Diabetes has reached epidemic proportions, yet many don’t know they suffer from it

What is diabetes?Diabetes is a disease that occurs when there is an inability to produce adequate amounts of insulin (a hormone produced by beta cells in the pancreas) to maintain blood glucose levels within normal limits, and it represents a major medical, social, and economic burden worldwide.The prevalence of diabetes has reached epidemic proportions globally, with 424.9mn affected adults aged 20-79, representing 8.8% of the global adult population.This figure is predicted to rise to 628.6mn by 2045, affecting almost 10% of the worldwide adult population. Type 2 diabetes accounts for 90 to 95% of diabetes cases, with type 1 diabetes accounting for about 5%. However, half of those with type 2 diabetes have not been diagnosed.In Qatar, 20% of the population is affected by diabetes (type 2 accounting for 90% of those) with a projected rise to 24% in the next two decades. Diabetes in Qatar affects all segments of society, from the young to the elderly, and places a significant social and economic burden on Qatari society.What is the difference between type 1 and type 2 diabetes, and are there other types?The reasons underlying the inability to produce adequate amounts of insulin depend upon the type of diabetes. Type 1 is essentially a total insulin deficiency due to the destruction of beta cells by the body’s immune system. Type 2 is a complex disease characterised by insulin resistance and insulin deficiency. The degrees of resistance and deficiency vary, but insulin deficiency is key to developing diabetes. Gestational diabetes is a form of diabetes that can develop during pregnancy as pregnancy is a state of increased insulin resistance and these women have a higher risk of developing type 2 diabetes later in life. There are also genetic defects of beta cell function and insulin action, such as Maturity Onset Diabetes of the Young (MODY). Some conditions, such as diseases of the exocrine pancreas, can cause secondary diabetes as can certain drugs, corticosteroids being a prime example.  What are the symptoms of diabetes?Those with type 1 diabetes may experience thirst, a frequent need to urinate, weight loss, fatigue, blurred vision, ketoacidosis (a life-threatening conditions where the body starts breaking down fat at a rapid rate), and infections.Type 2 diabetes can lead to thirst, frequent urination, and malaise, but symptoms are usually much milder and many individuals with type 2 diabetes do not know they have the disease until they are tested. In certain circumstances, it can be difficult to distinguish between type 1 and type 2 diabetes (see Table 1). Distinguishing the type of diabetes can be particularly difficult in younger patients who are treated with insulin, but clinically appear to have type 2 diabetes, and older patients with late onset of diabetes who require insulin and share characteristics of patients with type 1 diabetes where Latent Autoimmune Diabetes of Adulthood (LADA) should be considered. What role is Qatar Biomedical Research Institute (QBRI) playing in relation to diabetes research?The genetic risks for type 2 diabetes are likely to be different for Qataris compared to other Asians and Europeans. Therefore, identification of factors that are associated with the high prevalence of type 2 diabetes in the Qatari population is an important focus of ongoing research at the Diabetes Research Center (DRC) at Qatar Biomedical Research Institute (QBRI), part of Hamad Bin Khalifa University.Diabetic complications are costly, extremely difficult to manage, and lead to increased mortality rates. Diabetic patients are also at increased risk of neurological impairment and certain forms of cancer, so identifying biomarkers that predict the future development of diabetes and/or its related complications is imperative.Accordingly, biomarker discovery is a major focus of the ongoing research at the DRC. With the advent of stem cells, the concept of mimicking nature to generate new beta-cells to reverse diabetes has emerged, although more work needs to be done to allow for safe and effective therapy. In collaboration with the Harvard Stem Cell Institute, the Stem Cell group at DRC is working towards developing safe and effective stem cell-derived therapy to meet the needs of diabetic patients in Qatar.The underlying causes of insulin resistance are not addressed by any current therapy.The DRC is also investigating the mechanisms of insulin resistance to identify new targets for drug discovery. The mechanisms underlying the susceptibility of kidney, retina, peripheral nerve and arteries to damage in diabetes are yet to be proven, but the DRC has made advances towards understanding these. The centre is paving the way towards improved biomarkers and focused treatments, or precision medicine for diabetes, in order to tackle this globally devastating disease. Can we prevent or reverse diabetes if we follow a healthy lifestyle?In the Gulf region, the diabetes epidemic is largely fuelled by obesity and sedentary lifestyles. Type 1 diabetes is not reversible but type 2 is largely preventable and can be reversed in its earlier stages by adopting a healthy lifestyle, the mainstays of which include regular exercise, a healthy diet and maintaining a healthy weight. Anyone can suffer from diabetes and those with affected family members are at an increased risk. It is therefore a good idea to follow your doctor’s advice as to the frequency of testing for diabetes.