World Diabetes Day 

November 14th is World Diabetes Day, a day to raise awareness and promote diabetes education worldwide. Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin (the hormone that regulates blood sugar) or when the body cannot effectively use the insulin it produces[1]. 

Uncontrolled diabetes leads to dangerously high blood sugar levels that can cause serious complications like heart disease, stroke, kidney failure, blindness, and amputations of extremities[3]. 

The theme for World Diabetes Day 2023 is “Empowering Global Health” with a focus on improving affordable and equitable access to diabetes education, medication, technology, and care. 

What is Diabetes? 

Diabetes is a complex life-long metabolic disorder that prevents the body from properly regulating blood glucose (sugar) levels[2]. There are three main types of diabetes: 

Type 1 Diabetes 

Type 1 diabetes (previously called juvenile diabetes or insulin-dependent diabetes) is an autoimmune disease where the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. 

This means the body no longer produces any insulin. It usually develops in childhood or adolescence but can appear in adults too. People with type 1 diabetes require daily insulin injections or the use of an insulin pump to survive. About 10% of people with diabetes have type 1[4]. 

Type 2 Diabetes 

Type 2 diabetes (previously called adult-onset or non-insulin dependent diabetes) is the most common type, affecting about 90% of people with diabetes globally. It develops when the body becomes resistant to insulin and/or doesn’t make enough insulin. 

It most often appears in adults, but rates among youth are rising. Many people with type 2 diabetes require insulin and/or oral medications to manage blood sugars. Diet, exercise, and weight control play an important role[5]. 

Gestational Diabetes

Gestational diabetes occurs in 2–10% of pregnancies when hormonal changes in the mother block the action of insulin. It usually resolves after childbirth but increases the risk that both mother and baby develop type 2 diabetes later[7]. 

Controlling blood sugar levels during pregnancy reduces complications. Some women need to take insulin while pregnant. 

Diabetes is Rising Worldwide 

The International Diabetes Federation estimates 537 million adults (age 20-79) are currently living with diabetes – that’s 1 in 10 adults worldwide. This number is projected to rise to 643 million by 2030 and 783 million by 2045 globally as rates continue climbing around the world. 

Here are some key facts about the global diabetes epidemic from IDF[6]: 

• Over half (53%) of people living with diabetes are undiagnosed. 
• The proportion of people with type 2 diabetes is increasing in most countries. 
• 1 in 2 people living with diabetes (237 million people) are of working age (20-65 years). 
• Diabetes caused 6.7 million deaths in 2021 and at least $966 billion in health expenditure estimated to surpass $1054 billion by 2045. 
• Urbanization, unhealthy diets, reduced physical activity, and higher life expectancy are fueling type 2 diabetes. 
• Low- and middle-income countries are the most impacted. 

This massive and growing health burden poses challenges for healthcare systems and societies. Early diagnosis, access to affordable medications and supplies, and proper self-care and education are essential. 

Symptoms and Complications 

The most common diabetes symptoms include[8]: 

• Frequent urination 
• Increased thirst and appetite 
• Unexplained weight loss 
• Fatigue 
• Blurred vision 
• Slow healing cuts/sores 
• Tingling or numbness in hands/feet 

But many people show no signs at all for many years, allowing high blood sugar to silently damage organs. That’s why screening is recommended, especially if risk factors like obesity or family history are present.

If left untreated or uncontrolled, diabetes can lead to disabling and life-threatening health complications including: 

• Heart and blood vessel disease: 2-3x higher risk of heart attacks, strokes, and blockages in arteries of legs 
• Nerve damage (neuropathy): Pain, numbness and tingling in hands and feet 
• Kidney disease (nephropathy): Leading cause of kidney failure requiring dialysis or transplant 
• Eye damage (retinopathy): Leading cause of blindness in adults 
• Foot damage: Ulcers, infections, and neuropathy can lead to amputations 
• Skin conditions 
• Hearing impairment 
• Alzheimer’s disease: Increased risk 
• Depression: 2-3x increased risk 

But research shows many complications can be prevented or delayed with early diagnosis, optimal blood sugar management, medications, and lifestyle changes.

