DIABETES

BY: Ezhuthachan Mithu Mohanan (MSIWM043)

Diabetes is a metabolic disorder characterized by hyperglycaemia which results in a lack of insulin secretion, insulin action, or both the conditions. Metabolic abnormalities are caused due to a low level of resistance to insulin. The effect of symptoms can be classified based on the type and duration of diabetes. Diabetes has also been associated with many metabolic disorders such as acromegaly and hypercortisolism for example insulin resistance has been observed in patients with acromegaly in the liver. Hypercortisolism (Cushing syndrome) produces visceral obesity, insulin resistance, dyslipidaemia which leads to hyperglycaemia and reduces glucose tolerance. Besides, diabetes been associated with metabolic disorders, clinical convergence between type 1 diabetes (T1D), and type 2 diabetes(T2D) is also observed. T2D patients develop a progressive decline in total beta-cell mass. Thus there are many interlinked complications due to diabetes.

According to the report by WHO 2019, 10 main issues demand attention one of them is noncommunicable diseases such as diabetes, cancer, and heart disease. These are collectively responsible for 70% of deaths worldwide. According to the National Health Portal, the Government of India, nearly 5.8 million deaths occur due to noncommunicable diseases in India (WHO 2015). As per data provided by Directorate General of Health Services Ministry of Health & Family Welfare, Government of India (MoHFW) 2016-2017, 2.24 core persons were screened for Common noncommunicable diseases like diabetes, hypertension, cardiovascular disorders, and common cancers. From this, 9.7 % was diagnosed to be diabetes, 12.09% was diagnosed to be hypertension, 0.55% was diagnosed to be cardiovascular disease and 0.17% was with common cancers.

Events occurred from discovery of Diabetes to development of various drugs 

YEAR	EVENTS
1552 BC	HESY-RA documented urination as symptom of mysterious disease
133 AD	Araetus of Cappodocia coined the word diabetes
1675	Thomas Willis coined the word mellitus
1776	Dobson confirmed presence of excess sugar in patients
1800	Discovered chemical test for presence of sugar in urine
1700’s and 1800’s	Physician began to realize dietary changes help manage diabetes
1857	Claude Bernard confirmed that the diabetes occur due to excess glucose production
1870’s	During Franco Prussian war French physician Apollinaire Bouchardat proved that the diabetes patients symptoms improved due to war related food rationing
1889	Oskar Minkowski and Joseph Von Mering extract obtained from dogs pancreas
Early 1900	Development of oat cure, potato therapy, starvation diet.George Zuelzar injected pancreatic extract to control diabetes
1916	Boston scientist Elliott Joslin wrote book “ The Treatment Of Diabetes Mellitus “
1922	Frederick Banting discovered insulin to treat diabetes and won Nobel Prize in medicine 1923
1978	Production of recombinant human DNA insulin
1996	For the treatment of type 22 diabetes Thiazolidinediones (TZDs) were introduced.
2005	The  amylin analogue known as pramlintide, which was approved by the FDA
2008	Colesevelam approved for type 2 diabetes by FDA
2009	Bromocriptine approved for diabetes
2013	Canagliflozin  is the first SGLT- 2 inhibitor  approved by FDA  [Sodium Glucose Co-Transporter 2 Inhibitors], Dapagliflozin approved in 2014 by FDA

(Source: Saudi Med et al., 2002, John et al., 2014)

Diagnosis of Diabetes: 

There are several methods used for the diagnosis of Diabetes Mellitus. According to American Diabetes Association (ADA) the most standard diagnostic criteria is as follows 

1. Hemoglobin A1c (HbA1c)
2. Fasting Plasma Glucose (FPG)
3. Oral Glucose Tolerance Test (OGTT)

 Hemoglobin A1c (HbA1c):

The average level of blood sugar over past two to three months can be diagnosed using hemoglobin A1c test. The main advantage of this type of diagnosis is that there is no need of fasting. A1c is measured using percentage The standard referred by ADA for normal person is less than 5.7%.

 Diagnosis of Diabetes by checking Hemoglobin A1c (HbA1c)

	Hemoglobin A1c
Normal	Less than 5.7%
Prediabetes	5.7% to 6.4%
Diabetes	6.5% higher

Fasting Plasma Glucose (FPG):

It is used to check fasting blood sugar levels. The patient should fast for 8 hours before the test. It is mainly done during morning. For normal person the FPG is lower than 100mg/dl.

Diagnosis of Diabetes by checking Fasting Plasma Glucose (FPG)

	FPG
Normal	100mg/dl or less
Pre diabetes	100 mg/dl to 125 mg/dl
Diabetes	126 mg/dl or high

Oral Glucose Tolerance Test (OGTT)

This method is used to diagnose blood sugar level before and after 2 hours of a sweet drink. For normal person the OGTT is less than 140mg/dl

 Diagnosis of Diabetes by checking Oral Glucose Tolerance (OGTT)

	OGTT
Normal	140mg/dl or less
Pre diabetes	149 to 199mg/dl
Diabetes	200 mg/dl or high