Diabetes

Commons symptoms of diabetes include excessive thirst, sudden weight loss, frequent urination and lack of energy. These can be mild or absent in people with type 2 diabetes. Many people with type 2 diabetes are diagnosed late, sometimes several years after onset of the condition.

The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the condition. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

Several risk factors have been associated with type 2 diabetes and include:

• Family history of diabetes
• Overweight
• Unhealthy diet
• Physical inactivity
• Increasing age
• High blood pressure
• Ethnicity
• Impaired glucose tolerance (IGT)*
• History of gestational diabetes
• Poor nutrition during pregnancy

*Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

People with type 1 diabetes require daily insulin treatment, regular blood glucose monitoring and a healthy lifestyle to manage their condition effectively.

The cornerstone of type 2 diabetes management is a healthy lifestyle. This includes a healthy diet, regular physical activity, not smoking, and maintaining a healthy body weight. Over time, a healthy lifestyle may not be enough to keep blood glucose levels under control and people with type 2 diabetes may need to take oral medication. If treatment with a single medication is not sufficient, combination therapy options may be prescribed. When oral medication is not sufficient to control blood glucose levels, people with type 2 diabetes may require insulin injections.

No effective and safe intervention currently exists to prevent type 1 diabetes. Research indicates that a majority of cases of type 2 diabetes could be prevented through healthy diet and regular physical activity. A healthy diet includes reducing the amount of calories if you are overweight, replacing saturated fats with unsaturated fats, eating dietary fibre and avoiding tobacco use, excessive alcohol and added sugar.

People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. Diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation. In addition, people with diabetes also have a higher risk of developing infections and, for example, have been disproportionately impacted by the severe effects of COVID-19.

People with diabetes are two to three times more likely than people without the condition to develop a cardiovascular disease (CVD). Diabetes and CVD are associated with a wide range of cardiovascular conditions that collectively comprise the largest cause of death in people with diabetes.

Strategies to prevent cardiovascular disease in people living with diabetes must focus on both lifestyle management and risk factor interventions. Age, gender, ethnicity and socio-economic background play a role in the likelihood of developing type 2 diabetes and related heart disease. A healthy diet, regular physical activity and avoiding tobacco can help reduce the risk or minimise its impact. Critical changes in policy approaches are also urgently needed and must include equitable access to appropriate care and the opportunities and means to afford heart-healthy choices.

This Roadmap is a key reference document for anyone involved in the planning, organisation, implementation and monitoring & evaluation of approaches related to CVD prevention in people living with diabetes. It outlines a vision of an ideal pathway of care, potential roadblocks along this pathway, and proposed solutions, with examples from practice. Developed in partnership with the International Diabetes Federation (IDF), the Roadmap draws on the expertise of diabetes expert clinicians, researchers, implementation science experts and people with lived experience from around the world. It presents an integrated approach to patient care, involving the patient, healthcare system and health policy perspective.