World Diabetes Day

IDF statistics state: there are 589 million adults with diabetes mellitus in the world, every 5 seconds one person develops the disease, and every 9 seconds one person dies from causes related to this condition. An even more alarming trend is that in half of the cases (252 million) people are unaware of their diagnosis. Insufficient detection of diabetes represents a serious threat to their health due to the risk of complications. IDF forecasts also warn that by 2050, the number of people with diabetes could reach 853 million.

In Russia, awareness of the threat has led to systemic changes in care organization, which over the past decade have increased the accessibility of 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 high glucose levels (hyperglycemia) lead to serious damage to many body systems, especially nerves and blood vessels.

Types of diabetes

People usually talk about two types of diabetes mellitus. But in reality, there are more.

• Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys beta cells of the pancreas that produce insulin. This type of diabetes requires lifelong insulin administration and manifests more often than type 2 diabetes in childhood and young adulthood.
• Type 2 diabetes accounts for about 90% of all diabetes cases. It develops as a result of ineffective insulin use by the body (insulin resistance). It is strongly associated with excess weight, obesity, and lifestyle. For a long time it can be asymptomatic. Type 2 diabetes is more common and more frequently occurs in people over 40 years old.
• Gestational diabetes – occurs during pregnancy and typically resolves after childbirth.
• Other specific types of diabetes – include diseases of the exocrine pancreas (pancreatitis, trauma, cystic fibrosis), endocrinopathies, as well as monogenic forms of diabetes (MODY), caused by genetic defects.
• Diabetes insipidus – a disease not related to glucose metabolism disorders, but caused by deficiency or impaired action of the hormone vasopressin.

Prediabetes: critical point

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

Diagnostic criteria

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

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

Prediabetes is a condition between normal and diabetes. For accurate diagnosis, an oral glucose tolerance test (OGTT) with 75g of glucose is performed – a laboratory research method in which a person drinks a solution containing a certain amount of glucose on an empty stomach, after which blood glucose level is measured first when fasting, and then after 2 hours.

Prediabetes is not just "slightly elevated sugar". This is a stage of impaired carbohydrate metabolism, which may hide:

• High risk of type 2 diabetes. The combination of prediabetes with visceral obesity and heredity means a very high probability of disease development.
• Possibility of hidden pathologies. Sometimes behind prediabetes other serious diseases are masked: type 1 diabetes 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 diabetes

Classic symptoms of diabetes, especially type 1, develop rapidly. In type 2 diabetes, they may be blurred or absent for years, which increases the risk of late diagnosis already at the complication stage.

Key symptoms:

• Polyuria: frequent and abundant urination, especially at night.
• Polydipsia: constant, unquenchable thirst.
• Polyphagia: increased appetite, often accompanied by weight loss (characteristic of type 1 diabetes).
• 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 a reason to immediately take a blood glucose test. Diabetes diagnosis is simple and accessible. Prediabetes and early-stage type 2 diabetes can be effectively controlled, dramatically reducing the risk of complications.

Causes and risk factors

For type 1 diabetes, the exact cause is unknown, but genetic predisposition and trigger factors (certain viral infections, ecology) play a key role.

For type 2 diabetes, the causes are insulin resistance and gradual exhaustion of pancreatic capabilities.

Risk factors for developing type 2 diabetes:

• Excess body weight and obesity (BMI≥25)
• Low physical activity
• Heredity (presence of diabetes 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 diabetes and is based primarily on lifestyle correction.

– Achieve and maintain a healthy weight. Weight reduction of even 5–7% significantly reduces risk.

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

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

– Quit smoking and limit alcohol consumption.

– Regularly undergo medical check-ups including blood glucose level monitoring, especially in presence of risk factors.

Diabetes care system in Russia

In Russia, about 5.6 million people officially suffer from diabetes, while the total number of diabetes patients in the Russian Federation may be about 12 million. Accordingly, about 6.4 million people live with diabetes without having either a 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 due to disability.

The modernization of endocrinological services, which began in Russia in 2023, is designed to reverse the situation. Currently, the country has a special project "Fighting Diabetes Mellitus", whose goal is to increase the availability of test systems and drugs for diabetes patients, as well as to create diabetes centers for patients throughout the country. About 9-10 billion rubles are allocated annually for project activities.

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

Over the past two years in Russia, 90 regional and 155 interregional endocrinological centers have been newly created or organized from existing medical organizations. In addition, 73 federal medical organizations that provide care directly to diabetes patients have been modernized.

Despite the achievements, problems remain:

– Low public awareness about the disease. This is being addressed by the government, including through opening diabetes schools for patients and their families.

– Low detection rate of diabetes at early stages. Up to 50% of people may be unaware of their diagnosis, which is why diabetes prevention is included in population medical examination programs in Russia.

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

– Despite program availability, there is a problem with irregular patient supply due to drug shortages and logistical difficulties in certain regions.

Advanced development directions include therapy personalization based on genetic testing, development of telemedicine consultations for residents of remote areas, and scaling the use of digital therapeutic solutions. However, to achieve indicators of countries with the best diabetes care (for example, Sweden), it is necessary to increase the volume of high-tech care and strengthen work on primary prevention.