Diabetes Literature Review 2022

Running head:LITERATURE REVIEW
LITERATURE REVIEW
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1LITERATURE REVIEW
Introduction:
Diabetes mellitus is a severe chronic metabolic disorder in human characterised by an insistent
hyperglycemia (Chen et al. 2017). It can be both as a result of impairment of insulin secretion, as
well as, resistance to peripheral actions of insulin, or both. Diabetes is as a very common and
prevalent cause of death leading to organ failure, especially kidney impairment, therefore, must
be treated at an early stage(Skyler et al. 2017). It is associated with other metabolic aberrations
in individual with diabetes that has lifelong implications leading to life threatening complication
and other micro vascular and macro vascular complications. There are many treatment options
available for diabetes mellitus like medications, insulin and others, however, individualised
approaches and interventions are found to be successful in the prevention and treatment of this
disease depending on the severity (Skyleret al. 2017). There is a huge requirement of educating
diabetes patients on the role and importance of maintaining a healthy lifestyle in order to prevent
diabetes and promote health (Asif 2014). The literature survey was conducted in order to identify
the internal and external factors contributing to the development of this disease and a thorough
analysis of the interventions available to address the risk by studying several articles and journals
and collecting data from those research studies.
Research Questions: What are the risk factors associated with the disease diabetes mellitus?
What are the self management strategies for the treatment of diabetes mellitus?

2LITERATURE REVIEW
Background:
Type 1 Diabetes: It is characterised by the autoimmune destruction of insulin-producing Beta
cells in the islets of the pancreas. Therefore, a complete deficiency of insulin is observed in the
patients with diabetes. In type 1 diabetes, the immune cells in human body which normally fights
against infection and foreign pathogen attacks its own cells in the pancreas that makes inulin as a
result of which the pancreas stops making insulin (Niddk.nih.gov 2019). This is mostly caused in
the children and adolescents and characterised by symptoms like polydipsia, polyuria and
polyphagia along with overt hyperglycemia. This type of diabetes are immune mediated nature
and that is why these are also classified as immune-mediated. It is partly inherited with a
multiple genes including some HLA genotypes that increases the risk of diabetes. In the
individuals who have genetic susceptibility are like to develop diabetes triggered by
environmental factors like diet, lack of physical activity and others.
Type 2 diabetes:
This type of diabetes are characterised by insulin resistance which can be a result of a
reduced or impaired insulin secretion. These are the most common type of diabetes recognised
worldwide and develops as a result of lifestyle factors and genetics(Niddk.nih.gov 2019). It is a
heterogeneous disorder characterised by peripheral insulin resistance, an impaired regulation in
the production of glucose and a declined Beta cell function, thereby leading to Beta cell failure.
In diabetes, the dysfunction of beta cell owing to impairment of insulin secretion. The
autoimmune destruction of the pancreatic Beta cell are a recognised as a subset of the type 2
diabetes (Cerf 2013).

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Non pharmacological Interventions:
Diet: It has been found that besides medications as therapy for the treatment of diabetes mellitus,
diet therapy plays an important role in managing diabetes. A diet with low saturated fat with a
high fiber content is recommended to the patients with diabetes (Asif 2014). Patients must be
made educated about the importance of maintaining a proper diet and how it impacts the
occurrence of diabetes in individuals (Raveendran, Chacko and Pappachan2018). Since, obesity
is the most prevalent risk factor in diabetes, a proper diet needs to be maintained in order to
reduce weight. Weight loss helps in improving insulin sensitivity in the liver and in the skeletal
muscle and also reduces accumulation of fat in the pancreas(Raveendran, Chacko and Pappachan
2018).
Physical activity: Involvement in physical activity can reduce the chance of developing
diabetes. It helps to keep weight in control. Diabetic patients are recommended to incorporate
physical exercising in their lifestyle as it pays a crucial role in lowering the blood sugar level.
Exercising regularly can also improve body’s sensitivity towards insulin, thus, increasing the
efficacy of the diabetes medications (Niddk.nih.gov 2019). In addition to that, physical
exercising can help in the effective reduction of body fats, which improves the body’s circulation
and as a result, helps in the reduction of the risk of heart diseases. This can also help in the
reduction of mental stress and thus improve the quality of life of the patient (Niddk.nih.gov,
2019).

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Method
Search Strategy
Data Source: Secondary data were collected from the research articles from several databases
like NCBI and Google Scholar and analysed for interpreting results to determine the risk factors
contributing to the occurrence of diabetes and studied the articles for identifying the external and
environmental factors affecting the disease. The articles chosen were published in 2013-2019,
mostly peer reviewed journals.
Search keywords like- Diabetes, Type 1 Diabetes, Type 2 Diabetes, Risk factors, Obesity.
Inclusion/Exclusion criteria: The articles those are relevant to the research area have been
taken with no restrictions or country or ethnicity because this article aims at providing
generalisability of the results. However, there were certain limitations like the language chosen
was English. Articles those are written in clear English language were chosen and no other
language was entertained. The articles with no proper information were excluded. The main
focus of this paper is to understand the prevalence of the disease identifying the external and
internal factors contributing to the development of the disease and also the intervention strategies
for the treatment of the disease identified worldwide.
Results:
The study was conducted using 9 articles and including their research findings in the paper from
the electronic database. The articles that were excluded had insufficcent information and an
inappropriate study settings.

