Diabetes is a disease that poses a serious threat to human health and has a significant impact on social development, mainly in the following aspects
I. High prevalence.
Diabetes is a worldwide epidemic disease, and its prevalence is increasing. According to WHO’s estimation, there are about 175 million people with diabetes worldwide, and it will reach 300 million by 2025. The prevalence of diabetes in China is also increasing dramatically, and in the past, diabetes was thought to be a disease of the middle-aged and elderly. In recent years, it has been found that diabetes, especially type 2 diabetes, is rapidly increasing in children and adolescents, both in the West and in China, as obesity increases in children and adolescents, making it a major health problem early in life.
The high incidence of complications of diabetes mellitus, resulting in tissue and organ destruction, is disabling and lethal, and poses serious risks.
(i) Acute complications.
Diabetic ketoacidosis is the most common acute complication of diabetes mellitus, which is common in type 1 diabetes mellitus and occurs in cases of poor metabolic control, concomitant infection, severe stress, interruption of insulin therapy and dietary disorders. type 2 diabetes mellitus can also occur in cases of poor metabolic control and severe stress. Delayed diagnosis or treatment can result in death. Mortality is higher in patients of young or advanced age, coma, or hypotension. The mortality rate is <5% in experienced medical centers in the United States, but can be as high as 10% in our primary care hospitals.
2. Diabetic non-ketotic hyperosmolar syndrome.
This syndrome is mostly seen in elderly patients. It causes coma, shock and multi-organ failure due to severe hyperglycemia and disturbance of water and electrolyte balance. The syndrome has a very high mortality rate, which can be as high as 15% even in high level hospitals.
3. Lactic acidosis.
The incidence of diabetes combined with lactic acidosis is not high, but the morbidity and mortality rate is very high. It mostly occurs in patients with hepatic and renal insufficiency, or with chronic cardiopulmonary insufficiency and other hypoxic diseases, especially those taking phenibut at the same time. It is mainly due to the large accumulation of lactic acid, a metabolite of anaerobic enzymes in the body, which leads to hyperlactatemia and further decrease in body fluid PH, resulting in lactic acidosis.
(ii) Chronic complications.
1. Vascular complications.
Cardiovascular disease is the main cause of disability and death in diabetic patients and causes economic losses. Since the 1980s, the incidence of coronary heart disease and death rate in the general population of western countries have been declining significantly due to the understanding of the causes and pathogenesis of coronary arteriosclerosis and the success of prevention and treatment trials. This is not the case in the diabetic population, where the prevalence of cardiovascular disease and mortality are increasing. The annual incidence of cardiovascular disease in the diabetic population is two to three times higher than in the non-diabetic population of the same age and sex. The Framingham Study of a 7-year primary prevention cohort of men aged 51-59 years and the Finnish Coronary Heart Disease Event and Mortality Study (1059 type 2 diabetic and 1373 non-diabetic cases) both showed that the incidence of cardiovascular events and mortality were significantly higher in diabetics than in non-diabetics. The National Cholesterol Education Program Adult Treatment Panel Report 3 (NCEP-ATP III) states that the risk of cardiovascular events within 10 years in diabetic patients without previous myocardial infarction is similar to that in nondiabetic patients with previous myocardial infarction, so diabetes is considered to be an equal risk for coronary heart disease.2 Type 2 diabetes is an independent risk factor for coronary heart disease.
Diabetic arterial endothelial cell dysfunction, arterial endothelial damage, followed by early onset of response to vascular injury and accelerated atherosclerosis are important causes of increased coronary events and death. Also diabetic cardiomyopathy, left ventricular diastolic dysfunction, predisposition to congestive heart failure and arrhythmias due to cardiac autonomic neuropathy are also important causes of increased cardiovascular mortality. The basis of vascular endothelial dysfunction and injury and atherosclerosis is diabetic insulin resistance and its associated risk factors, such as obesity, hypertension, hyperglycemia, small and dense LDL-C elevation, hypertriglyceridemia, low HDL-C, PAI-1 elevation, hyperhomocysteinemia (i.e., metabolic syndrome), and smoking. The metabolic syndrome, which is a multiple risk factor for cardiovascular disease, is present not only during diabetes but also in the pre-diabetes phase, such as impaired glucose tolerance. Therefore, when dealing with diabetes, and effective early intervention prevention and treatment to minimize the incidence of cardiovascular disease and mortality.
2, diabetic cerebrovascular disease.
Diabetic cerebrovascular disease is most common with ischemic encephalopathy due to cerebral atherosclerosis, such as transient ischemic attack (TIA), lacunar cerebral infarction, multiple cerebral infarction, cerebral thrombosis, etc. In diabetic vascular disease, cerebral thrombosis mostly occurs in the middle cerebral artery, while lacunar cerebral infarction is mostly seen in the blood supply area of deep penetrating branches in the brain, such as the nucleus accumbens, internal capsule, thalamus and the base of the pons. Because of the high incidence of hypertension in diabetes (20%-60%), hemorrhagic encephalopathy can also occur.
In 2002, cerebrovascular disease was the second leading cause of death in urban areas and the first in rural areas. The incidence of cerebrovascular disease is significantly higher in diabetics than in non-diabetics, especially in women, and the Framingham study found that the incidence of cerebral infarction was 2.5 times higher in men and 3.7 times higher in women aged 45-74 years with diabetes than in non-diabetics. Moreover, the incidence of ischemic stroke was higher in diabetics than in non-diabetics at all ages.
