Diabetes/ja: Difference between revisions

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====Blood pressure lowering====

[[Cardiovascular disease]] is a serious complication associated with diabetes, and many international guidelines recommend blood pressure treatment targets that are lower than 140/90&nbsp;mmHg for people with diabetes. However, there is only limited evidence regarding what the lower targets should be. A 2016 systematic review found potential harm to treating to targets lower than 140 mmHg, and a subsequent systematic review in 2019 found no evidence of additional benefit from blood pressure lowering to between 130 – 140mmHg, although there was an increased risk of adverse events.

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2015 American Diabetes Association recommendations are that people with diabetes and albuminuria should receive an inhibitor of the renin-angiotensin system to reduce the risks of progression to end-stage renal disease, cardiovascular events, and death. There is some evidence that [[angiotensin converting enzyme inhibitors]] (ACEIs) are superior to other inhibitors of the renin-angiotensin system such as [[angiotensin receptor blockers]] (ARBs), or [[aliskiren]] in preventing cardiovascular disease. Although a more recent review found similar effects of ACEIs and ARBs on major cardiovascular and renal outcomes. There is no evidence that combining ACEIs and ARBs provides additional benefits.

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==== Aspirin ====

The use of [[aspirin]] to prevent cardiovascular disease in diabetes is controversial. Aspirin is recommended by some in people at high risk of cardiovascular disease, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes. 2015 American Diabetes Association recommendations for aspirin use (based on expert consensus or clinical experience) are that low-dose aspirin use is reasonable in adults with diabetes who are at intermediate risk of cardiovascular disease (10-year cardiovascular disease risk, 5–10%). National guidelines for England and Wales by the [[National Institute for Health and Care Excellence]] (NICE) recommend against the use of aspirin in people with type 1 or type 2 diabetes who do not have confirmed cardiovascular disease.

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===Surgery===

[[Bariatric surgery|Weight loss surgery]] in those with [[obesity]] and type 2 diabetes is often an effective measure. Many are able to maintain normal blood sugar levels with little or no medications following surgery and long-term mortality is decreased. There is, however, a short-term mortality risk of less than 1% from the surgery. The [[body mass index]] cutoffs for when surgery is appropriate are not yet clear. It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.

A [[pancreas transplant]] is occasionally considered for people with type&nbsp;1 diabetes who have severe complications of their disease, including [[Chronic kidney disease|end stage kidney disease]] requiring [[kidney transplantation]].

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===Self-management and support===

In countries using a [[general practitioner]] system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Evidence has shown that social prescribing led to slight improvements in blood sugar control for people with type 2 diabetes. Home [[telehealth]] support can be an effective management technique.

The use of [[technology]] to deliver educational programs for adults with type 2 diabetes includes computer-based self-management interventions to collect for tailored responses to facilitate self-management. There is no adequate evidence to support effects on [[cholesterol]], [[blood pressure]], [[Behavior change (public health)|behavioral change]] (such as [[physical activity]] levels and dietary), [[Depression (mood)|depression]], weight and [[Quality of life (healthcare)|health-related quality of life]], nor in other biological, cognitive or emotional outcomes.

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==Epidemiology==

{{Main|Epidemiology of diabetes}}

[[File:Prevalence of Diabetes by Percent of Country Population (2014) Gradient Map.png|thumb|upright=1.4|Rates of diabetes worldwide in 2014. The worldwide prevalence was 9.2%.]]

[[File:Diabetes mellitus world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.4|Mortality rate of diabetes worldwide in 2012 per million inhabitants {{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|28–91}}{{legend|#ffe820|92–114}}{{legend|#ffd820|115–141}}{{legend|#ffc020|142–163}}{{legend|#ffa020|164–184}}{{legend|#ff9a20|185–209}}{{legend|#f08015|210–247}}{{legend|#e06815|248–309}}{{legend|#d85010|310–404}}{{legend|#d02010|405–1879}}{{div col end}}]]

In 2017, 425&nbsp;million people had diabetes worldwide, up from an estimated 382&nbsp;million people in 2013 and from 108&nbsp;million in 1980. Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.8% among adults, nearly double the rate of 4.7% in 1980. Type&nbsp;2 makes up about 90% of the cases. Some data indicate rates are roughly equal in women and men, but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake.

The WHO estimates that diabetes resulted in 1.5&nbsp;million deaths in 2012, making it the 8th leading cause of death. However another 2.2&nbsp;million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes. For example, in 2017, the [[International Diabetes Federation]] (IDF) estimated that diabetes resulted in 4.0&nbsp;million deaths worldwide, using modeling to estimate the total number of deaths that could be directly or indirectly attributed to diabetes.

