World Diabetes Day was first organized by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in 1991, reflecting the growing prevalence of diabetes worldwide. Today, there are more than 250 million people with diabetes worldwide, an increase of 7 million every year. In Hungary, 5-10% of the population (i.e. 600,000-700,000 people) are affected by diabetes.
The aim of World Diabetes Day is to raise awareness about the risks of diabetes and the importance of prevention.
Diabetes is a growing public health problem worldwide. There are two main types of the disease: type 1 diabetes and type 2 diabetes. Type 1 diabetes is autoimmune in origin and mostly occurs in younger age groups. Type 2 diabetes usually develops in adulthood or older and is related to lifestyle: sedentary lifestyle and unhealthy diet contribute to the onset of the disease. Diabetes is a disease of the metabolism of glucose and is characterized by elevated blood glucose levels. This condition is associated with a number of long-term health complications, such as cardiovascular disease, kidney failure, vision problems and neuropathy. As a consequence of diabetes, a limb is amputated every worldwide.
Main symptoms of diabetes
- increased thirst and dry mouth
- frequent urination
- tiredness, lethargy
- prolonged wound healing
- frequent skin infections
Screening for diabetes
Depending on the type of diabetes, it can take weeks to years for symptoms to develop. While symptoms of type 1 diabetes can appear within a few weeks or months, type 2 diabetes can take several years to develop symptoms. Screening for diabetes offers the opportunity to detect the disease when it is asymptomatic or with few symptoms and to reduce the chance of developing long-term complications and their severity by starting treatment early. Screening is recommended for those at increased risk.
Conditions associated with an increased risk of developing type 2 diabetes and prediabetes:
- Over 45 years of age
- Overweight, obesity
- High blood fat and cholesterol levels
- Family history of diabetes
- High blood pressure
- Existing cardiovascular disease
- Sedentary lifestyle
- Previous gestational diabetes
- Polycystic ovary syndrome
- Regular use of certain medicines (e.g. steroids, diuretics)
Oral glucose tolerance test (OGTT)
Among people at high risk, oral glucose tolerance test is recommended, which takes an average of 2.5 hours. During the test you should not eat, drink, smoke or walk, and you should wait in a relaxed state. The OGTT is preceded by a fasting blood glucose check, which requires finger-prick sampling. If the reading is above 7.0 mmol/L, the OGTT should not be performed (this value is related to the suspicion of diabetes).
- Normal fasting blood glucose is <6.1 mmol/L.
- Between 6.1 and 7.0 mmol/L is called impaired glucose metabolism or prediabetes.
- Fasting blood glucose levels above 7.0 mmol/l are considered to be an obvious form of diabetes.
If the finger-prick result is less than 7.0 mmol/L, venous blood sample is taken at 0 min (zero point).
Subsequently, 75 g of glucose (available from pharmacies) dissolved in 2 dl of water should be consumed within 5 minutes. This is followed by venous blood sampling after one and two hours for 3-point glucose and insulin measurements.
Diagnosis of diabetes
- If the fasting blood glucose level is higher than 7.0 mmol/L, a diagnosis of diabetes is considered, but this should be confirmed by a fasting blood glucose measurement at another time.
- During the OGTT, the values measured 2 hours after consumption of 75 g of glucose indicate the body’s glucose tolerance level. A diagnosis of diabetes can be made at a level above 11.1 mmol/L.
Further tests for diabetes
In addition to traditional blood glucose tests such as fasting blood glucose and OGTT, measuring hemoglobin A1c (HbA1c) can provide additional information about the average blood glucose levels in the body over the past 2-3 months. In case of persistently high blood glucose levels, glucose molecules bind to hemoglobin, which is a protein that carries oxygen in the blood. Therefore, an HbA1c test is one of the best ways to check that blood glucose levels have been properly controlled over the past few days.
As untreated diabetes can damage to the kidneys and liver, it is recommended to test for metabolic abnormalities and renal function by taking blood samples to check additional parameters (ions, creatinine, urea, microalbumin, liver enzymes). Abdominal ultrasound, ophthalmological and cardiac examinations are also recommended to confirm/exclude possible complications.
It is estimated that diabetes affects twice as many people in Hungary as are diagnosed (around 500,000 people do not even know they have diabetes), so screening is needed for early detection and prevention. Screening is not only recommended for people with high risk or with symptoms, but for all healthy people over the age of 40 every year.