Risk factors for diabetic cerebrovascular disease include hyperglycemia, hypertension, dyslipidemia, abnormal blood rheology, smoking, and chronic inflammatory states. Of these, hypertension is particularly important and is an independent risk factor for diabetic ischemic encephalopathy. Blood pressure is uncontrolled in 77% of patients with ischemic stroke, making antihypertensive therapy important to reduce the incidence of stroke. This has been confirmed by UKPDS and other clinical trials of antihypertensive therapy such as HOPE, HOT and LIFE. Myocardial infarction in the elderly is also a risk factor for stroke. The risk of stroke after discharge was 2.5 times higher in 121,432 cases of acute myocardial infarction in hospitalized patients over 65 years of age than in those without myocardial infarction in foreign studies.
3. Diabetic eye disease.
Lesions can occur in all parts of the eye in diabetic patients, such as corneal abnormalities, iris neovascularization, and optic neuropathy. The prevalence of glaucoma and cataracts is higher in diabetic patients than in non-diabetic patients of the same age. Diabetic retinopathy is the main cause of blindness in diabetic patients, and the prevalence of retinopathy increases with age and duration of the disease in all types of diabetes. 99% of type 1 diabetes and 60% of type 2 diabetes have retinopathy of varying degrees of duration for more than 20 years. The risk of diabetic retinopathy increases after puberty.
4. Diabetic nephropathy.
Diabetic nephropathy occurs in about 20% to 30% of patients with type 1 or type 2 diabetes. Some of them progress to end-stage nephropathy. Without special intervention, about 80% of type 1 diabetics with persistent microalbuminuria develop clinical nephropathy within 10 to 15 years, at which time hypertension may develop. Once clinical nephropathy occurs, without effective intervention, the glomerular filtration rate gradually decreases within a few years, with 50% of patients developing end-stage renal disease after 10 years and more than 75% after 20 years.
After the diagnosis of diabetes mellitus in type 2 diabetic patients, many of them immediately develop microalbuminuria and even overt nephropathy, and without special intervention, 20% to 40% of them progress to clinical nephropathy, and about 20% progress to end-stage nephropathy after 20 years. Because of the large number of patients with type 2 diabetes, more than half of the kidney disease patients currently on dialysis in Western countries are diabetic.
The presence of microalbuminuria in type 2 or type 2 diabetic patients not only marks the presence of early kidney disease, but also greatly increases the prevalence of cardiovascular disease and the risk of death, and should therefore be given high priority.
5. Diabetic foot.
Diabetic foot is the result of the combined effect of diabetic lower limb vasculopathy, neuropathy and infection, which can lead to foot ulceration and even amputation in severe cases. The average number of amputations due to diabetes in the United States from 1989 to 1992 was 1605 cases per year, and foot ulcers are the main factor in amputations. Forty percent of foot and lower extremity amputations in adults are due to diabetes. A study in the United Kingdom followed 469 patients with diabetes who had no previous foot ulcers and found that 10.2% of patients developed foot ulcers over four consecutive years. The rate of amputation was 10.3 times higher in diabetic men and 13.8 times higher in women than in non-diabetic people of the same sex. There is a lack of epidemiological data on diabetic foot in China.
6, diabetic osteoarthropathy.
The incidence of diabetic osteoarthropathy is about 0.1% to 0.4%, mainly due to neuropathy, and infection can aggravate the damage. Although the incidence of this disease is not high, but can cause joint dislocation, deformity, seriously affect the function of the joint, so that the patient’s quality of life is reduced.
7, diabetes and oral diseases.
Diabetic patients’ organism’s anti-infection ability against bacteria is reduced, and the oral and maxillofacial tissues and the gingival and periodontal tissues in the oral cavity are prone to infection, which can cause pus overflowing from the alveoli, alveolar bone resorption and loose teeth. Infections occurring in the soft tissues of the maxillofacial region have a rapid onset and rapid expansion of inflammation, which can cause sudden deterioration of the general condition at the early stage of the disease and can cause death if not treated in time.
(iii) Associated diseases and infections.
1, hypoglycemia.
Diabetic obese people are often accompanied by postprandial hyperinsulinemia, so late postprandial hypoglycemic symptoms can occur, but the degree is light. The most common and more serious hypoglycemia is related to diabetes drug therapy overdose. Among them, insulin and sulfonylurea oral hypoglycemic drugs are the most common. The latter, in particular, is glibenclamide (euglycemia). Severe hypoglycemia is particularly dangerous in the elderly and children.
2. Metabolic syndrome.
Centripetal obesity, hypertension, dyslipidemia, cholelithiasis, hyperuricemia and polycystic ovary syndrome often occur in clusters with diabetes (i.e. metabolic syndrome), which increases the risk of diabetic cardiovascular disease.
3. Erectile dysfunction.
Very common, about half of type 2 diabetic patients have it, mainly due to diabetic autonomic neuropathy.
4, acute and chronic infections.
Diabetic patients with reduced cellular and humoral immune function are often prone to urinary tract and biliary tract infections, fungal or bacterial infections of the skin, as well as pneumonia and tuberculosis.