Type 2 diabetes: a global pandemic set to reach alarming numbers. What are the solutions?

We talked to Rosa Maria Paragliola, Professor of Endocrinology at UniCamillus University

Over the last two decades, people affected by type 2 diabetes have risen from 150 million to more than 350 million—with numbers set to rise, unfortunately. Suffice it to say that both the WHO and the International Diabetes Federation estimate an increase of more than 640 million people affected worldwide by 2030. It is no coincidence that there is talk of a ‘global pandemic’.

In Italy, the numbers are no less alarming, considering that diabetic patients account for 6% of the total population, with 73 disease-related deaths per day.

A drama for the individual patient, families and caregivers, but also from a social point of view: the chronic nature of diabetes makes it an enormous economic burden on the National Health System. And it is even more so, considering the comorbidity related to diabetes, with problems affecting the heart, vascular system, kidneys and sight.

In addition to genetic and hereditary factors, the causes of type 2 diabetes also include an unhealthy lifestyle, characterised by poor diet and sedentary life, resulting in obesity or overweight, combined with smoking and alcohol. It is not by chance that in a society of ‘affluence’ (with dietary abuse and poor physical exertion) there is an exponential increase in this problem.

The advancing age, of course, does not help. Analysing data on 285,000 Italian adults collected by the PASSI e PASSI d’Argento surveillance systems—coordinated by the National Institute of Health and the Regions—in the period 2016-2022, we find that the percentage of patients suffering from diabetes increased considerably with advancing age. If before the age of 50 it remains below 5%, towards the age of 80 it reaches 23%.

To better explore the causes and possible solutions, we interviewed Rosa Maria Paragliola, Professor of Endocrinology at UniCamillus University.

In just 20 years, the number of people suffering from diabetes in the world has more than doubled, reaching exorbitant figures. What do you think about the recent trend of increasing diabetes cases both nationally and globally? What main factors contribute to it?

“Diabetes is a chronic disease characterised by the presence of hyperglycaemia, i.e. high blood glucose levels. The most frequent form of this condition is the so-called ‘type 2 diabetes’, which means the body finds it difficult to use the hormone insulin correctly. Insulin is produced by the pancreas and allows glucose to enter the body’s cells to be used as an energy source.

The number of people with diabetes is gradually increasing over the years, and this trend represents a major social problem, if we consider all the complications with which diabetes can be associated. Apart from acute complications (which can even lead to coma in the most severe cases), chronic complications can occur over the course of years involving various organs and tissues, such as the eyes, kidneys, nerves and blood vessels. The risks, therefore, are the loss of visual capacity, impaired kidney function, cardiovascular disease and limb damage.

There are many factors that might predispose an individual to the risk of diabetes—in particular type 2 diabetes. Certainly, an important contribution should be sought in genetic factors and family predisposition, but it is essential to emphasise the role played by unhealthy lifestyles, which are unfortunately part of modern living habits. A diet characterised by an excess of sugar, refined carbohydrates and fat, and low in fibre increases the risk of diabetes. Obesity and sedentary lifestyles also contribute to the risk of diabetes by reducing tissue sensitivity to insulin. Other detrimental factors for health are cigarette smoking and alcohol abuse, which, in addition to being risk factors for other chronic diseases, also negatively affect the risk of developing diabetes. Unfortunately, some medications, including corticosteroids, may also increase the risk of blood glucose alterations. Finally, it should be borne in mind that, as life expectancy increases, a greater percentage of people are reaching older ages: as the risk of type 2 diabetes increases with age, an increase in the elderly population inevitably leads to more cases of diabetes.”

Let’s talk about the institutions. What strategies do you think the institutions can implement to improve diabetes management in our country?

Promoting awareness campaigns is a key element in improving diabetes management. It is important for the general public to be clearly informed about the risk factors and the complications of diabetes and, above all, to be made aware of the importance of prevention, which consists in adopting healthy lifestyles (a balanced diet, physical activity, abstaining from smoking, and so on). These programmes should be promoted from childhood onwards through educational projects in schools, aimed at encouraging the choice of healthy foods, according to the principles of the Mediterranean diet, and banning processed foods, which are rich in ‘hidden’ sugars and increase the risk of becoming overweight and obese.  

It would also be useful to propose screening campaigns to diagnose diabetes at an early stage, especially in the presence of risk factors (family history, overweight, obesity, use of medications that may increase the risk of diabetes).”

