World Diabetes Day (14th November)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
Regular blood sugar screening with routine and advanced IVD laboratory tests may not play vital role in the management of diabetes. In India, efficient management of diabetes and related complications are seriously affected by several socioeconomical factors(1, 2). The South Asian phenotype and genotype are distinct, as indicated by central obesity, making general persons in these thickly-populated countries (India, Pakistan, Bagladesh, etc), more prone to diabetes and related complications, even at normal BMI(1). Hence, better awareness and education for the preventive measures against high blood sugar are necessary for persons living in South Asia. Moreover, significantly increased air pollution in all the major cities of India and other countries increase the risk of type 2 diabetes (T2D)(3). Mismanaged diabetes leads to immunocompromised state and brittle diabetes making an individual vulnerable to infectious diseases, as seen in pandemic (e.g., COVID 19) and epidemic phases(6) . Recent various studies indicate that diabetes poses a high economic burden on individuals and households(4, 5) and direct the need to arrange awareness and interventional campaigns regarding diabetes and associated risk factors in order to minimise the burden of diabetes(9).
Note: The words brittle (labile) diabetes means “unstable” diabetes. A patient with brittle diabetes shows blood glucose levels often swing from very high blood glucose to very low blood glucose.
Q1. What is the worldwide prevalence of diabetes mellitus with respect to the various types diabetes?
ANS: The worldwide prevalence of diabetes mellitus is constantly on increase. The estimated global incidence of diabetes in adults was 537 million, with 90% of cases of T2D in 2021(1). Globally, India has the second-highest number of patients with diabetes at 77 million and the number is projected to increase to 134 million by 2045(3). India contributed to the highest number of diabetes-associated complication deaths in South Asia in 2019(1). About 2,50,000 patients of type 1 diabetes are present in India (2024). Around 95,600 children are suffering from type-1 diabetes below the age of 14 years in India with nearly 16,000 new cases diagnosed each year(2). Significantly increased number of obese children in India have shown also to develop T2D(10).
Q2. What are the socioeconomical factors that affect efficient management of Diabetes and related complications?
ANS: The socioeconomical factors that affect efficient management of Diabetes and related complications are: Poor awareness of diabetes and diabetic risk factors, life-style changes, large number of festival sweet-food habits and addictions, mismanaged obesity, reluctance to use preventive methods, increased sedentary life-styles, insufficient healthcare infrastructures, erroneous diagnosis on the type of diabetes, failure of choices on correct combinations of medications, laboratory tests related cost factors, and non-adherence to long-term medication(1).
Q3. What are the various types of Diabetes and related managements?
ANS: Diabetes mellitus can be classified as (1) Polygenic (involving two or more genes: Examples: Type 1 Diabetes mellitus (T1D) and Type 2 Diabetes mellitus (T2D) and (2) Monogenic (involving a single gene): Maturity-onset Diabetes mellitus (MODY). T1D diabetes is an autoimmune disease characterized by insulin deficiency and hyperglycemia. Appropriate insulin therapy is required to manage T1D. In the case of T2D, insulin may be present in sufficient quantity, however, due to insulin-resistance, body cell are unable to use glucose for energy requirements. Appropriate oral drug combinations are prescribed to manage T2D. There are many inherited maturity-onset type diabetic cases (MODY) present in India. In the case of MODY, insulin may be present in insufficient quantities. Appropriate oral drug combinations are prescribed to manage MODY(11, 12).
Q4. What are the routine Diabetic Profile Tests and associated clinical significance?
| ROUTINE DIABETIC PROFILE TESTS (11, 12) | CLINICAL SIGNIFICANCE |
| 1) Blood glucose fasting (F) and Post prandial (PP) | High values indicate Diabetes mellitus |
| 2) Urine glucose fasting (F) and Post prandial (PP) | Glucose present in urine indicate Diabetes mellitus |
| 3) Serum Urea and Creatinine | High values indicate adverse effects on Kidney functions |
| 4) Serum Cholesterol, LDL, HDL and Triglycerides | Abnormal values indicate adverse effects on Heart and blood vessels |
| 5) Blood glycosylated hemoglobin (HbA1C) | Values > 6.4 indicate poor blood glucose management in the past 3 months |
| 6) Urine Ketone bodies | Presence in urine Indicates metabolic acidosis |
| 7) Serum Bicarbonate | Low in blood indicates metabolic acidosis |
- High or low values means compared to respective “Normal ranges” (Reference ranges).
