Inadequate diabetic care: global figures cry for preventive measures and personalized treatment
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Diabetes mellitus (DM) is a lifelong progressive disease. Currently there are more than 285 million DM-affected people worldwide. Globally the prevalence of diabetes continues to rise and is more pronounced in countries with large populations such as China, India and USA. Driving forces behind the epidemic are obesity, aging of the population and longer life expency. Prospective, the majority of diabetic population will be in their six to eight decades of life with the implication of more females than males. Severe micro- and macrovascular complications associated with diabetes lead to a highly increased morbidity and mortality. Therefore, DM is projected to be one of the leading health problems of 21st centuary. Urgent measures are required to reduce the diabetic burden. Thus advanced predictive diagnostic tools and personalized treatment strategies in (pre)diabetic care are critical and should exert beneficial impact on public health.
KeywordsDiabetes epidemic scale Economical burden Morbidity mortality Healthcare-providers Policy-makers Related pathologies
Global prevalence of Diabetes mellitus
Diabetes mellitus (DM) is a lifelong progressive disease. It is classified as a group of heterogeneous metabolic disorders characterized by hyperglycemia as a common feature. The vast majority cases of DM fall mainly into two broad etiopathogenetic categories, classified as type 1 and type 2 DM. Type 1 DM is induced by beta cell destruction, whereas pancreatic beta cell dysfunction and insulin resistance are hallmark features of type 2 DM.
A number of factors are known to impact the disease development. Genetic predisposition, is well-acknowledged for both types of DM . Further factors can be summarized as environmental influence, life style, increased stress, nutritional behaviors, such as frequent fast food consumption, and low physical activity. As a consequence, the number of diabetic patients is continuously increasing worldwide.
The prevalence of DM has already achieved epidemic proportion with more than 285 million patients worldwide . Statistically, DM-affected patients comprise almost 6.4% of the world’s population . The incidence of type 1 DM accounts for 5–10% of all new DM diagnoses, while the dominating type 2 DM accounts for 90–95% of all cases worldwide .
Main contributing factors can be summarized as aging of the population, urbanization, increasing prevalence of obesity and low physical activity etc. [5, 6, 7, 8, 9]. The increased prevalence of DM is predicted to occur virtually for every nation, while the greatest increase is expected in developing countries [10, 13]. In developed countries, the prevalence of DM has been shown to be similar in urban and rural areas. In contrast, significantly higher DM prevalence occurs in the urban population of developing countries, which may relate to factors such as unbalanced diet, obesity, decreased physical activity and stress . The prospective estimates are that from 2010 to 2030, there will be an increase of 69% in the number of adult diabetic pateints for the developing countries, while for developed countries it is expected to increase by 20% .
Impact of aging, education and socioeconomic status on DM prevalence
In most countries, a lower educational level was associated with higher prevalence of diabetes compared to better educated groups. In western countries, the risk for developing diabetes is strongly linked to a low socioeconomic status. Most of the studies have shown that people with higher socioeconomic position have a low prevalence of diabetes, while people with low socioeconomic status have a higher prevalence of the disease [9, 19, 20, 21, 22]. Further, the influence of socioeconomic factors on DM prevalence has been shown to be higher among women compared to men.
Gender aspect in DM-Prevalence
Prevalence of DM-associated complications and mortality
Microvascular complications, due to damage to small blood vessels, are involved in the pathomechanisms of all chronic DM-related pathologies. Diabetic neuropathy is the leading DM-associated complication. Peripheral sensory neuropathy is the most common form of diabetic neuropathy affecting 40–50% of patients with diabetes . It mainly affects the feet, leading to foot lesions, numbness and foot/toe amputation. Diabetic retinopathy, the earliest manifestation of organ damage developed in DM population, is the second most common complication (see Fig. 5a). In diabetic patients, nephropathy is the main risk factor for all cardiovascular mortalities . Recent studies in the United States implicate chronic nephropathy as the leading cause of renal failure. It is affecting also up to 40% of patients with diabetes worldwide .
Macrovascular complications, which relate to the heart and large blood vessels, are peripheral vascular diseases, coronary artery diseases, arthrosclerosis and stroke .
Cancer provocation in diabetes
DM micro- and macrovascular complications are one of the leading health problems of 21st century.
Over the next 20 years, DM-affected population is likely to be increase by 50%.
Although prevalence of diabetes continues to rise in every nation, the highest increase is expected to occur in countries with large populations – China, India and USA.
Urban population in developing countries is projected to double which will likely lead to increased diabetic prevalence.
Most important demographic change in DM prevalence across the world appears to be the increase in older population (age above 60 years), as a consequence of longer life span.
DM is more frequent in females than males.
The progressive prevalence of DM will lead to a very high economic burden.
Severe complications lead to highly increased morbidity and mortality among DM patients. Global excess mortality due to diabetes is more pronounced in developing countries and individuals with low socioeconomic status.
Early prevention of DM in childhood and adults
Improved physical activity, individual nutrition and lifestyle
Application of advanced predictive diagnostics to preventively treat individuals at high risk
Personalized treatment in (pre)diabetes
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