Diabetes is the silent killer which affect vital organs of the body and blood vessels

Diagnosis and Monitoring 

Diabetes is diagnosed by testing blood sugar levels[9]: 

• A1C test: Reflects average blood glucose over 2-3 months. 6.5% or higher indicates diabetes. 
• Fasting plasma glucose: 126 mg/dL or higher after no food for 8 hours indicates diabetes. 
• Oral glucose tolerance test: 200 mg/dL or higher 2 hours after drinking sugary solution confirms diabetes. 
• Repeat testing on different days is needed for diagnosis. 

At-home blood sugar monitoring is key for people with diabetes to assess their response to medications and meals. A finger stick glucometer is used to test glucose levels. 

For people using insulin, regular blood sugar checks are vital. Continuous glucose monitors (CGM) help track levels 24/hours a day. 

Regular A1C tests (every 3-6 months) provide important feedback on overall blood sugar control. Lower A1C goals are set for adults (less than 7%) and for youth (less than 6.5%). 

Diabetes Management and Treatment 

Diabetes is a complex disease requiring comprehensive self-management education and support by a healthcare team to prevent complications. Key components of diabetes care include[10]:

• Healthy eating: Individualized nutrition plan, carb counting, portion control. 
• Physical activity: 150 minutes/week minimum, resistance exercise. 
• Medications: Insulin, metformin, and other drugs to lower blood sugar. 
• Glucose monitoring: Using finger sticks and/or continuous glucose monitor (CGM). 
• Preventing low blood sugar: Carrying quick-acting glucose tabs or snacks. 
• Healthy coping: Managing stress and psychological health. 
• Medical care: Regular physician and eye exams to prevent complications. 
• Foot care: Daily inspection and hygiene to prevent infections and ulcers. 
• Avoiding smoking and limiting alcohol intake. 

For type 1 diabetes, insulin delivery via injections or an insulin pump is required for survival along with careful meal planning and blood sugar testing. New technologies like closed-loop pump systems, pancreas transplants, and artificial pancreas research offer hope. 

Lifestyle changes like healthy eating, physical activity, and weight loss are foundational for type 2 diabetes management. 

If blood sugars are not controlled with lifestyle alone, various oral and injectable medications like metformin, SGLT2 inhibitors, GLP-1 agonists, and insulin are prescribed. Bariatric surgery can be considered for some. 

Healthy Living with Diabetes 

Making positive daily choices empowers people with diabetes to thrive: 

• Choose nutrient-dense, high-fiber foods like vegetables, fruits, whole grains, beans, lentils, nuts, and healthy fats. Avoid added sugars. 
• Get regular physical activity (150 min/week) like walking, swimming, and strength training. 
• Take medications and/or insulin as prescribed. 
• Check blood sugars and record results. 
• Inspect your feet and keep your skin moisturized to prevent wounds. 
• Learn techniques to manage stress like meditation, yoga, or talking to friends. 
• Get enough sleep and rest to help control blood sugars. 
• Join a diabetes support group to connect with others. 
• Reduce risks like avoiding tobacco and limiting alcohol. 
• Make regular appointments with your healthcare team. 

No matter what type of diabetes you have, the most important thing is maintaining your health and preventing complications through education and self-care. 

Improving Diabetes Care Worldwide

Despite advancements, many barriers to optimal diabetes prevention, diagnosis, and care persist globally: 

• Limited healthcare access: In low- and middle-income countries especially, access to medications, supplies, equipment, and care is constrained by high costs and limited resources. 
• Lack of awareness and education: Myths and misinformation exist. Many lack an understanding of diabetes risks, prevention, and self-care. 
• Affordability of care: Many struggle to pay for doctor visits, medications, test strips, and insulin. Globally, only around 50% of people with type 2 and less than 30% with type 1 have access to insulin. 
• Diagnosis gaps: Lack of universal screening means many millions are undiagnosed. 
• Psychological barriers: Stress, denial, depression, diabetes burnout, and stigma hamper self-care. 
• Disparities: Lower-income, marginalized groups and rural communities are disproportionately impacted by diabetes and complications. 

To address these gaps, the World Health Organization/IDF Global Monitoring Framework outlines targets for improving diabetes care globally by 2030 including: 

• 80% of people with diabetes diagnosed and treated 
• 90% receiving affordable medications and supplies 
• 60% achieving glucose targets 
• 0% experiencing catastrophic healthcare costs 
• 30% reduction in diabetes-related mortality 

Achieving these goals requires major commitments from governments, healthcare systems, and society to invest in diabetes prevention, diagnosis, education, affordable treatment, and universal health coverage. 

