The Diabetes Control and Complications Trial (DCCT) was a clinical study conducted by the United States National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that was published in the New England Journal of Medicine in 1993. Test subjects all had diabetes mellitus type 1 and were randomized to a tight glycemic arm and a control arm with the standard of care at the time; people were followed for an average of seven years, and people in the treatment had dramatically lower rates of diabetic complications. It was as a landmark study at the time, and significantly changed the management of all forms of diabetes.[86][130][131]
What medication is available for diabetes? Diabetes causes blood sugar levels to rise. The body may stop producing insulin, the hormone that regulates blood sugar, and this results in type 1 diabetes. In people with type 2 diabetes, insulin is not working effectively. Learn about the range of treatments for each type and recent medical developments here. Read now
Patients with type 2 diabetes can still make insulin, but not enough to control their glucose levels. Type 2 diabetes is therefore initially treated with a combination of lifestyle changes (diet and exercise) which reduce the need for insulin and therefore lower glucose levels. If this is insufficient to achieve good glucose control, a range of tablets are available. These include metformin and pioglitazone, which, like diet and exercise, reduce insulin requirements; sulphonylureas (e.g. gliclazide), which stimulate insulin secretion; DPP4 inhibitors (e.g sitagliptin) and GLP-1 agonists (e.g. liraglutide), which stimulate insulin production and reduce appetite; and SGLT2 inhibitors (e.g. dapagliflozin), which lower blood sugar levels by causing sugar to pass out of the body in the urine. In many patients, particularly after several years of treatment, insulin production is so low or so insufficient compared with the patient's needs that patients with type 2 diabetes have to be treated with insulin injections, either alone or in combination with tablets.
Jump up ^ Farmer, AJ; Perera, R; Ward, A; Heneghan, C; Oke, J; Barnett, AH; Davidson, MB; Guerci, B; Coates, V; Schwedes, U; O'Malley, S (27 February 2012). "Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes". The BMJ. 344: e486. doi:10.1136/bmj.e486. PMID 22371867.

The good news is that behavior still seems to help shape whether someone with the genetic disposition actually develops type 2—and that changes in diet and exercise can sometimes be enough to ward off the disease. "People sometimes have the misconception that if we say something is genetic, then they can't do anything about preventing diabetes and its complications," says Hanis. But he notes that in a landmark study, lifestyle interventions prevented or delayed type 2 in nearly 60 percent of people at high risk. "If we focus on changing the environment, we can prevent diabetes," he says. "As we understand the genetics, we can prevent more of it."


Although there are dozens of known type 1 genes, about half of the risk attributable to heredity comes from a handful that coordinate a part of the immune system called HLA, which helps the body recognize nefarious foreign invaders, such as viruses, bacteria, and parasites. Type 1 diabetes is an autoimmune disease, in which the body's own immune system destroys the cells in the pancreas that produce insulin, so perhaps it is no surprise that immunity genes are involved. Other autoimmune diseases share the HLA gene link, which may be why people with type 1 are more likely to develop additional auto­immune disorders.
Type 1 Diabetes: About 5 to 10 percent of those with diabetes have type 1 diabetes. It's an autoimmune disease, meaning the body's own immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no insulin, and must take insulin everyday. Although the condition can appear at any age, typically it's diagnosed in children and young adults, which is why it was previously called juvenile diabetes.