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==History==

{{Main|History of diabetes}}

Diabetes was one of the first diseases described, with an [[Ancient Egypt|Egyptian]] manuscript from {{Abbr|c.|circa}} 1500 [[Common Era|BCE]] mentioning "too great emptying of the urine." The [[Ebers papyrus]] includes a recommendation for a drink to take in such cases. The first described cases are believed to have been type&nbsp;1 diabetes. Indian physicians around the same time identified the disease and classified it as ''madhumeha'' or "honey urine", noting the urine would attract ants.

The term "diabetes" or "to pass through" was first used in 230&nbsp;BCE by the Greek [[Apollonius (physician)|Apollonius of Memphis]]. The disease was considered rare during the time of the [[Roman empire]], with [[Galen]] commenting he had only seen two cases during his career. This is possibly due to the diet and lifestyle of the ancients, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease "diarrhea of the urine" (diarrhea urinosa).

The earliest surviving work with a detailed reference to diabetes is that of [[Aretaeus of Cappadocia]] (2nd or early 3rd{{nbsp}}century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "[[Pneumatic school|Pneumatic School]]". He hypothesized a correlation between diabetes and other diseases, and he discussed differential diagnosis from the snakebite, which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.

Two types of diabetes were identified as separate conditions for the first time by the Indian physicians [[Sushruta]] and [[Charaka]] in 400–500&nbsp;CE with one type being associated with youth and another type with being overweight. Effective treatment was not developed until the early part of the 20th century when Canadians [[Frederick Banting]] and [[Charles Best (medical scientist)|Charles Best]] isolated and purified insulin in 1921 and 1922. This was followed by the development of the long-acting insulin [[NPH insulin|NPH]] in the 1940s.

===Etymology===

The word ''diabetes'' ({{IPAc-en|ˌ|d|aɪ|.|ə|ˈ|b|iː|t|iː|z}} or {{IPAc-en|ˌ|d|aɪ|.|ə|ˈ|b|iː|t|ᵻ|s}}) comes from [[Latin]] ''diabētēs'', which in turn comes from [[Ancient Greek]] [[wikt:διαβήτης|διαβήτης]] (''diabētēs''), which literally means "a passer through; a [[siphon]]". [[Ancient Greece|Ancient Greek]] [[physician]] [[Aretaeus of Cappadocia]] ([[Floruit|fl.]] 1st{{nbsp}}century [[Common Era|CE]]) used that word, with the intended meaning "excessive discharge of urine", as the name for the disease. Ultimately, the word comes from Greek διαβαίνειν (''diabainein''), meaning "to pass through", which is composed of δια- (''dia''-), meaning "through" and βαίνειν (''bainein''), meaning "to go". The word "diabetes" is first recorded in English, in the form ''diabete'', in a medical text written around 1425.

The word ''[[wikt:mellitus|mellitus]]'' ({{IPAc-en|m|ə|ˈ|l|aɪ|t|ə|s}} or {{IPAc-en|ˈ|m|ɛ|l|ᵻ|t|ə|s}}) comes from the classical Latin word ''mellītus'', meaning "mellite" (i.e. sweetened with honey; honey-sweet). The Latin word comes from ''mell''-, which comes from ''mel'', meaning "honey"; sweetness; pleasant thing, and the suffix -''ītus'', whose meaning is the same as that of the English suffix "-ite". It was [[Thomas Willis]] who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a person with diabetes had a sweet taste (glycosuria). This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and [[Persian people|Persians]].

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==Society and culture==

{{Further|List of films featuring diabetes}}

The 1989 "[[St. Vincent Declaration]]" was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy but also economically{{snd}}expenses due to diabetes have been shown to be a major drain on health{{snd}}and productivity-related resources for healthcare systems and governments.

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=== Diabetes stigma ===

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=== Racial and economic inequalities ===

People with diabetes who have neuropathic symptoms such as numbness or tingling in feet or hands are twice as likely to be [[unemployed]] as those without the symptoms.

In 2010, diabetes-related emergency room (ER) visit rates in the United States were higher among people from the lowest income communities (526 per 10,000 population) than from the highest income communities (236 per 10,000 population). Approximately 9.4% of diabetes-related ER visits were for the uninsured.

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===Naming===

Diabetes mellitus is also occasionally known as "sugar diabetes" to differentiate it from [[diabetes insipidus]].

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==Other animals==

{{main|Diabetes in dogs|Diabetes in cats}}

In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as [[Poodle|Miniature Poodles]].

Feline diabetes is strikingly similar to human type 2 diabetes. The [[Burmese cat|Burmese]], [[Russian Blue]], [[Abyssinian cat|Abyssinian]], and [[Norwegian Forest cat|Norwegian Forest]] cat breeds are at higher risk than other breeds. Overweight cats are also at higher risk.

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== See also ==

* [[Outline of diabetes]]

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== External links ==

{{Diabetes}}

{{Disease of the pancreas and glucose metabolism}}