What is diabetes?
Diabetes is a chronic disease characterized by an increase in the concentration of glucose in the blood, known as hyperglycaemia, caused by several factors:
- the reduced availability of insulin;
- blood- and tissue-level inactivation of insulin;
- the low sensitivity of the target tissues to the hormone;
- the combination of the above factors.
There are two different types of diabetes: type 1 diabetes and type 2 diabetes. These are two very different diseases, both in terms of their onset and their treatment and impact on patients’ lives.
Type 1 diabetes
This type of diabetes is characterised by irreversible damage to the pancreas with a consequent lack of insulin production. It affects 3–5% of diabetics and tends to arise in childhood and adolescence and only more rarely in adults. It is an autoimmune disease: the immune system produces autoantibodies against beta cells in the pancreas that it identifies as foreign. The actual causes of this abnormal immune response are not yet known: it could, however, be associated with hereditary factors that are influenced by environmental factors, e.g. certain viral infections.
Type 2 diabetes
Type 2 diabetes is characterised by high levels of glucose in the blood due to an insufficient production of insulin or a failure of the body’s cells to respond to insulin. It is the most common form and affects more than 90% of patients with diabetes and tends to occur after 30–40 years of age.
There are several mechanisms involved in the genesis of this metabolic pathology, but the main feature is insulin resistance, that is a reduced action of insulin at the level of the target organs that leads to an excess of hepatic glucose production and a reduction in the use of glucose by the muscles. Some of the most relevant risk factors for the onset of this type of diabetes are a family history, sedentary lifestyle, a diet high in fat and sugar and being overweight.
Type 2 diabetes can exhibit a gradual onset and may remain unnoticed for several years before leading to the development of symptoms. It is important not to underestimate diabetes as long-term hyperglycaemia leads to various complications such as retinopathy, nephropathy, neuropathy and cardiovascular diseases (coronary artery disease, stroke, arteriopathy).
During pregnancy too, some women may experience a temporary increase in blood glucose levels. In this case, we are talking about gestational diabetes.
What causes this?
Type 2 diabetes depends on both genetic and environmental factors. Genetic factors confer a predisposition to the development of the disease. Obesity, age, a sedentary lifestyle and unbalanced diets rich in sugar are particularly important environmental factors.
What are the main symptoms?
Diabetes-typical hyperglycaemia causes several symptoms:
- Frequent urination
- Feeling thirsty
- A strong appetite
- Recurrent fatigue
- Blurred vision
- Slow healing of wounds.
Unlike type 1 diabetes, which starts quickly, type 2 diabetes develops very slowly. In some patients, symptoms may be mild or almost imperceptible. However, the constant presence of blood glucose values above normal increases the risk of complications that can lead to neurological, renal, ocular and cardio-cerebrovascular damage.
Can type 2 diabetes be cured?
Type 2 diabetes is a chronic disease that currently has no cure, which can, however, be effectively controlled with appropriate treatment. It is essential to keep blood glucose levels normal not only with drug therapy but also by adopting a healthy lifestyle with a balanced diet and regular exercise. It is also important to carry out periodic checks to monitor the effectiveness of the therapy.
Type 2 diabetes and metabolic syndrome
Diabetes is a condition that characterizes the clinical presentation of metabolic syndrome together with high blood pressure and obesity. In contrast, patients with metabolic syndrome have a two times greater risk of developing heart disease and five times greater risk of developing diabetes. The simultaneous presence of diabetes, high blood pressure and obesity significantly increases the likelihood of developing heart problems, strokes and other vascular disorders. Due to unhealthy habits and lifestyles, metabolic syndrome is becoming increasingly common in the population and currently affects one in four adults. Metabolic syndrome is also known as insulin resistance syndrome, since it is believed that the main cause of this condition is the resistance of the cells to the action of insulin. In the case of insulin resistance, the cells do not respond adequately to insulin. Consequently, blood glucose levels increase despite the body producing increasingly higher doses of insulin to keep blood glucose under control.
Type 2 diabetes: diagnosis and tests
It is essential to promptly diagnose type 2 diabetes in order to adopt the appropriate therapeutic measures to prevent the disease from worsening. When symptoms attributable to diabetes appear, it is advisable to visit the family doctor and perform some blood tests, such as:
- the level of glycated haemoglobin, which allows us to evaluate the average concentration of glucose in the last three months
- the fasting blood glucose value on at least two different days
- the presence of glucose in urine, since urine normally does not contain glucose but when blood glucose is high, sugar can pass through the renal filter and be present in urine.
In addition, the Genetic Score test based on the genetic screening of hundreds or millions of variants throughout the genome, identifies the genetic risk associated with different metabolic pathways, allowing us to determine the risk of developing type 2 diabetes.
The result of the Genetic Score Test, after being interpreted by the specialist in the context of the patient’s clinical information, allows us to initiate a preventive strategy plan based on diet, lifestyle and/or pharmacological treatments.
Dr Maria Luisa Casella
