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Know the signs and symptoms of diabetes

Article in The Indian Journal of Medical Research · November 2014

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Indian J Med Res 140, November 2014, pp 579-581

Editorial

Know the signs and symptoms of diabetes

Diabetes mellitus is a serious metabolic disease, developing diabetes at a younger age when compared
affecting people of all geographic, ethnic or racial with the western populations5. Therefore, it is essential
origin and its prevalence is increasing globally1. that efforts are made to diagnose diabetes early so that
Burden from this costly disease is high on the low and the long term sufferings by the patients and the societal
middle income countries (LMIC) where the impacts of burden can be considerably mitigated.
modernization and urbanization have caused marked Risk factors for diabetes
adverse changes in lifestyle parameters.
Many studies have shown that awareness about the
In 2013, of the estimated 382 million people with diabetes and its complications is poor among the general
diabetes globally, more than 80 per cent lived in LMIC. population specially in the rural areas6,7. There is an
It was estimated that India had 65.1 million adults with urgent need to create awareness among the population
diabetes in 2013, and had the 2nd position among the regarding diabetes and about the serious consequences
top 10 countries with the largest number of diabetes. of this chronic disorder. Epidemiological data from
This number is predicted to increase to 109 million by India have shown the presence of a number of risk
2035 unless steps are taken to prevent new cases of factors which can be easily identified by simple non-
diabetes1. Primary prevention of diabetes is feasible invasive risk scores8,9. The major risk factors are listed
and strategies such as lifestyle modification are shown in Box 1.
to be effective in populations of varied ethnicity2,3. Signs and symptoms of diabetes
However, for implementation of the strategies at the
population level, national programmes which are The signs and symptoms of diabetes are disregarded
culturally and socially acceptable and practical have by many because of the chronic progression of the
to be formulated which are currently lacking in most
of the developed and developing countries. Early Box 1. Major risk factors for type 2 diabetes in Indians
diagnosis and institution of appropriate therapeutic 1. Positive family history of diabetes
measures yield the desired glycaemic outcomes and
2. Age >35 yr
prevent the vascular complications4.
3. Overweight (Body mass index ≥23 kg/m2 ) and obesity
Type 2 diabetes which accounts for 85-95 per cent (Body mass index ≥25 kg/m2 )
of all diabetes has a latent, asymptomatic period of 4. Enlarged waist or upper body adiposity (>90 cm for
sub-clinical stages which often remains undiagnosed men and >80 cm for women)
for several years1. As a result, in many patients the 5. Presence of hypertension
vascular complications are already present at the 6. Recent weight gain
time of diagnosis of diabetes, which is often detected 7. Sedentary lifestyle
by an opportunistic testing. Asian populations in
8. Gestational diabetes
general, particularly Asian Indians have a high risk of

This editorial is published on the occasion of World Diabetes Day – November 14, 2014

579
580 INDIAN J MED RES, November 2014

disease. People do not consider this as a serious problem fasting glucose (IFG) (fasting glucose >110 - <125
because unlike many other diseases the consequences mg/dl), impaired glucose tolerance (IGT) (2 h glucose
of hyperglycaemia are not manifested immediately. >140-<200 mg/dl) and presence of diabetes (fasting >
People are not aware that damage can start several 126 and 2 h glucose >200 mg/dl). If a random blood
years before symptoms become noticeable. This is glucose value is > 150 mg/dl, further confirmation
unfortunate because recognition of early symptoms by an OGTT is warranted. Recently, glycosylated
can help to get the disease under control immediately haemoglobin (HbA1c) has been recommended as the
and to prevent vascular complications. test for diagnosis of diabetes (>6.5%). Presence of pre-
Warning signs & classic symptoms of diabetes diabetes is indicated by HbA1c values between 5.7 - 6.4
per cent11.
Considering the asymptomatic nature of type
2 diabetes in the early stages, it is essential that the Screening for undiagnosed T2DM is recommended
people are educated on its warning signs (Box 2). at the first prenatal visit in women with above risk
factors, using standard diagnostic method criteria.
The classic symptoms of diabetes such as polyuria,
Screening for gestational diabetes (GDM) at 24-28 wk
polydypsia and polyphagia occur commonly in type
of gestation is recommended in women who do not
1 diabetes, which has a rapid development of severe
have previous history of diabetes, as GDM remains
hyperglycaemia and also in type 2 diabetes with very
asymptomatic11. A history of GDM carries a high risk
high levels of hyperglycaemia. Severe weight loss is
common only in type 1 diabetes or if type 2 diabetes for developing diabetes.
remains undetected for a long period. Unexplained Significance of identifying prediabetes
weight loss, fatigue and restlessness and body pain are
also common signs of undetected diabetes. Symptoms Even prediabetic stages such as IFG and IGT
that are mild or have gradual development could also carry high risk for vascular complications such as
remain unnoticed. cardiovascular diseases. The recent estimates by the
International Diabetes Federation (IDF)1 indicate that
Screening test for diabetes globally there are more than 316 million people (6.9%)
A person of Asian origin aged 35 yr or more with with IGT. Among them, more than 70 per cent live in
two or more of the above risk factors, should undergo LMIC1.
a screening test for diabetes. An oral glucose tolerance It is also important to note that currently one third of
test (OGTT) is commonly used as the screening test10. those who have IGT are in the productive age between
Fasting and 2 h post glucose tests can identify impaired 20-39 yr and, therefore, are likely to spend many years
at high risk of developing diabetes and/or complications
of diabetes1. Some persons with prediabetes experience
Box 2. Warning signs of diabetes reactive hypoglycaemia 2-3 hours after a meal. This
1. Unexplained weight loss is a sign of impaired insulin metabolism indicative of
2. Frequent fatigue
impending occurrence of diabetes. Therefore, periodic
3. Irritability
4. Repeated infections especially in the medical check-up in people with such signs or risk
• Genital areas factors for diabetes would reduce the hazards involved
• Urinary tract in having undiagnosed diabetes. It would help improve
• Skin the health status of a large number of people who
• Oral cavity otherwise would be silent sufferers from the metabolic
• Delayed wound healing aberrations associated with diabetes.
5. Dry mouth
6. Burning, pain, numbness on feet Conclusions
7. Itching
8. Reactive hypoglycaemia Awareness about the signs and symptoms and
9. Acanthoses nigricans-the presence of velvety dark periodic screening especially in the presence of risk
patches of the neck, arm pit, groin which is an indicator factors and warning signs of diabetes, would go a long
of insulin resistance
way in preventing new cases of diabetes by providing
10. Decreased vision
11. Impotence or erectile dysfunction an opportunity to intervene at the stage of prediabetes.
It is evident that diabetes can be prevented among
 Ramachandran: Know the signs & symptoms of diabetes 581

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