Iran (IMNA) - According to Dr. Ali Kachouei, endocrinology and metabolism specialist, diabetes is characterized by chronic hyperglycemia resulting from insufficient insulin production or impaired cellular response to insulin. Insulin is an essential hormone that facilitates glucose uptake by cells for energy production. Inadequate insulin secretion or action leads to elevated blood glucose, which over time, can cause significant organ damage.
Classification of Diabetes
- Type 1 Diabetes (T1DM): An autoimmune condition often manifesting in childhood or adolescence, caused by destruction of pancreatic beta cells leading to absolute insulin deficiency.
- Type 2 Diabetes (T2DM): Common in adults, associated with insulin resistance and relative insulin insufficiency.
- Gestational Diabetes: Develops during pregnancy, usually resolves postpartum, but increases future risk of T2DM.
Glycemic Targets and Prediabetes
Dr. Maryam Rajali, family physician and diabetes expert, notes that normal fasting plasma glucose in healthy individuals ranges from 70–100 mg/dL, with postprandial glucose less than 140 mg/dL. Fasting glucose levels between 100–125 mg/dL indicate prediabetes, reflecting an elevated risk for type 2 diabetes. Regular monitoring of these parameters is essential for early detection and preventive interventions.
Clinical Presentation
Early diabetes may be asymptomatic. Classical manifestations include polydipsia, polyuria, fatigue, unintentional weight loss, blurred vision, and slow-healing wounds. Both Drs. Kachouei and Rajali emphasize that timely screening and diagnosis are vital for preventing progression and minimizing complications.
Risk Factors and Epidemiology
Dr. Kachouei explains that type 2 diabetes constitutes 90–95% of all cases and develops insidiously, often remaining undiagnosed for 8–11 years. Risk factors include overweight or obesity, age over 35, family history of diabetes or cardiovascular disease, hypertension, and certain medications. Assessment of BMI and evaluation of additional risk factors provide a practical method for identifying at-risk individuals.
Renal Implications of Uncontrolled Diabetes
Dr. Kachouei further explains that uncontrolled hyperglycemia contributes to renal injury. Hyperglycemia induces hemodynamic, metabolic, and inflammatory changes in the glomeruli (mesangial expansion), leading to glomerulosclerosis and fibrosis. Chronic kidney disease can develop, sometimes requiring dialysis. Patients with diabetic nephropathy have a threefold higher risk of cardiovascular mortality.
Screening and Monitoring Recommendations
Dr. Rajali highlights the importance of regular diabetes screening, particularly for high-risk populations, including individuals with family history, overweight, or age over 45. Laboratory evaluation should include fasting plasma glucose, hemoglobin A1C, and, when indicated, oral glucose tolerance testing. Prediabetes (fasting glucose 100–125 mg/dL) is a critical window for intervention, as metabolic and vascular complications may already begin.
Complications of Poorly Controlled Diabetes
Chronic hyperglycemia can result in:
- Microvascular complications: nephropathy, retinopathy, neuropathy
- Macrovascular complications: coronary artery disease, cerebrovascular disease
- Peripheral complications: foot ulcers, infections, increased risk of amputations
Lifestyle and Therapeutic Interventions
Dr. Rajali emphasizes that lifestyle modification is fundamental for prevention and management: regular physical activity, a balanced diet low in refined sugars and saturated fats, maintaining healthy body weight, and avoiding tobacco. In patients with established diabetes, adherence to prescribed pharmacotherapy, routine glucose monitoring, and medical follow-up are essential for optimal disease control.
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