World Diabetes Day

IDF statistics indicate that 589 million adults worldwide have diabetes, with one person developing the disease every 5 seconds and one person dying from diabetes-related causes every 9 seconds. An even more concerning trend is that in half of all cases (252 million), people are unaware of their diagnosis. Poor detection of DM poses a serious health threat due to the risk of complications. IDF projections also warn that by 2050, the number of people with diabetes could reach 853 million.

In Russia, recognition of this threat has led to systematic changes in care organization that over the past decade have improved access to modern diagnostic and treatment methods.

What is Diabetes?

Diabetes mellitus is a chronic metabolic disease in which the body cannot effectively use or produce insulin, a hormone that regulates blood glucose levels. Chronically elevated glucose levels (hyperglycemia) lead to serious damage to many body systems, especially nerves and blood vessels.

Types of Diabetes

We typically speak of two types of diabetes mellitus, but there are actually more.

• Type 1 DM is an autoimmune disease in which the immune system attacks and destroys the insulin-producing beta cells of the pancreas. This type requires lifelong insulin administration and manifests more commonly than type 2 DM in childhood and young adulthood.
• Type 2 DM accounts for approximately 90% of all diabetes cases. It develops as a result of ineffective insulin utilization by the body (insulin resistance). It is strongly associated with excess weight, obesity, and lifestyle. It can remain asymptomatic for extended periods. Type 2 DM is more common and occurs more frequently in people over age 40.
• Gestational diabetes occurs during pregnancy and typically resolves after delivery.
• Other specific types of diabetes include diseases of the exocrine pancreas (pancreatitis, trauma, cystic fibrosis), endocrinopathies, and monogenic forms of diabetes (MODY) caused by genetic defects.
• Diabetes insipidus is a disease unrelated to glucose metabolism disturbance but caused by deficiency or dysfunction of the hormone vasopressin.

Prediabetes: A Critical Juncture

This is a borderline condition in which blood sugar levels are above normal but have not yet reached diabetes diagnostic criteria. It is the body's signal of high risk for developing type 2 DM.

Diagnostic Criteria

Normal fasting venous plasma glucose is considered less than 6.1 mmol/L by Russian standards or less than 5.6 mmol/L by American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) standards.

Diabetes mellitus is diagnosed when fasting glucose is ≥7.0 mmol/L or ≥11.1 mmol/L at any time, and glycated hemoglobin (HbA1c) exceeds or equals 6.5%.

Prediabetes is a state between normal and diabetes. For accurate diagnosis, an oral glucose tolerance test (OGTT) with 75 g glucose is performed, a laboratory method in which the person drinks a glucose solution on an empty stomach, after which blood glucose levels are measured first while fasting, then two hours later.

Prediabetes is not simply "slightly elevated sugar." It is a stage of impaired carbohydrate metabolism that may conceal:

• High risk of type 2 DM. The combination of prediabetes with visceral obesity and heredity means a very high probability of disease development.
• Possibility of hidden pathologies. Sometimes other serious diseases mask themselves as prediabetes: type 1 DM at a preclinical stage, pancreatitis, or even pancreatic cancer. In these cases, simple lifestyle changes won't help, specific treatment is required.

How to Recognize DM

Classic DM symptoms, especially type 1, develop rapidly. With type 2 DM they may be subtle or absent for years, increasing the risk of late diagnosis at the complication stage.

Key Symptoms:

• Polyuria: frequent and abundant urination, especially at night
• Polydipsia: constant, unquenchable thirst
• Polyphagia: increased appetite, often with weight loss (characteristic of type 1 DM)
• Chronic fatigue, weakness, drowsiness
• Vision deterioration: blurriness, "veil" before the eyes
• Slow wound and abrasion healing, frequent fungal infections
• Numbness or tingling in hands and feet.

The appearance of even one of these symptoms is reason to immediately have blood glucose tested. Diabetes diagnosis is simple and accessible. Prediabetes and early-stage type 2 DM can be effectively controlled, dramatically reducing complication risk.

Causes and Risk Factors

For type 1 DM, the exact cause is unknown, but genetic predisposition and trigger factors (certain viral infections, environmental factors) play key roles.

For type 2 DM, causes include insulin resistance and gradual pancreatic exhaustion.

Risk factors for developing type 2 DM:

• Excess weight and obesity (BMI ≥25)
• Low physical activity
• Heredity (presence of DM in close relatives)
• Age over 45 years
• History of gestational diabetes
• Arterial hypertension
• Polycystic ovary syndrome (PCOS)

How to Protect Yourself

Prevention is effective for type 2 DM and is based primarily on lifestyle modification.

– Achieve and maintain healthy weight. Body weight reduction of even 5-7% significantly decreases risk.

– Follow healthy eating principles. Limit sugar, saturated and trans fats. Increase fiber intake (vegetables, whole grains).

– Engage in regular physical activity. At least 150 minutes of moderate aerobic exercise (brisk walking, swimming) weekly.

– Quit smoking and limit alcohol consumption.

– Undergo regular medical examinations and checkups including blood glucose monitoring, especially with risk factors present.

Diabetes Care System in Russia

Approximately 5.6 million people in Russia are officially diagnosed with DM, while the total number with diabetes in Russia may be around 12 million. Accordingly, about 6.4 million people live with DM without diagnosis or treatment. The economic burden of the disease is estimated at hundreds of billions of rubles annually, including direct treatment costs and indirect losses from disability.

Reversing this situation is the goal of endocrinology service modernization that began in Russia in 2023. The country currently operates a special "Fight Against Diabetes" project aimed at increasing access to test systems and medications for people with diabetes, as well as creating diabetes centers for patients nationwide. Approximately 9-10 billion rubles are allocated annually for project activities.

In 2025, for example, regions have already received more than 4.2 billion rubles to strengthen the material and technical base of endocrinology services: for equipping regional centers and medical organizations with modern diagnostic equipment, and for deploying a network of more than 1,200 health schools for adults and children with diabetes. This decision will complete formation of a unified coordinating network of endocrine centers nationwide.

Over the past two years, Russia has newly established or organized from existing medical organizations 90 regional and 155 interregional endocrinology centers. Additionally, 73 federal medical organizations providing care directly to patients with diabetes have undergone modernization.

Despite achievements, challenges remain:

– Low public awareness of the disease. The government is addressing this through opening diabetes schools for patients and their families.

– Low detection of DM at early stages. Up to 50% of people may be unaware of their diagnosis, so diabetes prevention is included in population screening programs in Russia.

– Access to insulin pump systems and continuous glucose monitoring systems remains uneven and limited in regions compared to major city centers.

– Despite program availability, there are problems with irregular patient supply due to medication shortages and logistical difficulties in certain regions.

Advanced development directions include therapy personalization based on genetic testing, expansion of telemedicine consultations for residents of remote areas, and scaling use of digital therapeutic solutions. However, to achieve indicators of countries with the best diabetes services (for example, Sweden), high-tech care volumes must be increased and primary prevention efforts strengthened.