People who are obese -- more than 20% over their ideal body weight for their height -- are at particularly high risk of developing type 2 diabetes and its related medical problems. Obese people have insulin resistance. With insulin resistance, the pancreas has to work overly hard to produce more insulin. But even then, there is not enough insulin to keep sugars normal.
There are a number of rare cases of diabetes that arise due to an abnormality in a single gene (known as monogenic forms of diabetes or "other specific types of diabetes").[10][13] These include maturity onset diabetes of the young (MODY), Donohue syndrome, and Rabson–Mendenhall syndrome, among others.[10] Maturity onset diabetes of the young constitute 1–5% of all cases of diabetes in young people.[38]
Having diabetes requires life-long treatment and follow-up by health professionals. Diabetes can be linked to damage of the eyes, kidneys and feet. It is also associated with increased risk of strokes, heart attacks and poor blood circulation to the legs. Medical care aims to minimise these risks by controlling diabetes, blood pressure and cholesterol and screening for possible complications caused by the diabetes. 
Another form of diabetes called gestational diabetes can develop during pregnancy and generally resolves after the baby is delivered. This diabetic condition develops during the second or third trimester of pregnancy in about 2% of pregnancies. In 2004, incidence of gestational diabetes were reported to have increased 35% in 10 years. Children of women with gestational diabetes are more likely to be born prematurely, have hypoglycemia, or have severe jaundice at birth. The condition usually is treated by diet, however, insulin injections may be required. These women who have diabetes during pregnancy are at higher risk for developing Type II diabetes within 5-10 years.
Diabetes mellitus has been recorded in all species but is most commonly seen in middle-aged to older, obese, female dogs. A familial predisposition has been suggested. It is possible to identify two types of diabetes, corresponding to the disease in humans, depending on the response to an intravenous glucose tolerance test. Type I is insulin-dependent and comparable to the juvenile onset form of the disease in children in which there is an absolute deficiency of insulin—there is a very low initial blood insulin level and a low response to the injected glucose. This form is seen in a number of dog breeds, particularly the Keeshond, Doberman pinscher, German shepherd dog, Poodle, Golden retriever and Labrador retriever.
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Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco.[2] Control of blood pressure and maintaining proper foot care are important for people with the disease.[2] Type 1 DM must be managed with insulin injections.[2] Type 2 DM may be treated with medications with or without insulin.[9] Insulin and some oral medications can cause low blood sugar.[13] Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM.[14] Gestational diabetes usually resolves after the birth of the baby.[15]

Does having type 2 diabetes affect life expectancy? While continued improvements in therapies and care for type 2 diabetes may be helping patients live longer, the unfortunate reality is that type 2 diabetes has been shown to decrease life expectancy by up to ten years, according to Diabetes UK. There is still much to be done to ensure that all patients have access to appropriate healthcare and treatments to live a happier and healthier life with type 2 diabetes.
The body’s immune system is responsible for fighting off foreign invaders, like harmful viruses and bacteria. In people with type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin.
Diabetes can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly) and Cushing's syndrome. In acromegaly, a pituitary gland tumor at the base of the brain causes excessive production of growth hormone, leading to hyperglycemia. In Cushing's syndrome, the adrenal glands produce an excess of cortisol, which promotes blood sugar elevation.
A metabolic disease in which carbohydrate use is reduced and that of lipid and protein enhanced; it is caused by an absolute or relative deficiency of insulin and is characterized, in more severe cases, by chronic hyperglycemia, glycosuria, water and electrolyte loss, ketoacidosis, and coma; long-term complications include neuropathy, retinopathy, nephropathy, generalized degenerative changes in large and small blood vessels, and increased susceptibility to infection.

