Risk factors and complications

RISK FACTORS AND COMPLICATIONS OF DIABETES

The totality of risk factors associated with type 1 diabetes is still under research, but having a family member with type 1 diabetes predictably increases the risk of the disease. Environmental factors or exposure to certain viral infections are also linked to the risk of type 1 diabetes.

Regarding type 2 diabetes in children and adolescents, the most important risk factors include obesity combined with genetic predisposition and/or a family history of the disease, low birth weight (< 2500 g) or macrosomia from a diabetic mother (> 4000 g), early menarche in girls (pubic hair appearance before the age of 8). Additionally, an increase in metabolic and hypertension diseases has been reported in male children with low birth weight, indicating and supporting the theory of predisposition to diabetes even in intrauterine life. Furthermore, through systematic exposure to bacterial lipopolysaccharides, the intestinal microbiome plays a crucial role in influencing chronic inflammation and thus, the onset of type 2 diabetes and obesity.

In other words, risk factors associated with Type 2 Diabetes include: family history of diabetes, increased body weight, unhealthy diet, physical inactivity, aging, high blood pressure, ethnicity (Africans, Asians, Native Americans, Hispanics are more predisposed), impaired glucose tolerance (a category of blood glucose higher than normal but below the diagnostic point for diabetes), a history of gestational diabetes or unhealthy nutrition during pregnancy.

Among these determining factors in the onset of type 2 diabetes, one deserves special attention, namely, unhealthy diet, as a consequence of the lifestyle associated with large urban populations. Broadly, an unhealthy diet involves sustained consumption of unhealthy, processed foods, against the backdrop of an eminently inactive lifestyle characterized by long periods of sedentary behavior.

Worth mentioning in this context are randomized controlled trials from different parts of the world, such as Finland, the USA, China, or India, which have shown that lifestyle modification with physical activity and/or a healthy diet can delay or prevent type 2 diabetes. With this in mind, numerous interventions, awareness campaigns, education, and social marketing have been successfully implemented at the community level. Predictably, the emphasis is particularly on movement, regular physical activity, but also on a healthy diet. One thing becomes certain following these conclusions, namely that a healthy outlook on life, theorized and materialized on the basis of evidence-based arguments, plays a fundamental role in preventing type 2 diabetes and its complications. Furthermore, prevention starts as early as the child’s life when dietary habits and the rhythm of physical activity are established. These parameters invariably regulate metabolism and long-term energy balance, and by adopting a healthy lifestyle as early as possible, we have the most important weapon against obesity, diabetes, and disease in general.

In light of these, it would be advisable to also review the complications of diabetes, which systematically demonstrate the severity of the diagnosis. These can be acute (hypoglycemia, hyperglycemia, diabetic ketoacidosis) but also chronic (nutritional complications, Nobécourt syndrome, Mauriac syndrome). Regarding metabolic complications, we mention dyslipidemias, and in the case of degenerative vascular diseases, we point out not only diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, atherosclerosis, and cardiopathy but also lipodystrophy, hypertrophy at the injection site, and limited joint mobility (cheiroarthropathy). Among the associated autoimmune diseases, the most common are hypo-hyperthyroidism, Addison’s disease, celiac disease, and lipoid necrobiosis.

Cardiovascular disease (CVD) analysis deserves special attention in the context of diabetes complications. Through high blood pressure, hypercholesterolemia, and associated hyperglycemia, diabetes inexorably affects the heart and blood vessels. It represents, therefore, the main cause of potentially fatal coronary heart disease (acute myocardial infarction – AMI) or stroke. At the same time, kidney disease (diabetic nephropathy), caused by diabetes through the impairment of small blood vessels in the kidneys, leads to a decrease in the efficiency of kidney function and thus, renal failure. Statistically, nephropathy is more commonly found in people with diabetes than in those without diabetes, and maintaining blood sugar and blood pressure close to normal levels can significantly reduce the risk of disease at this level.

On the other hand, regarding peripheral nerve disease (diabetic neuropathy), it has been shown that diabetes can cause damage to nerves in the body. Through high blood sugar and blood pressure, diabetes leads to problems with digestion, erectile dysfunction, and many other dysfunctions, among which the most common are those affecting the extremities, especially the lower limbs (diabetic foot). The impairment of nerves in these areas is called peripheral neuropathy and can cause pain, tingling, numbness, and a lack of sensitivity. What is truly regrettable is that the loss of sensitivity in these areas allows for unnoticed injurious effects, creating conditions for severe infections, ulcers, or possible amputations. Indeed, diabetics have a 25 times higher risk of amputation than non-diabetics, but with a healthy multidisciplinary management, these can largely be prevented.

In the case of ocular disease or diabetic retinopathy, which occurs as a result of prolonged damage to small blood vessels in the retina and manifests itself by reducing vision or even blindness (total blindness) in the late stages of the disease, diabetes remains responsible for a large number of affected patients. Very high levels of blood sugar, blood pressure, and cholesterol are again common denominators, representing the main determinants in the clinical picture of retinopathy. However, regular eye health examinations and maintaining blood sugar and lipid levels as close to normal as possible can prevent or at least efficiently manage retinopathy.

On another note, we cannot move forward in the analysis of diabetes complications without mentioning those that occur during pregnancy. Women with any type of diabetes are at risk for certain complications during pregnancy if they do not carefully monitor their blood sugar, or more importantly, do not manage their overall health. To prevent possible organ damage to the fetus, women with type 1 or type 2 diabetes must maintain target levels of blood glucose, even long before conception. Especially, all women with diabetes during pregnancy, whether it is type 1, 2, or gestational, must adopt a healthy lifestyle and diet in such a way as to achieve not only normal blood sugar but also minimize diabetes-related complications. Hyperglycemia during pregnancy can cause excessive weight gain in the child, and this excess can lead to expulsion problems, traumas for both mother and child, and sudden hypoglycemia in the baby after birth. Children exposed in utero to hyperglycemia have a considerably higher risk of diabetes in the future.