Will diabetes mellitus become an epidemic?
Last updated: 07/11/24
Defining diabetes and its causes
Looking at modern society in terms of the food being consumed and the amount of exercise undertaken collectively, it is entirely inevitable that diabetes will become an epidemic. Now before delving into the above statement further, diabetes mellitus (from Greek ‘siphon’ and Latin ‘sweet’) is a non-communicable disease that occurs when blood sugar levels in the body are so high, that the pancreas is unable to produce adequate insulin in order to manage this problem. Also, diabetes can be categorised into various types, but the most common are types 1 and 2 as well as gestational (which happens during pregnancy). There is also diabetes insipidus (from Latin ‘lacking taste’), and this is where the kidneys are unable to conserve water.
The causes of diabetes mellitus can be divided based on the type. Since type 1 can be caused by the body’s immune system attacking the pancreas, this means that the beta cells are unable to make enough insulin because they are damaged. Not only can type 1 diabetes arise this way, it is possible that environmental factors such as diet and viral infections lead to the disease. As for type 2, it primarily comes from insulin resistance, meaning that the body does not respond to the hormone effectively compared to a person without diabetes. This in turn impacts insulin mediated glycogen synthesis and glycolysis leading to hyperglycemia as seen in figure 1.
There are many reasons why diabetes is likely to become an epidemic. Firstly, there is a clear connection between obesity and type 2 diabetes which cannot be ignored; this is because an article found that people with both conditions are exacerbated perhaps due to increased NEFAs (non esterified fatty acids) and glycerol among other linked biochemicals. On the other hand, this same article stated that people with type 1 diabetes are not usually obese. Nevertheless, it is vital that in order to prevent the incidence of type 2 diabetes in later life, it is important to implement strategies such as regular exercise and lowering carbohydrate intake in the diet.
Alluding to the previous paragraph, one of the major factors to the increase in obesity and type 2 diabetes diagnoses is the sedentary lifestyle or decreased mobility through sitting. A meta-analysis evaluated 10 studies with over 500,000 volunteers and concluded that there was a 112% cumulative increase in type 2 diabetes risk linked to watching TV. Additionally, a study showed that more sedentary time had raised body and trunk fat percentage while there was reduced appendicular skeletal muscle mass. Taking into account these findings among others, it is evident that exercise does play a role in reducing the risk of type 2 diabetes.
Counteracting the previous paragraphs, it is equally plausible that diabetes will not be epidemic because there are current pharmaceutical drugs taken orally like sulfonylureas and meglitinides that cause the pancreas to release insulin aside from injection based ones such as amylin mimetics, which maintains blood glucose concentration, which are used for type 2 diabetes. As for those afflicted with type 1 diabetes, they mainly take insulin because they are in deficit of the hormone or they can have a pancreatic transplant, which has more than 96% and 83% survival rates after 1 and 5 years of the operations respectively, although it does have a major complication of rejection like any other type of operation.
With regards to future treatments, a review discussed how newer drugs for decreasing blood glucose such as dipeptidyl peptidase-4 (DPP-4) inhibitors have been re-evaluated for cardiovascular outcome trials by showing patients experiencing a decrease in other non-communicable diseases like myocardial infarction and albuminuria, indicating that they can be useful for heart and kidney diseases associated with type 2 diabetes. Furthermore, there are other potential therapies such as probiotics and prebiotics that can be used along with faecal transplants to change the gut microbiome for type 2 diabetes patients.
It is uncertain that diabetes will/won’t become an epidemic
From a more neutral perspective, there is not enough certainty that diabetes will or will not become an epidemic simply because accurately predicting the future 100% of the time is impossible. As such, the future interventions for treating diabetes may not actually get to exist, perhaps due to prospective factors like politics and societal values with respect to science as well as taking into account the difficulty for a therapeutic method to be put onto the market for the patients to consider.
Another point to address is the fact that the human body is so incredibly complex that it took humans thousands of years to truly discover all of the current facts known in relation to its anatomy and physiology along with having some level of understanding of them. Not only that, there are still observations about the human body that are still unclear to scientists today and so the drugs for treating diabetes may or may not be effective depending on who is receiving the therapy because each person is genetically unique.
Conclusion
Referring to all of the arguments made, it is evident that diabetes is a huge burden for modern and future societies because of its links to obesity or sedentary lifestyle and consuming foods high in carbohydrates. Yet, this issue may be prevented by exploring future therapies, exploiting current ones and implementing non-clinical interventions such as increased regular exercise and reducing carbohydrate intake. Therefore, it is the responsibility of each patient and health organisation to manage diabetes before it becomes even worse.
Written by Sam Jarada
Related articles: Pre-diabetes / Diabetes drug to treat Parkinson's / The world vs the next pandemic
REFERENCES
Diabetes UK. Types of diabetes. Diabetes UK. 2022.
Paschou SA, Papadopoulou-Marketou N, Chrousos GP, Kanaka-Gantenbein C. On type 1 diabetes mellitus pathogenesis. Endocrine Connections. 2018 Jan;7(1):R38–46.
Cersosimo E, Triplitt C, Solis-Herrera C, Mandarino LJ, DeFronzo RA. Pathogenesis of Type 2 Diabetes Mellitus. Nih.gov. MDText.com, Inc.; 2018.
Algoblan A, Alalfi M, Khan M. Mechanism linking diabetes mellitus and obesity. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2014 Dec;7(587–591):587.
Barnes AS. The epidemic of obesity and diabetes: trends and treatments. Texas Heart Institute journal. 2011;38(2):142–4.
Hamilton MT, Hamilton DG, Zderic TW. Sedentary Behavior as a Mediator of Type 2 Diabetes. Medicine and Sport Science. 2014;60:11–26.
Li D, Yang Y, Gao Z, Zhao L, Yang X, Xu F, et al. Sedentary lifestyle and body composition in type 2 diabetes. Diabetology & Metabolic Syndrome. 2022 Jan 15;14(1).
Mayo Clinic. Diabetes treatment: Medications for type 2 diabetes. Mayo Clinic. 2018.
Bahar SG, Devulapally P. Pancreas Transplantation. PubMed. Treasure Island (FL): StatPearls Publishing; 2022.
Bailey CJ, Day C. The future of new drugs for diabetes management. Diabetes Research and Clinical Practice. 2019 Sep;155:107785.
Bailey CJ, Day C. Treatment of type 2 diabetes: future approaches. British Medical Bulletin. 2018 Jun 1;126(1):123–37.