Raising Awareness on World Diabetes Day 

World Diabetes Day was created in 1991 by the International Diabetes Federation (IDF) and the World Health Organization in response to the escalating health threat posed by diabetes globally. 

It became an official UN Day in 2006 with the passage of the UN Resolution on Diabetes. It is held every year on November 14, the birthday of Sir Frederick Banting, who co-discovered insulin in 1921. 

Key facts about World Diabetes Day[11]: 

• It is the world’s largest diabetes awareness campaign reaching a global audience of over 1 billion.
• The blue circle logo is the global symbol for diabetes awareness. Landmarks light up in blue. 
• Hundreds of events and campaigns take place around the world. 
• It draws attention to issues of importance each year – past themes have focused on diabetes and human rights, women and diabetes, education, and prevention. 
• Health organizations, advocates, healthcare providers, and people with diabetes organize local activities. 
• Awareness events, screenings, fundraisers, and educational initiatives are held. 
• Media campaigns, resources, and reports are launched. Blue lighting illuminates monuments. 
• The WHO and IDF collaborate with partners worldwide on materials and projects. 
• It provides an opportunity for the diabetes community to speak in a united voice.
• The reach and impact continue to grow each year. 

This World Diabetes Day 2023, make your voice heard by: 

• Wearing blue, the color of diabetes awareness 
• Attending local events in your area 
• Sharing messages and infographics on social media 
• Telling your diabetes story 
• Reaching out to leaders about key issues 
• Learning more about diabetes risks, signs, care 
• Getting screened if at risk 
• Supporting organizations helping people with diabetes 
• Educating your community about prevention 
• Lighting monuments and buildings in blue 

Together we can raise awareness of the global diabetes epidemic, reduce stigma, improve access to care, support those impacted, and decrease complications. The future depends on all of us uniting to address this major public health threat. 

Helpful Diabetes Online Resources 

• American Diabetes Association – Offers info on managing blood sugar, diet, complications, community support and more. Call 1-800-DIABETES or visit www.diabetes.org. 
• JDRF (Juvenile Diabetes Research Foundation) – Provides info and community for those with T1D. Has local chapters and events. Visit www.jdrf.org. 
• American Association of Diabetes Educators – Locate diabetes educators and accredited programs through their website www.diabeteseducator.org. 
• National Institute of Diabetes and Digestive and Kidney Diseases – Government resource for diabetes research, treatment, prevention info. Website www.niddk.nih.gov. 
• Diabetes Teen Connect – Online community of teens with T1D sharing support. Visit www.jdrf.org/t1d-resources/living-with-t1d/teenagers/.
• Taking Control of Your Diabetes (TCOYD) – National nonprofit offering conferences, resources and online events. Visit www.tcoyd.org. 
• Local Hospital Diabetes Education Classes – Many hospitals offer group classes on managing diabetes. 

References

[1] Sapra, A., & Bhandari, P. “Diabetes.” StatPearls, updated 21 Jun. 2023, StatPearls Publishing, 2023 Jan-. 

[2] “What is Diabetes?” American Diabetes Association, https://www.diabetes.org/diabetes. 

[3] “Complications.” American Diabetes Association, 
https://www.diabetes.org/diabetes/complications. 

[4] “Type 1 Diabetes.” Mayo Clinic, 
https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011. 

[5] “Understanding Type 2 Diabetes” American Diabetes Association, 
https://diabetes.org/about-diabetes/type-2 

[6] “Diabetes Facts and Figures.” International Diabetes Federation, 
https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html. 

[7] “Gestational Diabetes.” American Diabetes Association, 
https://www.diabetes.org/diabetes/gestational-diabetes. 

[8] “Symptoms.” National Institute of Diabetes and Digestive and Kidney Diseases, https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes. 

[9] “Diagnosing Diabetes and Learning About Prediabetes.” American Diabetes Association, https://www.diabetes.org/a1c/diagnosis. 

[10] “Treatment and Care for Diabetes.” World Health Organization, 
https://www.who.int/diabetes/action_online/basics/en/index3.html. 

[11] “ABOUT WORLD DIABETES DAY” World Diabetes Day, 
https://worlddiabetesday.org/about/facts-figures/