Understanding and managing diabetes

Diabetes is a chronic condition with an ever-increasing global prevalence, representing a major challenge for healthcare systems. Its diagnosis, management, and monitoring are constantly evolving thanks to scientific progress. This article explores five key questions to help deepen your knowledge and integrate recent advances into clinical practice.

The answers to these questions are drawn from scientific literature.

What are the pathophysiological differences between type 1 and type 2 diabetes?

Type 1 diabetes (T1D) is an autoimmune disease in which the immune system attacks the insulin-producing beta cells of the pancreas, resulting in a complete lack of insulin and requiring lifelong insulin therapy [1].

In contrast, type 2 diabetes (T2D) is characterized by insulin resistance and relative insulin deficiency, often associated with obesity and a sedentary lifestyle [1]. Additionally, beta-cell dysfunction in T2D leads to a significant loss of secretory capacity well before diagnosis [2], although beta-cell function can be reversible in some cases [2].

The underlying mechanisms differ: T1D is primarily related to genetic and environmental factors that trigger autoimmunity [3], whereas T2D is associated with obesity-induced systemic inflammation that contributes to insulin resistance [4].

Sources:

• Singh, R., Gholipourmalekabadi, M., & Shafikhani, S. H. (2024). Animal models for type 1 and type 2 diabetes: advantages and limitations. Frontiers in Endocrinology, 15.
• Wysham, C., & Shubrook, J. (2020). Beta-cell failure in type 2 diabetes: mechanisms, markers, and clinical implications. Postgraduate Medicine, 132, 676–686.
• Mittal, R., Camick, N., Lemos, J. R. N., & Hirani, K. (2024). Gene-environment interaction in the pathophysiology of type 1 diabetes. Frontiers in Endocrinology, 15.
• Pezhman, L., Tahrani, A., & Chimen, M. (2021). Dysregulation of Leukocyte Trafficking in Type 2 Diabetes: Mechanisms and Potential Therapeutic Avenues. Frontiers in Cell and Developmental Biology, 9.

What are the key biomarkers for diagnosing and monitoring diabetes?

The key biomarkers for diagnosing and monitoring diabetes include glycated hemoglobin (HbA1c), the primary indicator of glycemic control, which has shown a 0.063% reduction in patients benefiting from chronic care management (1).

Other markers of insulin resistance, such as HOMA-IR and QUICKI, have shown significant diagnostic value in distinguishing prediabetes from diabetes, with a positive correlation with HbA1c (2).

Urinary biomarkers like neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) are also used for early diagnosis of diabetic nephropathy (3).

Additionally, inflammatory biomarkers such as immunoglobulin-free light chains (FLC) are emerging as specific and sensitive indicators for diabetes (4).

Sources:

• Shao, Y. et al. (2023). The Impact of Reimbursement for Non–Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes. Medical Care, 61, 157–164.
• Cybulska, A. et al. (2023). Diagnostic markers of insulin resistance to discriminate between prediabetes and diabetes in menopausal women. European Review for Medical and Pharmacological Sciences, 27(6), 2453–2468.
• Quang, T. H. et al. (2020). Evaluation of Urinary Neutrophil Gelatinase Associated Lipocalin and Kidney Injury Molecule-1 as Diagnostic Markers for Early Nephropathy in Patients with Type 2 Diabetes Mellitus. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 2199–2207.
• Matsumori, A. (2022). Novel Biomarkers of Inflammation for the Management of Diabetes: Immunoglobulin-Free Light Chains. Biomedicines, 10.

What are the current therapeutic strategies for managing type 2 diabetes?

Current therapeutic strategies for managing type 2 diabetes include pancreatic β-cell regeneration by promoting their proliferation, inducing transdifferentiation of non-β cells, and stem cell reprogramming (1).

Diabetes care also focuses on improving patient autonomy through self-care management, where factors like health literacy and self-efficacy play a key role (2). Furthermore, the use of antioxidants has shown potential to improve glycemic control, including reductions in HbA1c and fasting blood glucose levels (3).

Lastly, personalized medicine is becoming increasingly relevant, tailoring treatments based on genetic profiles and individual patient characteristics (4).

