducing risks of cancer associated with diabetes.

Gestational diabetes, if not carefully managed, can bring about complications for both the baby and the mother. Such complications are associated with premature birth, respiratory distress syndrome, excessive birth weight, hypoglycaemia, stillbirth, etc. Along with the baby, the mother is also at the risk of developing serious complications like preeclampsia, future diabetes, etc. Screening for gestational diabetes, losing extra weight before pregnancy, eating healthy foods, exercise, lifestyle changes are some of the preventive measures that can be adopted for diabetic complications during pregnancy.

Often diabetic neuropathy, arterial disease and obesity can lead to a greater predisposition towards various bone and joint disorders. Some of the common bone and joint complications include Charcot joint, diabetic hand syndrome, Osteoporosis, Osteoarthritis, frozen shoulder, and so on. The only way of overcoming diabetes-related bone and joint complications is to identify them early. It is advisable to be aware of the conditions to be able to treat them before they develop further, cause pain, discomfort or restrict movement.

Apart from the mentioned, there are numerous other complications which are caused by diabetes. It affects various organs of the body leading to their improper functioning. Diabetes can lead to development of the diseases of the Thyroid including Hashimoto's disease, Graves' disease, etc. Fibromyalgia is another condition which is linked to diabetes. Studies have also shown correlation between diabetes and impairment of hearing, lung diseases, various muscle conditions, fertility related issues, sexual dysfunction, etc. Uncontrolled blood glucose levels over a prolonged period of time can be accounted for the development of such numerous diabetic complications.

Pediatric or juvenile diabetes is chronic type 1 diabetes which affects the young population, particularly children under the age of 15. Such diabetes brings about lifetime dependency on exogenous insulin. Signs and symptoms of pediatric diabetes are similar to other types of diabetes and children are more likely to develop the disease if there is a family history of diabetes. Complications of pediatric diabetes also generally include heart diseases, nerve damage, nerve, kidney and eye damage, skin conditions, osteoporosis, etc. Proper diagnosis, treatment and management are the possible remedies for this type of diabetes.

Diabetic emergencies are quite common in people with diabetes and are usually caused due to severe hypoglycaemia, Diabetic ketoacidosis, HHS, infections and diabetic complications.  Such emergencies are often characterised by a sudden manifestation of unexplained symptoms, like loss of consciousness, signs of a stroke, seizures, confusion, muscle weakness, signs of a heart attack, etc. These emergencies can even prove to be fatal if the patient receives delayed medical care. Hence appropriate and timely identification and management of diabetic emergencies might prove to be helpful in preventing such a situation.

One of the best preventive measures one can adopt for diabetes is undertaking diabetic screening tests. Such screening is useful for detecting diabetes at an early stage and consequently taking appropriate measures to curb the further development of diabetes-related complications. Screening tests can be performed for the eyes (retinopathy screening), nerves, kidney, blood pressure, cholesterol, etc. A variety of tests are also available for diagnosing or distinguishing between certain types of diabetes including HbA1c test, C-peptide test, antibodies test, etc.

It is always advisable to take up preventive measures for such a disease which brings about so many serious complications. Some of the measures include undertaking a balanced diet, doing regular exercise, making lifestyle changes and cutting down on harmful habits such as smoking, alcohol consumption. Adopting preventive measures for Pre-diabetes, which is a precursor to type 2 diabetes is also recommended. Diabetic medications are also helpful for lowering the risk of diabetes in patients for whom lifestyle interventions might not be sufficient.

Treatment strategy of diabetes aims at keeping blood glucose levels near to the normal range. This treatment should be specific to every individual depending on the type of diabetes one is having. While Type 1 diabetes is usually treated with insulin, Type 2 diabetes usually requires management with diet and exercise. A variety of anti-diabetic medication, insulin treatment, transplants, surgery and herbal remedies are available which should be coupled with planned diet, physical exercise and blood glucose screening for effectively treating diabetes. 