Recently, battery-operated insulin pumps have been developed that can be programmed to mimic normal insulin secretion more closely. A person wearing an insulin pump still must monitor blood sugar several times a day and adjust the dosage, and not all diabetic patients are motivated or suited to such vigilance. It is hoped that in the future an implantable or external pump system may be perfected, containing a glucose sensor. In response to data from the sensor the pump will automatically deliver insulin according to changing levels of blood glucose.
George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology
The word diabetes (/ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtɪs/) comes from Latin diabētēs, which in turn comes from Ancient Greek διαβήτης (diabētēs), which literally means "a passer through; a siphon".[111] Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE) used that word, with the intended meaning "excessive discharge of urine", as the name for the disease.[112][113] Ultimately, the word comes from Greek διαβαίνειν (diabainein), meaning "to pass through,"[111] which is composed of δια- (dia-), meaning "through" and βαίνειν (bainein), meaning "to go".[112] The word "diabetes" is first recorded in English, in the form diabete, in a medical text written around 1425.
Polyuria is defined as an increase in the frequency of urination. When you have abnormally high levels of sugar in your blood, your kidneys draw in water from your tissues to dilute that sugar, so that your body can get rid of it through the urine. The cells are also pumping water into the bloodstream to help flush out sugar, and the kidneys are unable to reabsorb this fluid during filtering, which results in excess urination.
Diabetes was one of the first diseases described,[107] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine".[108] The Ebers papyrus includes a recommendation for a drink to be taken in such cases.[109] The first described cases are believed to be of type 1 diabetes.[108] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.[108][109]
Jump up ^ Attridge, Madeleine; Creamer, John; Ramsden, Michael; Cannings-John, Rebecca; Hawthorne, Kamila (2014-09-04). "Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus". Cochrane Database of Systematic Reviews (9): CD006424. doi:10.1002/14651858.CD006424.pub3. ISSN 1469-493X. PMID 25188210.
Constant advances are being made in development of new oral medications for persons with diabetes. In 2003, a drug called Metaglip combining glipizide and metformin was approved in a dingle tablet. Along with diet and exercise, the drug was used as initial therapy for Type 2 diabetes. Another drug approved by the U.S. Food and Drug Administration (FDA) combines metformin and rosiglitazone (Avandia), a medication that increases muscle cells' sensitivity to insulin. It is marketed under the name Avandamet. So many new drugs are under development that it is best to stay in touch with a physician for the latest information; physicians can find the best drug, diet and exercise program to fit an individual patient's need.
Blood travels throughout your body, and when too much glucose (sugar) is present, it disrupts the normal environment that the organ systems of your body function within. In turn, your body starts to exhibit signs that things are not working properly inside—those are the symptoms of diabetes people sometimes experience. If this problem—caused by a variety of factors—is left untreated, it can lead to a number of damaging complications such as heart attacks, strokes, blindness, kidney failure, and blood vessel disease that may require an amputation, nerve damage, and impotence in men.
Classic symptoms of DM are polyuria, polydipsia, and weight loss. In addition, patients with hyperglycemia often have blurred vision, increased food consumption (polyphagia), and generalized weakness. When a patient with type 1 DM loses metabolic control (such as during infections or periods of noncompliance with therapy), symptoms of diabetic ketoacidosis occur. These may include nausea, vomiting, dizziness on arising, intoxication, delirium, coma, or death. Chronic complications of hyperglycemia include retinopathy and blindness, peripheral and autonomic neuropathies, glomerulosclerosis of the kidneys (with proteinuria, nephrotic syndrome, or end-stage renal failure), coronary and peripheral vascular disease, and reduced resistance to infections. Patients with DM often also sustain infected ulcerations of the feet, which may result in osteomyelitis and the need for amputation.
Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.
Insulin is vital to patients with type 1 diabetes - they cannot live without a source of exogenous insulin. Without insulin, patients with type 1 diabetes develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and electrolytes in the urine. Lack of insulin also causes the inability to store fat and protein along with breakdown of existing fat and protein stores. This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis (DKA). Symptoms of diabetic ketoacidosis include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death may result.
The classic symptoms of diabetes such as polyuria, polydypsia and polyphagia occur commonly in type 1 diabetes, which has a rapid development of severe hyperglycaemia and also in type 2 diabetes with very high levels of hyperglycaemia. Severe weight loss is common only in type 1 diabetes or if type 2 diabetes remains undetected for a long period. Unexplained weight loss, fatigue and restlessness and body pain are also common signs of undetected diabetes. Symptoms that are mild or have gradual development could also remain unnoticed.

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin.
George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology
Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels.[76][77] The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher.[78] Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.[78] Specialized footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this remains equivocal, however.[79]
The more common form of diabetes, Type II, occurs in approximately 3-5% of Americans under 50 years of age, and increases to 10-15% in those over 50. More than 90% of the diabetics in the United States are Type II diabetics. Sometimes called age-onset or adult-onset diabetes, this form of diabetes occurs most often in people who are overweight and who do not exercise. It is also more common in people of Native American, Hispanic, and African-American descent. People who have migrated to Western cultures from East India, Japan, and Australian Aboriginal cultures also are more likely to develop Type II diabetes than those who remain in their original countries.
Don’t be alarmed: This is not diabetic retinopathy, where the blood vessels in the back of the eye are getting destroyed, says Dr. Cypess. In the early stages of diabetes, the eye lens is not focusing well because glucose builds up in the eye, which temporarily changes its shape. “You’re not going blind from diabetes,” Dr. Cypess says he assures patients. “In about six to eight weeks after your blood sugars are stabilized, you’re not going to feel it anymore; the eye will adjust.” Here are more surprising facts you never knew about diabetes.
When the blood glucose level rises above 160 to 180 mg/dL, glucose spills into the urine. When the level of glucose in the urine rises even higher, the kidneys excrete additional water to dilute the large amount of glucose. Because the kidneys produce excessive urine, people with diabetes urinate large volumes frequently (polyuria). The excessive urination creates abnormal thirst (polydipsia). Because excessive calories are lost in the urine, people may lose weight. To compensate, people often feel excessively hungry.
Your doctor will check your blood glucose levels, and if you are diagnosed with diabetes, your doctor will guide you on a plan to keep your blood sugar levels normal. If your diabetes is mild, your doctor will likely recommend a diet plan, exercise, and weight loss. Your doctor may prescribe medications that help reduce blood sugar levels. In some women, insulin may be necessary.
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