- Postprandial means 2 hrs after lunch.
- Adverse effects on heart and blood vessels means increase in the thickening of arteries that supply blood to the heart due to plaque deposits caused mainly by cholesterol deposits (atherosclerosis).
- Prolonged elevated blood glucose values (Test No 1 and 2) indicate adverse effects of hyperglycemia on brain, neuronal system, retina of eyes, kidneys, legs and arteries.
Q5. What is the impact of 5th generation IVD Diabetic profile markers on the diagnosis of specific type of diabetes?
ANS: The following are the 5th generation markers of diabetes detection and differentiation (11, 12):
- Pancreatic islet cell antibodies (ICA).
- Insulin antibodies (IAA).
- Blood insulin, fasting, pulses, and in response to glucose intake.
- C-peptide
- High sensitivity C-reactive protein.
Note:
Tests 1, 2, 3 and 4 are useful for the diagnosis of type of Diabetes mellitus and Test 5 is inflammation marker, to determine degree of percentage of inflammatory status in the body and risk of cardiovascular disease.
Q6. How does HbA1C test and latest IVD markers could impact Diabetic patient outcomes and overall healthcare costs?
ANS: A sustained reduction in HbA1c level among adult diabetic patients is associated with significant cost savings within 1 to 2 years of improvement(9).
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References
(1) WHO. Global report on diabetes. April 21 (2016). https://www.who. int/publications/i/item/9789241565257 (accessed June 15, 2018).
(2) Minke M A Eilander , Maartje de Wit, Joost Rotteveel , Frank J Snoek. Low Self-Confidence and Diabetes Mismanagement in Youth with Type 1 Diabetes Mediate the Relationship between Behavioral Problems and Elevated HbA1c. J Diabetes Res. (2015) Nov 23;2016:3159103. doi: 10.1155/2016/3159103.
(3).Balti EV, Echouffo-Tcheugui JB, Yako YY, Kengne AP. Air pollution and risk of type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Res Clin Pract 2014; 106: 161–72.
(4). Sumit Oberoi , Pooja Kansra. Economic menace of diabetes in India: a systematic review. Int J Diabetes Dev Ctries. 2020 Jun 17;40(4):464–475. doi: 10.1007/s13410-020-00838-z
(5). L C Rosella M, Lebenbaum, T Fitzpatrick , D O’Reilly, J Wang, G L Booth, T A Stukel, W P. Impact of diabetes on healthcare costs in a population‐based cohort: a cost analysis. Diabet Med. 2015 Aug 19;33(3):395–403.doi: 10.1111/dme.12858
(6). Alexander A Huang, Samuel Y Huang. Diabetes is associated with increased risk of death in COVID‐19 hospitalizations in Mexico 2020: A retrospective cohort study. Health Sci Rep. 2023 Jul 5;6(7):e1416. doi: 10.1002/hsr2.1416 .
(7) American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009; 32 (suppl 1): S62–67.
(8). Tattersall, R. B. & Fajans, S. S. A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people. Diabetes 24, 44–53 (1975).
(9). Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients. 2019;11: 766. pmid:30939855
(10) Uchechukwu S Oranika, Oluwakemi L Adeola, Thelma O Egbuchua, Okelue E Okobi, Daad G Alrowaili , Ayokunle Kajero, Oluwagbemiga M Koleowo, Emeka Okobi, Ademiluyi B David, Jennifer C Ezeamii. The Role of Childhood Obesity in Early-Onset Type 2 Diabetes Mellitus: A Scoping Review. Cureus. 2023 Oct 31;15(10):e48037. doi: 10.7759/cureus.48037
(11) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
(12) Godkar PB, Godkar DP. Medical Biochemistry, Theory and Practicals (1st edition, 2024), CBS Publishers, New Delhi, India.
