Differentiating Between Type 1 and Type 2 Diabetes

Epidemic of Type 2 Diabetes

There are two main forms of diabetes. Type 1 diabetes (insulin dependent) is primarily due to autoimmune-mediated destruction of pancreatic beta cells, resulting in absolute insulin deficiency. While type 1diabetes is also on the increase the actual numbers of people with type 1diabetes in India is relatively speaking still small. Type 2 diabetes (non-insulin dependent) on the other hand accounts for over 90-95% of all diabetic people and is characterized by insulin resistance and/or abnormal insulin secretion, either of which may predominate. The diabetes epidemic relates particularly to type 2 diabetes, and is taking place both in developed and developing nations with particular reference to India and is predominantly due to the changing demography and increased longevity.

Differentiating Between Type 1 and Type 2 Diabetes

The table below provides a few clinical points to differentiate Type 1and Type 2 diabetes

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A person with diabetes is likely to have type 1 diabetes mellitus if:

•    Age at clinical onset or diagnosis is below 25 years

•    Has abrupt onset of severe symptoms (polyuria, polydipsia and/or unexplained weight loss)

•     Is ketosis prone (may develop ketoacidosis spontaneously)

•    Is dependent on exogenous insulin to sustain life

•    Has a BMI < 18.5 kg/m2

A person with diabetes is likely to have type 2 diabetes mellitus if the above mentioned criteria are not fulfilled and there is no other obvious secondary cause for diabetes mellitus such as steroid use, acromegaly, etc.

Goals for Treatment

The goals of management in people with diabetes are to provide:

•    Relief from diabetic symptoms and improvement in quality of life.

•    Prevention of acute complications.

•    Prevention of microvascular complications like retinopathy, neuropathy and nephropathy.

•    Prevention of macro-vascular complications like cardiovascular, cerebro-vascular and peripheral vascular disease.

•    Prevention of infections.

Type 2 diabetes is more common in adults. In urban areas, the risk of obesity in children is increasing. An increase in prevalence of type 2 diabetes in children is also noted. Although type 1diabetes occurs more commonly in persons below 25 years, it can also develop at any age.

Therefore, the complete treatment of people with diabetes requires advocating a healthy life style with focus on increased physical activity and proper balanced diet to attain and maintain desirable body weight. Also meticulous attention is to be given to achieve normoglycemia, control of hypertension and management of dyslipidemia.

Diabetes Education

Diabetes education means empowering people with diabetes with knowledge and providing tools crucial for making them active partners in the diabetes management team. These include:

•    In-depth information about diabetes, its complications and treatment

•    Appropriate self-care skills

•    Appropriate resources for self-care

•    A positive attitude

•    Self-monitoring skills

The compliance of people with diabetes is essential for effective management of diabetes. Education programmer is intended to help people to understand why these actions are so important and thereby increase their motivation for self-management.

Prevention of Diabetes

There is an urgent need for strategies to prevent the emerging epidemic of diabetes apart from treating diabetes and associated complications. Several factors are thought to contribute towards the acceleration of the epidemic, the most important being the rapid epidemiological transition due to urbanization and life style changes seen in developing countries. Identifying the individuals at risk is essential in planning preventive measures. Prevention of diabetes has several windows of opportunities. The three stages of prevention are:

Primary pre11ention targets people by early diagnosis through screening programmes before the

onset of the disease. All people at risk should be regularly screened and encouraged at each health care visit to pursue a healthy life-style, including a healthy diet, adequate exercise and weight control.

SecoiUlary prevention is to prevent the onset of complications in those who are already diagnosed to have diabetes. This can be achieved by meticulous control of diabetes with the help of diet. physical activity, drugs and life style modification process.

Tertiary prevention of diabetes should be aimed at limiting physical disability and rehabilitation measures in those who have already developed diabetic complications and to prevent them from going into end stage complications of diabetes.

Given the huge burden of diabetes in India, it is necessary to develop national Guidelines to ensure uniformity in the management of diabetes throughout the country. With this in view, the Indian Council of Medical Research (ICMR) and World Health Organization (WHO) conducted a National Workshop on "Guidelines for Management of Type 2 Diabetes," during May 200-4th May, 2003, at Chennai. The main objectives were to develop specific Guidelines for the diagnosis and targets for control, diagnostic criteria for diabetes, glucose intolerance and gestational diabetes, self-monitoring and annual follow-ups, screening for asymptomatic and high-risk individuals, various treatment modalities including diet and life-style modifications and medical interventions and early detection of complications with appropriate measures to arrest and reverse them.

It is hoped that these Guidelines will assist them to achieve targets and goals of therapy by executing proper management policies to reduce the risk of diabetic complications, thus enabling the people with diabetes to lead a near normal and healthy life.

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