Diabetes Mellitus: Types, Diagnosis, and Current Treatment
Diabetes mellitus (DM) is a group of metabolic diseases characterized by chronic hyperglycemia (elevated blood glucose levels). It is caused by impaired insulin secretion, insulin action, or both.
According to the International Diabetes Federation, more than 537 million people worldwide live with diabetes; In Russia, over 5 million have been diagnosed, but taking into account undiagnosed cases, the actual number is significantly higher.
Diabetes is not only a "sugar" disease: chronic hyperglycemia gradually damages blood vessels, nerves, kidneys, eyes, and heart. Cardiovascular complications remain the leading cause of death in type 2 diabetes.
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Types of Diabetes Mellitus
| Type | Mechanism | Who gets it? | Characteristics |
|---|---|---|---|
| Type 1 Diabetes | Autoimmune destruction of β-cells → absolute insulin deficiency | More common in children and young adults | Insulin-dependent from day one |
| Type 2 Diabetes | Insulin Resistance + Relative Insulin Deficiency | Adults (more common after age 40), but increasingly common in young people with obesity | The primary form (>90% of all cases of diabetes) |
| Gestational Diabetes | Insulin Resistance during Pregnancy | Pregnant Women | Normalizes after childbirth, but increases the risk of type 2 diabetes |
| Type 3c Diabetes (Pancreatogenic) | Exocrine Pancreatic Diseases (Chronic Pancreatitis, Cancer, Resection) | Patients with pancreatic pathology | Underestimated type; requires specific management |
| Monogenic forms (MODY) | Mutations of individual genes | Young patients, often with a family history | Often mistaken for type 1 or type 2 diabetes |
Diagnosis
The diagnosis of diabetes mellitus is established based on the following criteria (one is sufficient; in the absence of symptoms, two confirmations are required):
| Indicator | Normal | Prediabetes | Diabetes mellitus |
|---|---|---|---|
| Fasting plasma glucose | < 6.1 mmol/L | 6.1–6.9 mmol/L (IGN) | ≥ 7.0 mmol/L |
| Glucose 2 hours after OGTT | < 7.8 mmol/L | 7.8–11.0 mmol/L (IGT) | ≥ 11.1 mmol/L |
| HbA1c | < 6.0% | 6.0–6.4% | ≥ 6.5% |
| Random glucose (+ symptoms) | — | — | ≥ 11.1 mmol/L |
IFG — impaired fasting glucose; IGT — impaired glucose tolerance
Type 2 diabetes treatment: a modern approach
Treatment goals are individualized
The target HbA1c is determined individually depending on age, the presence of complications, concomitant diseases and the risk of hypoglycemia:
- 7.0% is the general target for most adults
- 6.5% — at a young age, with a short duration of diabetes, without complications
- <8,0% — in the elderly, severe complications, high risk of hypoglycemia
Non-medicinal basis
- Reduction of body weight by ≥5% in obesity: significantly improves glycemic control
- Diet: restriction of fast carbohydrates, refined sugar; Mediterranean type of diet
- Physical activity: ≥150 min/week of moderate intensity
Frequently Asked Questions (FAQ)
Can type 2 diabetes be cured?
With early-stage type 2 diabetes, significant weight loss (bariatric surgery or intensive lifestyle changes) can lead to long-term remission with normal glucose levels in some patients without medication. This isn't a "cure" in the true sense, but it is a possible goal.
Is Semaglutide the same as Ozempic?
Yes. Ozempic is the trade name for the subcutaneous form of semaglutide. Vegovi is the same molecule, but in a dosage for the treatment of obesity. Ribersus is the oral form.
How do insulins differ?
Insulins vary in duration of action: ultra-short (act for 3-4 hours - on food), long/basal (12-24 hours or more - background). In type 1 diabetes, both are needed; with type 2 diabetes, they often start with one basal.
Does high blood sugar in the morning mean that I “sleep poorly and eat a lot”?
No. Morning hyperglycemia may be a manifestation of the "dawn phenomenon" (a physiological increase in counter-regulatory hormones) or the Somogyi effect (rebound hyperglycemia after nocturnal hypoglycemia). Each case requires analysis and correction by a doctor.
Should I start treatment if I have prediabetes?
For prediabetes, lifestyle changes and weight loss are the primary treatments—these reliably prevent or delay the development of type 2 diabetes. The use of preventive medication (metformin) is decided on an individual basis.
Is the CMG sensor dangerous for MRI?
Most CGM systems must be removed or deactivated before an MRI. Check with your device manufacturer and notify your radiologist.
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Symptoms: When to get tested
Classic symptoms of hyperglycemia (characteristic primarily in type 1 diabetes and decompensated type 2 diabetes):
In type 2 diabetes, symptoms are often absent or subtle. The disease is often discovered incidentally during laboratory testing or at the stage of complications. Therefore, regular screening is important for people at risk.
Risk factors for type 2 diabetes: