What is Diabetes

Present Situation

According to the Global Diabetes Report published by the World Health Organization in 2016¹, the number of people with diabetes worldwide increased from 108 million in 1980 to 422 million in 2014 (90% of which was type II diabetes), and the proportion of patients in the global population increased. Nearly doubled from 4.7% in 1980 to 8.5% in 2014. According to 2012 statistics, 15 million people died of diabetes, which increased the risk of other diseases because of high blood sugar, resulting in a death toll of 22 million. Diabetes may have different complications, including heart attack, stroke, kidney failure, leg amputation, vision loss, and nerve damage. The International Diabetes Federation's 2017 report predicts that by 2045, the number of people with diabetes worldwide may reach 629 million, of which about 50% are patients with rickets². Among China's total population of 1.357 billion in 2013, 10.9% (148 million people) have diabetes. At the same time, diabetes age is also younger in China. The prevalence of under 40 is 4.9%³, while 90% of the diabetes patients are type II, and the above data show that diabetes is one of the most threatening non-communicable diseases in the world.

(1) Roglic, G. (2016). WHO Global report on diabetes: A summary. International Journal of Noncommunicable Diseases, 1(1), 3
(2) International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium: International Diabetes Federation, 2017.
(3) Wang, L., Gao, P., Zhang, M. et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA. 2017

According to the Centre of Health Protection in Hong Kong, diabetes is a major chronic disease in Hong Kong and is a considerable cause of death. It ranks 10th among the most common fatal diseases in Hong Kong. In 2015, the total number of inpatients discharged and death with diabetes was approximately 13,700, while the number of registered deaths because of diabetes was 492, accounting for 1.1% of the total deaths. Diabetes-related deaths are mostly caused by various complications, so the number of people dying from diabetes is believed to be more than this number.

At present, 15% of patients diagnosed with diabetes in public hospitals, and the proportion of patients with other serious diseases having diabetes is also very high. Among them, 30% of patients with heart disease or stroke have diabetes, and 40% of patients receiving peritoneal dialysis have diabetes. According to death statistics, one out of every five diabetic patients died of cancer. Because the symptoms are easily overlooked, it is estimated that half of diabetes have not been diagnosed. There is a younger trend in the prevalence of diabetes in Hong Kong, 20% of patients were diagnosed before the age of 40.

What is Diabetes?

Diabetes is a metabolic disease characterized by a patient's blood sugar that is higher than the standard value for a long time ⁴.
Glucose, also known as blood sugar, is converted from food after eating, and then enter the blood. β cells in the pancreas secrete insulin (a protein hormone), which participates in regulating carbohydrate and fat metabolism, and balances the blood sugar level. It promotes the liver and skeletal muscle to convert glucose into glycogen. Insulin is like a key in your blood, which can open the "gateway" of your body's cells, allowing blood sugar to enter, where it can be stored or converted into energy. If the body's insulin secretion is imbalanced or the body's response to insulin is declined, this will cause blood sugar level to rise.

(4) About diabetes. World Health Organization. [4 April 2014]

Types of Diabetes

The World Health Organization divides diabetes into the following types: type I diabetes, type 2 diabetes, and gestational diabetes. Although the symptoms of each type of diabetes are similar or even the same, the causes of the disease and their distribution in populations are different.

Symptoms

Diabetic patients gave no obvious symptoms. The main clinical manifestations were polydipsia, polyuria, polyphagia, and weight loss. People excrete unwanted substances in the body by urinating. Because the urine of diabetes contains a large amount of glucose, the osmotic pressure of the urine is increased, and the recovery ability of the renal tubules is reduced, so the amount of urine is increased. When the amount of urine is increased, the water is also discharged in a large amount. Dehydration occurs, so patients often feel dry and want to drink water. At the same time, because a large amount of glucose cannot be fully utilized, and excreted from the urine, it is prone to hunger, so patients constantly want to eat. When the glucose metabolism is dysfunctional and the calories intake is insufficient, the glucose, protein, and fat originally stored in the body are consumed, so patients’ weight will gradually decrease. These are the reasons why people with diabetes generally have symptoms of polydipsia, polyuria, polyphagia and weight loss.

Diagnosis

Common methods for diagnosing diabetes include “Urine Glucose Test”, “Fasting Blood Glucose Test”, “Oral Glucose Tolerance Test”, and “Glycated Hemoglobin (HbA1c) Test”.

Treatment


Western medical research shows that diabetes is a lifelong disease that cannot be cured. The medical goal can only control hyperglycemia and related metabolic disorders through the long-term use of drugs, healthy lifestyles, and self-care to control or alleviate symptoms and to prevent the occurrence of metabolic complications.

Medication for type II diabetes is mainly taken to control the blood sugar level of patients from different aspects, including promoting the secretion of more insulin (such as Glibenclamide), facilitating insulin operation (such as Januvia), releasing more sugar when urinating (such as Invokana), and reducing the production of sugar from liver (such as Metformin). If the drug fails to effectively regulate the patient's blood sugar levels, insulin injection is required. Because of the pancreas of type I diabetes cannot produce insulin, insulin injection is the main treatment.

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