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The study conducted by Purnell, Zinman and Brunzell 2013, was to determine the influence of
excessive weight gain in diabetes mellitus on atherosclerotic disease. The sample population was
people with type 1 diabetes mellitus including 97% white, 45% female and mean age of 35 years
and were randomly assigned to the treatment for conventional or intensive treatment in the
Diabetes Control and Complications Trail (DCCT) ad they underwent an intima-media thickness
as n= 1015 and a coronary artery calcium score with n= 925 in the follow up process in the
Epidemiology of Diabetes interventions and complications (EDIC) study. Intensive treatment
subjects were classified by quartile of body mass index changed in the course of DCCT. Excess
gains retain a higher coefficient of bodily mass and waist circumference, require more insulin,
have more intima-media thickness (+5%, P < 0.001 EDIC year 1, P = 0.003 EDIC year 6), and
incline towards a greater coronary artery calcium scores (odds ratio, 1.55; confidence interval,
0.97 to 2.49; P = 0.07) than the minimal gainers (Purnell, Zinman and Brunzell 2013). More
intima media with intensive but not conventional treatment were associated with increased
frequency of family history of diabetes mellitus, hypertension and hyperlipidemia. The research
findings showed that Excess weight gain in DCCT is correlated with steady rises in central
obesity, resistance to insulin, dyslipidemia or blood pressure, and more comprehensive EDIC
atherosclerosis (Purnell, Zinman and Brunzell 2013).
The study conducted by Louati et al. 2015, was to determine the prevalence of osteoarthritis in
patients with diabetes mellitus and the association of diabetes mellitus with osteoarthritis. A
systematic literature review and a Meta analysis was conducted including cohort and cross
sectional studies by assessing the patients with diabetes mellitus. 49 studies were included in the
study from 299 publications and 28 cross sectional studies, 10 case controlled studies and 11
cohort studies were included. This Meta analysis conducted highlighted a high occurrence of

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osteoarthritis in the patients with diabetes and relationship between both the diseases, represents
an advance step towards the individualisation of Diabetes Mellotus Osteoarthritis within a
metabolic phenotype of Osteoarthritis.
It was found in a study by Skyler et al. 2017, that although therapeutic interventions encourage
the prevention and treatment of diabetes mellitus, there is a huge impact of individualized
strategies taken for the intervention process (Skyler et al. 2017). It was estimated that diabetes
occurs both in male and female at an equal rate and reduces the life expectancy almost 13 years.
About 5-15% of adults were estimated to be diagnosed with diabetes type 1 and needs immediate
treatment (Skyler et al. 2017).
However, the study conducted in the United States in the year 2014, shows that about 95% of the
individuals that is, nearly 30 million of people are diagnosed and living with type 2 diabetes. It
was also found that about 86 million of individuals were suffering from prediabetes and are at a
high risk of developing type 2 diabetes (Cdc.gov 2014). The demographic factors affecting the
occurrence of diabetes are identified as age, race, ethnicity and socioeconomic status.
The occurrence of type 1 diabetes was found to be 80-90% in children and adolescents
(Kharroubi and Darwish 2015). As per the year 2013, it was estimated that about 497100 youths
ranging from 0-14 years are diagnosed with diabetes according to the International Diabetes
Federation (IDF) and the number of newly diagnosed cases were 78900 (Guariguataet al. 2014).
Type 2 diabetes is a globally recognised prevalent cause of death among individuals. It is
generally caused due to external factors like obesity. Individuals with type 2 diabetes are at a
high risk for micro vascular including nephropathy, retinopathy and neuropathy, as well as,
macro vascular complications like cardiovascular comorbidities due to hyperglycaemia and

7LITERATURE REVIEW
related complications (Skyler et al. 2017). Type 1 diabetes results from immune mediated
destruction of Beta cells, whereas, type 2 diabetes occurs as a result of glucose specific insulin
secretory defects. The common symptoms observed are headache, blurred vision, fatigue, slow
healing of wounds and cuts, skin rashes and other related symptoms (Ramachandran 2014). If
diabetes remains undetected and untreated for a prolonged period of time can lead to lifelong
implications including organ failure, kidney impairment and eventually leads to death
(Ramachandran 2014).
Conclusion:
The review conducted gave results on the rate of occurrence of diabetes among all age groups
including, children, adolescents, young adults and elder people and identified the risk factors
associated with them. There were many evidences showing the implications of lifestyle factors
contributing to the development of this disease. The environmental factors that were identified
were obesity, lack of involvement in physical activities, and an unhealthy and inappropriate diet
were identified as the leading cause of diabetes. There are evidences showing the prevalence of
osteoarthritis due to diabetes mellitus. Most patients with diabetes are found to be obese, and
obesity impacts the degree of insulin resistance. It was found that obesity is the most common
and prevalent cause of diabetes among children and young adolescents. An increased prevalence
of this disease among various age groups was found due to lifestyle factors and consumption of
unhealthy foods. The occurrence of diabetes mong young children is probably because of obesity
and contributes as the main risk factor among that particular age group. From the above survey,
it was found that diabetes, which is a prevalent cause of death among individuals leading to
kidney impairment and organ dysfunctioncan be controlled and prevented by taking initiative