A common form of treating people with diabetes is administering anti-diabetic drug. While insulin is the drug of choice for treating Type 1 diabetes, other classes of medicines like Sulphonylureas, Thiazolidinediones, Alpha Glucosidase Inhibitors, etc. are used to treat Type 2 Diabetes. Some drugs act uniquely to keep diabetes under control while others manifest similar behaviour due to which they have been grouped into specific classes of anti-diabetic drugs. There are some drugs which can be used to treat both the types of Diabetes. These work in different ways to help keep a check on the blood sugar.

Also referred to as Complementary and Alternative Medicine (CAM), this procedure of treatment, which is not a part of standard medical care, have been found to be beneficial for many individuals with diabetes. Such treatments include Chinese Medicine, Acupuncture, Ayurvedic Medicine, Aromatherapy, relaxation therapy, etc. Some of these therapies aim at treating the body and the mind and are also helpful for relaxing and relieving stress. Additionally such therapies help in mitigating nerve pain in individuals who have diabetic neuropathy.

Apart from prevention and treatment, it is extremely important to manage the condition of diabetes as efficiently as possible. Management of diabetes mainly aims to minimize the risk of long-term consequences associated with diabetes. It not only involves keeping a check on blood sugar, blood pressure and cholesterol levels but also focussing on modern approaches like exercise, dietary and lifestyle management often coupled with on-going blood glucose level monitoring. Besides this, self-management of diabetes is also very crucial for the proper adherence to dietary and lifestyle modifications.

Nutrition forms a very important part of diabetes care. Balancing all the right nutrients in the right amount helps in maintaining a healthy diet. Often a diabetic diet is recommended to individuals with diabetes which is naturally rich in nutrients and low in fat and carbohydrates. The objective of such nutritional therapies is to attain and maintain optimal metabolic outcomes by keeping the blood glucose level as close to the normal range as possible. Dietary fibres also form a crucial part of diabetic diet as these moderates how the body digests and helps control blood sugar levels.

Of the many risk factors of diabetes, genetics play a very strong role in the development of both types of diabetes. Individuals with a family history of diabetes are more likely to develop the condition than those without any diabetes in the family. Some types of diabetes like MODY is can be directly inherited. Studies have shown that Type 2 diabetes has a very strong genetic component and the likelihood of developing it if parents and/or siblings are already having the condition is far more as compared to Type 1 diabetes.

Also termed as Syndrome X, metabolic syndrome refers to a group of conditions like increased blood pressure, blood sugar, greater waist circumference and abnormal cholesterol or triglyceride levels that occur together, thereby, enhancing the risk of developing heart disease, stroke and diabetes. Most commonly occurring symptoms include abdominal obesity, fatigue, insulin resistance, frequent urination, etc. Metabolic syndrome is usually brought about due to overweight, obesity and inactivity and can be reversed by being physically active, losing weight, having proper diet and making certain lifestyle changes.

One of the most important features of diabetes management is the self-management of diabetes which can be successfully achieved and complications prevented with the help and support of the nursing team. Diabetes specialist nurses play a crucial role in screening diabetic persons, detecting early onset of diabetes, assessing nutritional needs of the patient, promoting self-management, providing prevention advice, spreading awareness on diabetes and also providing health coaching. In this context, it is extremely necessary for nurses to be well educated, trained and skilled adequately to be able to proficiently deliver care, support self-management and provide advice to diabetic persons.

Diabetes is a serious condition which still doesn't have a cure which makes new research, treatment and management techniques a crucial necessity. Over the past years there have been considerable breakthroughs in understanding and preventing diabetic complications. While some research focuses on generating artificial pancreas or engineering insulin-producing beta cells, some other researches are directed towards finding newer and longer lasting drug molecules, devising more efficient diets and also developing intensive treatment programs. Needless to say, trends and advances on diabetes research is the need of the hour for bringing about excellent management of this serious life-threatening disease.