2 Reasons Why Diabetes Treatment is Challenging

Diabetes poses a significant global threat, affecting millions of people worldwide. According to the International Diabetes Federation (IDF), approximately 537 million individuals, or 1 in 10 people, currently suffer from diabetes in 2021. Shockingly, this condition leads to 6.7 million deaths each year, resulting in a life lost every 5 seconds.

As a clinical pharmacist, I have noticed that many patients with diabetes or prediabetes fail to give this condition the attention it deserves. It is disheartening to witness individuals suffer vision loss or kidney damage due to diabetes-related complications. In this article, I aim to shed light on the reasons why diabetes treatment can be challenging, with the hope of motivating more patients to take their condition seriously and pursue better management.

1. Blood sugar levels begin to rise long before diabetes is diagnosed.

A comprehensive Swedish study involving over 290,000 individuals sought to assess their risk of developing type 2 diabetes over a 20-year period. The results revealed that those who eventually developed diabetes experienced a gradual increase in blood sugar levels, lipid profiles, inflammatory markers, and BMI. This suggests that these health indicators were deteriorating as early as 20 years before the onset of diabetes.

2. 80% of pancreatic beta cells have already lost their function at the time of diabetes diagnosis.

Extensive studies, such as SAM and VAGES, conducted on individuals with type 2 diabetes, impaired fasting glucose, and normal blood sugar levels, have demonstrated that pancreatic beta cells lose around 65% of their function during impaired fasting glucose. By the time of diabetes diagnosis, these cells have already suffered damage exceeding 80%.

A notable UK study (UKPDS 16) on diabetes patients revealed that initially, medications like metformin and sulfonylureas, as well as dietary adjustments, improved pancreatic beta cell function in the first year, but over the subsequent five years, the function worsened.

Taken together, these studies indicate that diabetes does not suddenly manifest but evolves gradually over time. By the time of diagnosis, considerable organ and vascular damage is often present.

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