Prevention of Diabetes and Complications

Diabetes and Associated Disorders

Diabetes is a syndrome – literally a “running together” of associated conditions. Type 1 diabetes associates with a number of autoimmune disorders. Obesity, specifically central obesity, is prominent among these, and the combination of “diabesity” is associated with hypertension, dyslipidaemia and arterial disease – the so-called metabolic syndrome. More recently, it has been appreciated that certain types of cancer are more common in association with diabetes and obesity, and there has been controversy as to the extent to which treatments for diabetes can modulate the risk of cancer in one direction or the other.
The incidence of type 2 diabetes rises sharply in relation to obesity. The combination of obesity with insulin resistance or hyperinsulinaemia is however associated with all features of the metabolic syndrome, arterial disease and some types of cancer. Hypertension may arise as a complication of diabetic nephropathy, or (more commonly) as a feature of the type 2 diabetes syndrome. The prevalence of hypertension is increased in those with abnormal glucose tolerance, and it is commonly present at the diagnosis of diabetes. The association is independent of potential confounders such as age, glucose control or proteinuria. The dyslipidaemia of diabetes is characterized by high triglycerides and low HDL cholesterol. This is considered due to overproduction (or reduced removal) of VLDL particles, which is itself a feature of insulin resistance. Diabetes and obesity are associated with a similar range of cancers, including pancreatic, hepatic, endometrial, breast and colorectal cancers.