An important issue is involving people with diabetes in educational programmes. What difficulties does a physician face in this regard?

“The education of patients with diabetes is as important as it is complex and represents a constant challenge for the physician. The greatest difficulties, in many cases, are due to the patient’s poor acceptance of the disease, the established (and difficult to eliminate) presence of unsuitable lifestyles, and the lack of a supportive social and family context. Sometimes, the lack of communication between different specialists involved in the management of the patient is also a substantial barrier. First and foremost, the healthcare professional must strive to build an effective dialogue with the patient: medical information must be conveyed with clarity, simplicity and empathy, taking the appropriate time during medical examinations and possibly using other information channels. It would also be useful to involve the patients’ relatives, raising awareness of the importance of adhering to therapy and following appropriate lifestyles, as well as promoting multidisciplinary collaboration between the different healthcare professionals in charge of the patient.”

What are the first symptoms not to underestimate?

“The symptoms of diabetes that should not be underestimated are those indicating a hyperglycaemic condition. In particular, it is important to note excessive thirst, increased frequency of urination and the production of large amounts of urine, since the appearance of these complaints should prompt further evaluation.”

Considering that diabetes is a chronic condition, what are the necessary long-term check-ups?

“A patient with diabetes should have a number of regular check-ups in order to keep blood glucose levels within limits and to prevent complications or diagnose them early. First, it is useful for the patient to learn how to check blood glucose with a glucometer, i.e. a simple instrument that allows rapid blood glucose measurement at home, and to monitor body weight. Periodic laboratory tests (blood, urine) to check blood glucose levels, glycated haemoglobin, kidney function, and cholesterol levels are also indicated. It is equally important to monitor blood pressure and perform regular clinical and instrumental check-ups to ensure the health of the heart, vessels, eyes and lower limbs. Regular inspection of the feet is useful for early diagnosis of infection or nerve damage. The frequency of these checks may vary depending on the condition and individual history of each patient and should be established by the clinician.”

How is smoking related to diabetes?

“Smoking increases the risk of developing type 2 diabetes by 30-40% and significantly reduces life expectancy. These risks are directly proportional to the number of cigarettes smoked and the years of smoking habit. The chemicals in cigarettes cause an inflammatory condition that impairs insulin activity. In particular, nicotine interferes with specific mechanisms in the brain, which in turn regulate the release of the hormones insulin and glucagon, responsible for maintaining adequate blood glucose levels. This is also true for smoking diabetic patients on insulin treatment, who often require higher doses of the medication to control blood sugar. Moreover, smoking is an additional risk factor for complications associated with diabetes: smokers are more likely to suffer from diseases involving the heart, kidneys, blood vessels, eyes and nerves through the inflammatory action of cigarette combustion products. Smoking increases the risk of infections and ulcers, which in turn are frequent causes of amputations. In addition, nicotine promotes the accumulation of fat in the abdomen, which in turn is associated with reduced sensitivity to the action of insulin. Giving up smoking is vital to reduce all complications associated with diabetes and is part of the therapeutic tools to be adopted in the management of this condition.”

Considering the current scenario and future challenges, what are your main recommendations for policymakers and healthcare professionals to address the growing diabetes epidemic in Italy and worldwide?

“Addressing the rampant diabetes epidemic requires multiple approaches involving both politicians and all those institutions that regulate health sector activities. At the operational level, actions should be aimed at both the general public and healthcare professionals. The most crucial investment is certainly prevention. As already emphasised, people must be made aware and educated about the harmful risks of diabetes and the importance of following a healthy lifestyle, starting from school. Discouraging the use of ‘obesogenic’ foods, which increase the risk of metabolic syndrome, and thus promoting healthy dietary habits, represent one of the greatest and most complex challenges for food policymakers. Moreover, as early diagnosis of both diabetes and its complications is vital, free screening campaigns should be enhanced, especially in at-risk populations. It is essential for political institutions to ensure access to medical examinations and treatment by the National Health Service, especially for the less affluent sections of the population. Similarly, it would be useful to invest in educational support programmes for patients and their families, aimed at improving their ability to self-manage the disease. Healthcare professionals must receive constant theoretical and practical training on diabetes management, which also aims at improving communication strategies to optimise the doctor-patient relationship and multidisciplinary collaboration. Investing in diabetes research and in the development of new technologies to support medicine will, finally, both deepen our knowledge of the mechanisms underlying the disease and its complications and improve the therapeutic approach, the management of the disease, as well as the quality of life of our patients.”