Journal of Medicinal Plants Research Vol. 5(22), pp.

5337-5339, 16 October, 2011

Available online at http://www.academicjournals.org/JMPR
ISSN 1996-0875 ©2011 Academic Journals

Review

A review of diabetes mellitus

M. Akram1*, Naveed Akhtar2, H. M. Asif1, Pervaiz Akhtar Shah3, Tariq Saeed3,
Arshad Mahmood4 and Nadia Shamshad Malik5
1
Faculty of Eastern Medicine, Hamdard University, Karachi, Pakistan.
2
Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Pakistan.
3
University College of Pharmacy, The University of Punjab Lahore, Pakistan.
4
Department of Pharmaceutical Sciences, COMSATS Institute of Information Technology, Abbottabad, Pakistan.
5
School of Pharmacy, The University of Lahore, Islamabad Campus, Islamabad, Pakistan.
Accepted 13 September, 2011

Diabetes mellitus (DM) is a chronic and potentially disabling disease. It is a major and growing threat to
global public health. The prevalence of diabetes and its adverse health effects have risen more rapidly
in India and Pakistan. In Pakistan, majority of people live on or below the poverty line and having lack of
access to healthcare services, lack of national welfare schemes and provision of health insurance for
the poor population. In this article, different types of diabetes, risk factors and associated complication
have been studied.

Key words: Diabetes mellitus, risk factors, hyperuricemia, gout, global public health.

INTRODUCTION

Diabetes mellitus (DM) is a chronic and potentially
disabling disease. It is a major and growing threat to
global public health. The biggest impact of the disease is
on adults of working age; particularly in developing
countries. The prevalence of diabetes and its adverse
health effects have risen more rapidly in South Asia than
in any other region of the world (Ghaffar et al., 2004).
Diabetes mellitus is a serious public health concern all
over the world. In Pakistan, diabetes is on rise and if
proper intervention and preventive strategies were not
adopted the epidemic of diabetes will prove fatal. As we
are in the middle of a global epidemic of this disease and
projected increase in the prevalence of diabetes over the
next two decades emphasizes the importance of imple-
menting primary prevention, early detection and imparting
educational preventive program (Amos et al., 1997). The
preventive programs targeted towards general population
showed greater benefits rather than targeting only high
risk and diseased population (American Diabetic
Association, 2000). Different studies have proved
modifiable risk factors of type II diabetes includes; obesity
and physical inactivity (Tuomilehto and Wolf, 1987; King
and Dowd, 1990; Hamman, 1992; Zimmet, 1988; Stern,
1991; Ohlson et al., 1988; Manson et al., 1991). If we
*Corresponding author. E-mail: makram_0451@hotmail.com.
could detect and prevent these risk factors earlier, the
onset of disease can be delayed and prevented.
Knowledge about the disease plays a vital role in future
development of disease and its early prevention and
detection. Research studies have shown that wherever
massive education regarding diabetes mellitus is
provided to general population, it resulted in significant
increase in knowledge about the disease. Other factors,
such as obesity, which is characterized by a high body
mass index (BMI); advanced age and family history of
diabetes, are also associated with the higher incidence of
diabetes in the HCV-infected population (Kruzynska et
al., 1991; Monto et al., Petit et al., 2001). Diabetes is a
slow killer with no known curable treatments. However,
its complications can be reduced through proper
awareness and timely treatment.
Three major complications are related to blindness,
kidney damage and heart attack. It is important to keep
the blood glucose levels of patients under strict control for
avoiding the complications. One of the difficulties with
tight control of glucose levels in the blood is that such
attempts may lead to hypoglycemia that creates much
severe complications than an increased level of blood
glucose. Researchers now look for alternative methods
for diabetes treatment. The goal of this paper is to give a
general idea of the current status of diabetes research.
The author believes that diabetes is one of the highly
demanding research topics of the new century and wants
5338 J. Med. Plants Res.
to encourage new researchers to take up the challenges.
Type 1 diabetes mellitus has wide geographic variation in
incidence and prevalence (Silink, 2002). Annual incidence
varies from 0.61 cases per 100,000 population in China,
to 41.4 cases per 100,000 population in Finland.
Substantial variations are observed between nearby
countries with differing lifestyles, such as Estonia and
Finland, and between genetically similar populations,
such as those in Iceland and Norway.
Even more striking are the differences in incidence bet-
ween mainland Italy (8.4 cases per 100,000 population)
and the Island of Sardinia (36.9 cases per 100,000
population). These variations strongly support the
importance of environmental factors in the development
of type 1 diabetes mellitus. Most countries report that
incidence rates have at least doubled or more in the last
20 years. Incidence appears to increase with distance
from the equator (Silink 2002, Soltesz et al., 2007).
Several studies found that coffee consumption is
inversely associated with the risk of type 2 diabetes (Van
and Feskens, 2002, Van and Hu, 2005; Tuomilehto et al.,
2004; Salazar et al., 2004).
TYPES
Prediabetes
Prediabetes is a condition in which blood sugar levels are
too high to be considered normal but not high enough to
be labeled diabetes. People have prediabetes if their
fasting blood sugar level is between 101 and 126 mg/dL
or if their blood sugar level 2 h after a glucose tolerance
test is between 140 and 200 mg/dL.
Identifying people with prediabetes is important
because the condition carries a higher risk for future
diabetes as well as heart disease. Decreasing body
weight by 5 to 10% through diet and exercise can
significantly reduce the risk of developing future diabetes
(Thong et al., 2002).
Type 1 diabetes mellitus
This results from the body's failure to produce insulin and
presently requires the person to inject insulin (Also
referred to as insulin-dependent diabetes mellitus, IDDM
for short, and juvenile diabetes).
Type 2 diabetes mellitus
This results from insulin resistane, a condition in which
cells fail to use insulin properly, sometimes combined
with an absolute insulin deficiency. Formerly referred to
as non-insulin-dependent diabetes mellitus, NIDDM for
short, and adult-onset diabetes (Greer et al., 2001).
Gestational diabetes
Gestational diabetes (GDM) is defined as a carbohydrate
intolerance that normally develops during the 24th
through the 32nd week of pregnancy. This condition
affects 2 to 5% of all pregnant women and is the most
common disease affecting pregnancy (Harris, 1995.).
RESEARCH STUDY
Hyperuricemia in type 2 diabetes mellitus
A study was done to evaluate the relationship between
hyperuricemia and diabetes mellitus. It has been
previously suggested that elevated serum uric acid is a
feature of hyperinsulinemia and impaired glucose
tolerance. This study was done to evaluate the relation
between uric acid and metabolic parameters, creatinine
clearance and albumin excretion rate in a cohort of type 2
diabetic patients. In type 2 diabetes, hyperuricemia
seems to be associated with the insulin-resistant
syndrome and with early onset or increased progression
to overt nephropathy, while hypouricemia is associated
with worse metabolic control, hyperfiltration and a late
onset or decreased progression to overt nephropathy
(Bo, 2001).
Gout and the risk of type 2 diabetes
Gout is strongly associated with obesity, hypertension,
hyperlipidemia and diabetes. Because of genetic factors,
gout tends to run in some families. A study was done to
evaluate the independent relation between a history of
gout and the future risk of type 2 diabetes among men
with a high cardiovascular risk profile. As a conclusion, it
was found that men with gout are at a higher future risk of
type 2 diabetes independent of other known risk factors.
These data expand on well-established, cross-sectional
associations between hyperuricaemia, gout and the
metabolic syndrome, and extend the link to the future risk
of type 2 diabetes (Choil and Krishnan, 2008).
DISCUSSION
Diabetes is a chronic condition with numerous potential
complications that considerably affect patients, health-
care providers, payers, and society. Only through the
combined efforts of all these stakeholders can desired
outcomes be achieved in patients with diabetes. Further-
more, local health and educational systems should focus
more on the preventive aspects of the disease. Physical
activity and more nutritious eating habits should be
encouraged throughout childhood and adolescence in
order to reduce the frequency of obesity and to