8LITERATURE REVIEW
addressing self-management strategies like having proper diet, exercise and a healthy lifestyle. It
is characterised by chronic hyperglycemia resulting from either a defect in insulin secretion or in
insulin action or both. Diabetes is mainly classified into 3 types by clinical representation and
etiology. Type 1 diabetes is caused as a result of destruction of pancreatic Beta cells. It was also
found that diabetes can affect a number of individuals from all age groups, however, the risk
factors are different in various age groups. Early diagnosis and treatment can help in preventing
an individual from the severity of this disease since an uncontrolled blood sugar level for a
prolonged period of time can cause serious lifelong implications and lead to major health
impairment. Therefore, along with a proper treatment like medications and insulin, a healthy
lifestyle is important and must be maintained in order to prevent the occurrence of this disease.
Further Research
Further research needs to be conducted in this area to find more intervention strategies for
managing chronic as well as acute diabetic attacks and prevent the occurrence of diabetes among
all age groups and understand the risk factors and other comorbidities associated with the
disease.

9LITERATURE REVIEW
References:
Asif, M., 2014. The prevention and control the type-2 diabetes by changing lifestyle and dietary
pattern. Journal of education and health promotion, 3.
Cerf, M.E., 2013. Beta cell dysfunction and insulin resistance. Frontiers in endocrinology, 4,
p.37.
Chen, Z., Zang, X., Liu, M., Liu, M., Li, J., Gu, Z. and Ma, L., 2017. Abnormal Alterations of
Cortical Thickness in 16 Patients with Type 2 Diabetes Mellitus: A Pilot MRI Study. Chinese
Medical Sciences Journal, 32(2), pp.75-82.
Guariguata, L., Whiting, D.R., Hambleton, I., Beagley, J., Linnenkamp, U. and Shaw, J.E., 2014.
Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research
and clinical practice, 103(2), pp.137-149.
Guo, L., Parker, D.L., Zang, Y., Sweis, R.F., Liu, W., Sherer, E.C., Buist, N., Terebetski, J.,
Kelly, T., Bugianesi, R. and Priest, B.T., 2016. Discovery and optimization of a novel triazole
series of GPR142 agonists for the treatment of type 2 diabetes. ACS medicinal chemistry letters,
7(12), pp.1107-1111.
Kharroubi, A.T. and Darwish, H.M., 2015. Diabetes mellitus: The epidemic of the century.
World journal of diabetes, 6(6), p.850.
Louati, K., Vidal, C., Berenbaum, F. and Sellam, J., 2015. Association between diabetes mellitus
and osteoarthritis: systematic literature review and meta-analysis. RMD open, 1(1), p.e000077.

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Niddk.nih.gov (2019). Preventing Type 2 Diabetes | NIDDK. [online] National Institute of
Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-
information/diabetes/overview/preventing-type-2-diabetes [Accessed 23 Aug. 2019].
Niddk.nih.gov (2019). Symptoms & Causes of Diabetes | NIDDK. [online] National Institute of
Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-
information/diabetes/overview/symptoms-causes [Accessed 23 Aug. 2019].
Purnell, J.Q., Zinman, B. and Brunzell, J.D., 2013. The effect of excess weight gain with
intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in
type 1 diabetes mellitus: results from the Diabetes Control and Complications
Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study.
Circulation, 127(2), pp.180-187.
Ramachandran, A. (2014). Know the signs and symptoms of diabetes. [online] PubMed Central
(PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311308/ [Accessed 23
Aug. 2019].
Raveendran, A.V., Chacko, E.C. and Pappachan, J.M., 2018. Non-pharmacological treatment
options in the management of diabetes mellitus. European Endocrinology, 14(2), p.31.
Rmachandran, A. (2014). Know the signs and symptoms of diabetes. Indian Journal of Medical
Research, 140(5).
Skyler, J.S., Bakris, G.L., Bonifacio, E., Darsow, T., Eckel, R.H., Groop, L., Groop, P.H.,
Handelsman, Y., Insel, R.A., Mathieu, C. and McElvaine, A.T., 2017. Differentiation of diabetes
by pathophysiology, natural history, and prognosis. Diabetes, 66(2), pp.241-255.

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Wouters, O.J., O'donoghue, D.J., Ritchie, J., Kanavos, P.G. and Narva, A.S., 2015. Early chronic
kidney disease: diagnosis, management and models of care. Nature Reviews Nephrology, 11(8),
p.491.