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"Diabetes is a major threat to global public health that
is rapidly getting worse, and the biggest impact is on
adults of working age in developing countries. At least
171 million people worldwide have diabetes. This figure is
likely to more than double by 2030 to reach 366 million."
-- World Health Organization¹

Diabetes mellitus is a serious disease that can be life threatening. In 2000, nearly 6.8 million Japanese suffered from diabetes, and this number is expected to increase to nearly 8.9 million by 2030.² Diabetes is a chronic disease in which the pancreas cannot produce enough insulin or the body cannot use the insulin it produces effectively. Over time, diabetes, especially uncontrolled diabetes, can lead to serious damage of the nerves, blood vessels and other areas. According to the World Health Organization, almost three million people worldwide die annually due to diabetes.³

Diabetes comes from the Greek word meaning 'passing through' or 'siphon' and refers to one of the disease's major symptoms: excessive urine production. Mellitus comes from the Latin word meaning 'sweet taste' and refers to the sweetness of the urine. There are three main types of diabetes: Type 1, Type 2 and gestational diabetes. This article focuses on Type 2 diabetes (subsequent articles will focus on the other types).

Ninety percent of the people with diabetes suffer from Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes), in which the body cannot effectively use insulin.⁴ Insulin, a hormone produced in the pancreas, regulates carbohydrate metabolism, has effects on fat metabolism and impacts the liver's activity in storing or releasing glucose and in processing blood lipids.⁵ In patients with Type 2 diabetes, since the body cannot effectively use insulin, blood glucose levels increase and over time damage the heart, blood vessels, eyes, kidneys and nerves.

The symptoms of Type 2 diabetes include polydipsia (thirst), polyuria (excessive urination), constant hunger, weight loss, vision changes and fatigue.⁶ Type 2 diabetes is largely the result of excess body weight and lack of exercise, although genetic factors may also increase a person's susceptibility.

Initial treatment of Type 2 diabetes includes diet and exercise, and even moderate weight loss can result in a significant improvement. Oral antidiabetic drugs such as sulfonylureas, biguanides (metformin) and thiazolidinedines are often used to treat Type 2 diabetes. One of the newest treatments, exanatide, is an incretin mimetic. Incretins such as GLP-1 (glucagon-like peptide-1) enhance glucose-dependent insulin secretion and have other antihyperglycemic actions following their release into the circulation from the gut.⁷ Exanatide (Byetta) is an injectable medicine used to improve glucose control. There is no cure for Type 2 diabetes, but it can be prevented by maintaining a healthy weight, exercising regularly and eating healthy foods.

Discussion questions

1. Please summarize the article. What is the main point of the article?
2. What is diabetes?
3. How many people suffer from diabetes?
4. What causes diabetes?
5. Why do you think the incidence of diabetes is increasing so rapidly?
6. What medications are used to treat diabetes?
7. How can diabetes be prevented?

References:

1. World Health Organization. Diabetes Programme. (Accessed January 25, 2007)
2. World Health Organization. Diabetes Programme. (Accessed January 25, 2007)
3. World Health Organization. Diabetes Programme. (Accessed January 25, 2007)
4. World Health Organization. Diabetes Programme. (Accessed January 25, 2007)
5. Wikipedia. Insulin. (Accessed January 25, 2007)
6. World Health Organization. Diabetes Programme. (Accessed January 25, 2007)
7. Amylin and Eli Lilly. Byetta package insert. (Accessed January 25, 2007)

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