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Diabetes: looking to the future

Diabetes can be controlled by a balance of diet, exercise and medication, but what exactly is the disease and where is research taking companies such as GSK?

Shock was the first reaction when Jane was told she had type 2 diabetes. After all, she was only 35 years old. "I was young and I didn't think it could happen so soon," she recalls.

That was three years ago, when Jane was obese. "I knew I was at risk of any number of problems, but I did not expect a routine medical insurance test to show any problems. In a sense I am lucky my diabetes was picked up early."

Jane's test showed a high level of glucose in her urine. Today, she is in control of the symptoms of diabetes, helping to prevent possible further health problems later in her life.

How is diabetes treated?

Diabetes and the difficulties it brings can be managed sufficiently well so that a normal lifestyle is possible. In the treatment of diabetes, a balance of diet, exercise and medication is important, but what exactly is diabetes and what are companies such as GSK doing in terms of research and possible treatments for the future?

How many people have diabetes?

Jane is one of more than 180 million people in the world estimated by the World Health Organization (WHO) to have diabetes (estimates vary, with some putting the figure above 200 million).

The number of people with diabetes is likely to more than double by 2030 unless something is done to slow the epidemic, says WHO. Last year, an estimated 1.1 million people died from diabetes, almost 80 per cent of these deaths occurring in low- and middle-income countries.

By 2025, WHO says increases in diabetes rates will occur in developing countries because of population growth, aging, unhealthy diets, obesity and sedentary lifestyles.

WHO also estimates that in 2025 most people with diabetes in developed countries will be aged 65 years or older, while in developing countries most patients aged 45 to 64 will be affected by diabetes in their most productive years. The International Diabetes Foundation (IDF) predicts that in this period, developing countries will account for 80 per cent of the world’s diabetes population.

Diabetes mellitus

Diabetes mellitus, to give it its correct name, is a chronic disease which results in too much glucose in the blood. The blood-sugar level can be too high if the body does not make enough insulin, a hormone produced by the pancreas and which moves glucose out of the blood and into cells, where it is broken down to produce energy. If not treated, high levels of glucose in the blood can lead to long-term health problems.

The two types of diabetes

type 1 diabetes usually starts in childhood or young adulthood and is caused by a severe lack of insulin. In this case, most of the cells that produce insulin in the pancreas have been destroyed. type I diabetes is also known as juvenile diabetes or early onset diabetes because it usually develops before the age of 40, often in the teenage years.

type 2 diabetes develops when the body cannot produce enough insulin or when the insulin produced does not work properly. This type of diabetes is often linked with obesity. It was referred to as maturity onset diabetes because it occurs mostly in people over the age of 40. This is by far the most common type of diabetes (about 80 per cent of cases).

The causes of diabetes

Researchers don't know the exact cause of type 2 diabetes, the most common type of diabetes, but a number of risk factors have been identified. Diabetes occurs most often in adults older than 45, but it is appearing in much younger people. Weight, physical inactivity and race/ethnicity are common risk factors for developing type 2 diabetes, and there is evidence that diabetes runs in families, suggesting that genetics may play a role.

Diabetes symptoms

Without treatment, the main symptoms of diabetes are unusual thirst, excessive amounts of urine, tiredness, and weight loss and muscle wasting. However, type 2 diabetes is a progressive disease and patients may not experience these symptoms in the early stages. This might explain why so many people with type 2 diabetes remain undiagnosed until they see their doctor with a problem that is related to their diabetes.

Research directions

New studies suggest that a more aggressive treatment approach is needed to reduce the potential for complications from diabetes.

One area of current research interest is pre-diabetes, a condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as diabetes.

Pre-diabetes is a key stage in the development of type 2 diabetes, although not everyone with pre-diabetes goes on to develop type 2 diabetes. Typically, there is disturbance in blood sugar levels as measured by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Patients can have one or both of these conditions to be considered pre-diabetic.

More than 300 million people are thought to have pre-diabetes. By 2025, it is estimated that about 500 million people will have pre-diabetes. Also by 2025, it is estimated that south-east Asia will continue to have the highest prevalence of pre-diabetes (13.5 per cent), followed by Europe (10.9 per cent).

Control is the goal

Sponsored by GSK, the Global Partnership for Effective Diabetes Management is a multi-disciplinary taskforce of diabetes experts from leading institutions and diabetes organisations, committed to improving treatment outcomes for people with type 2 diabetes.  

Launched in 2004, the partnership's main education initiative is Control to Goal, a programme that addresses the potential blocks to effective diabetes management and provides guidance to healthcare professionals to help increase the proportion of patients who achieve recommended goals for glucose control.

Control to Goal provides support to healthcare professionals by defining good glucose control, highlighting the gaps between treatment guidelines and therapeutic practice, and providing practical guidance to help healthcare professionals get more diabetes patients to recommended glucose goals.

References
World Health Organization
International Diabetes Federation
Global Partnership for Effective Diabetes Management

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