Introduction

• Diabetes mellitus (DM): A metabolic condition characterised by elevated blood glucose.
• Types of DM:
  • Type 1 (T1DM): Absolute insulin deficiency due to autoimmune destruction of pancreatic beta cells.
  • Type 2 (T2DM): Insulin resistance with a functional insulin deficiency.

Aetiology

• T1DM:
  • Autoimmune destruction of beta cells.
  • Genetic factors: MHC and HLA polymorphisms.
• T2DM:
  • Insulin resistance linked to obesity and ageing.
  • Strong hereditary component and associated genes (e.g., TCF7L2).

Epidemiology

• Global Prevalence: Affects 1 in 11 adults (mostly T2DM).
• T1DM: Peaks in childhood; increasing incidence globally.
• T2DM: More common in older adults, but rising among younger populations due to lifestyle factors.

Pathophysiology

• Hyperglycaemia: Leads to osmotic diuresis and symptoms like polyuria and polydipsia.
• Insulin Resistance: Promoted by excess fatty acids and inflammation, leading to increased glucose levels.
• Chronic Hyperglycaemia: Causes damage to blood vessels and contributes to complications like retinopathy, nephropathy, and neuropathy.

Diagnosis and Evaluation

1. T1DM: Based on symptoms and elevated glucose; may include antibodies to glutamic acid decarboxylase.
2. T2DM: Fasting glucose and HbA1c testing.
3. ADA Criteria:
   • HbA1c ≥ 6.5%, Fasting plasma glucose ≥ 126 mg/dL, 2-hour plasma glucose ≥ 200 mg/dL.
4. Monitoring: Includes HbA1c, glucose testing, urine albumin, and lipid profile.

Treatment and Management

1. Goals:
   • Glucose: 90-130 mg/dL; HbA1c < 7%.
2. Patient Education:
   • Importance of diet, exercise (≥150 minutes weekly), and self-monitoring.
3. T1DM:
   • Insulin therapy (injections or pumps) is essential.
4. T2DM:
   • Initial management includes lifestyle changes, followed by pharmacologic therapies like:
     • Metformin (first-line), sulfonylureas, GLP-1 agonists, DPP-4 inhibitors, SGLT-2 inhibitors.
   • Bariatric surgery is considered for morbid obesity.
5. Complication Management:
   • Regular eye exams, foot care, and blood pressure control.
   • ACE inhibitors or ARBs to manage nephropathy.

Complications

1. Microvascular:
   • Retinopathy, nephropathy, neuropathy.
2. Macrovascular:
   • Increased risk of atherosclerosis and cardiovascular events.
3. Neuropathic:
   • Peripheral and autonomic neuropathy.
4. Diabetic Ketoacidosis (DKA):
   • Primarily in T1DM; requires urgent insulin and IV fluids.
5. Hyperosmolar Hyperglycaemic State (HHS):
   • Common in T2DM with severe dehydration.

Deterrence and Patient Education

1. Lifelong management through lifestyle changes.
2. Interprofessional approach: Involves physicians, pharmacists, dietitians, and diabetes educators.
3. Pharmacist’s Role:
   • Monitor therapy, prevent polypharmacy, educate on medication adherence.

References

• Vella, A., & Friedman, T. (2021). Type 1 and Type 2 Diabetes. In StatPearls. StatPearls Publishing.
• Sella, S., & Allen, K. (2023). Nutritional strategies in managing diabetes: A comprehensive review. Nutrients, 15(19), 4279.
• Atkinson, M. A., & Eisenbarth, G. S. (2017). Pathogenesis of type 1 diabetes: An immunologic perspective. Clinical and Experimental Immunology, 168(1), 35-46.
• Healthline. Difference Between Type 1 and Type 2 Diabetes.