promote healthier lifestyles early and throughout
adulthood.Aretaeus and Jalinoos (Galen) were followers
of Buqrat. Aretaeus (81 to 138 AD) provided the first
accurate description of the symptoms of diabetes. He
was the first who use the term “diabetes” in connection
with this ailment, which means “to run through” or
“Siphon”. He described the disease as “diabetes is a
dreadful affliction, not very frequently among men, being
a melting down of the flesh and limbs into urine” (Pickup
and William, 1997; Leopald, 1930; Henschen, 1969;
Atretaeus, 1856; 1856). Diabetes mellitus (DM) is a
chronic metabolic disorder caused by an absolute or
relative deficiency of insulin, an anabolic hormone. Insulin
is produced by the beta cells of the islets of Langerhans
located in the pancreas, and the absence, destruction, or
other loss of these cells results in type 1 diabetes
(insulin-dependent diabetes mellitus [IDDM]). Most
children with diabetes have type 1 diabetes mellitus
(T1DM) and a lifetime dependence on exogenous insulin.
The metabolic syndrome is thought of as a precursor to
type 2 diabetes. It is poorly defined and represents a
heterogeneous collection of various propensities to
diabetes. It has been suggested that lifestyle-intervention
and treating metabolic manifestations of this pre-diabetic
state can reduce the chance of progression to frank
diabetes and the risk of complications (Hu et al., 2006;
Tuomilehto, 2005; Ashcroft, 2006). Cardiovascular
disease (CVD) is the major cause of morbidity and
mortality in the diabetic population causing up to 80% of
deaths in these patients. Diabetes mellitus is an
independent risk factor for cardiovascular disease
mortality, increasing this risk by 1.5 to 4.5 fold (Unwin et
al., 2002; Wild et al., 2004). The prevalence of diabetes
world wide is estimated to increase to 4.4% of the
population by the year 2030 (366 million individuals) from
2.8% in 2000 (171 million individuals). Today researchers
are working on an insulin patch and inhaled insulin,
genetic engineering is being used to manipulate cells so
they secrete insulin. A sensor-computer-pump system
that mimics the insulin response of the normal pancreas
is being developed to function as an “artificial pancreas”.
Apart from these, various researches are still going on, to
explore new aspects of diabetes and its management.
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