Sources:

• Cui, D. et al. (2024). Pancreatic β-cell failure, clinical implications, and therapeutic strategies in type 2 diabetes. Chinese Medical Journal, 137, 791–805.
• Sabil, F. A. et al. (2019). Self-Care Management Support Factors in Type 2 Diabetes Mellitus: A Literature Review. Jurnal Keperawatan.
• Shrivastav, D. et al. (2023). Insights on antioxidant therapeutic strategies in type 2 diabetes mellitus: A narrative review of randomized control trials. World Journal of Diabetes, 14, 919–929.
• Sugandh, F. et al. (2023). Advances in the Management of Diabetes Mellitus: A Focus on Personalized Medicine. Cureus, 15.

What are the main risk factors for diabetes complications and how can they be prevented?

The main risk factors for diabetes complications include hyperglycemia, obesity, hypertension, dyslipidemia, and metabolic abnormalities linked to insulin resistance (1)(2). Complications can be acute, like diabetic ketoacidosis, or chronic, including retinopathy, nephropathy, neuropathy, and cardiovascular disease (3).

Preventing complications involves rigorous management of risk factors, including tight glycemic control, blood pressure (target <130/80 mm Hg), and LDL cholesterol levels (target <100 mg/dL) (4).

Lifestyle interventions such as improved nutrition and regular physical activity, along with pharmacological treatments like alpha-lipoic acid, are also recommended to reduce risks (5)(6). Finally, psychosocial support and diabetes education programs can enhance patient self-management (2).

Sources:

• Scheen, A. (2007). Diabetes: from clinical knowledge to a public health concern. Biologie Aujourd’hui, 201, 133–140.
• Park, P. et al. (2015). Improving Diabetes Management and Cardiovascular Risk Factors Through Peer-Led Self-management Support Groups in Western Kenya. Diabetes Care, 38, e110–e111.
• Forth, R. & Jude, E. (2011). Diabetes: complications, prevention and treatment. British Journal of Healthcare Management, 17, 30–35.
• Joseph, J. J. et al. (2022). Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes. Circulation, 145, e722–e759.
• Jeffrey, S. et al. (2021). The role of alpha-lipoic acid supplementation in the prevention of diabetes complications: A comprehensive review of clinical trials. Current Diabetes Reviews.
• Li, Y. et al. (2022). Emerging roles of Galectin-3 in diabetes and diabetes complications: A snapshot. Reviews in Endocrine & Metabolic Disorders, 23, 569–577.

What are the recent advances in diabetes research and their clinical impact?

Recent advances in diabetes research include a better understanding of the link between circadian rhythm and glucose metabolism, suggesting that circadian disruption could influence type 2 diabetes risk (1). Advanced microspheres are being developed for controlled drug delivery, showing promising potential for improving therapeutic efficacy and diabetes diagnosis (2).

Additionally, modern technological approaches for diabetic foot care, including remote monitoring sensors, are being explored to improve treatment adherence (3). Group visits for diabetic patients have also shown a reduction in HbA1c by -1.76% over 12 months, along with improved diabetes-related quality of life (4).

Lastly, adipose-derived stem cells cultured in 3D conditions exhibit enhanced properties, holding promise for more effective treatments (5).

Sources:

• Cheng, H. et al. (2024). Advancements in research on the association between the biological CLOCK and type 2 diabetes. Frontiers in Endocrinology, 15.
• Chauhan, P. et al. (2023). Recent Advancements of Microspheres for The Management of Diabetes. Research Journal of Pharmacy and Technology.
• Bus, S. et al. (2024). Offloading and adherence through technological advancements: Modern approaches for better foot care in diabetes. Diabetes/Metabolism Research Reviews, 40, e3769.
• Baig, A. A. et al. (2022). Impact of diabetes group visits on patient clinical and self-reported outcomes in community health centers. BMC Endocrine Disorders, 22.
• Shi, Y. et al. (2024). Advancements in culture technology of adipose-derived stromal/stem cells: implications for diabetes and its complications. Frontiers in Endocrinology, 15.

The importance of staying informed about diabetes

Diabetes remains a multifaceted condition that requires a personalized and patient-centered approach. Thanks to scientific advances and new therapeutic strategies, healthcare professionals now have increasingly effective tools to improve the management of this chronic disease.

Staying informed about the latest research and adapting clinical practices accordingly is essential to optimizing the quality of life for people living with diabetes.

This article was generated with Archie, the AI research assistant from PaperDoc. Thanks to reliable sources from scientific literature and the latest research, Archie provides accurate answers to all your medical questions.