Diabetes: preventing the disease and its complications. Urgent action is needed!

How does diabetes progress? It is an epidemic that is spreading rapidly around the world, alongside obesity, and France is no exception. According to the French national health insurance system, there are 3.8 million diabetics in our country. However, many sufferers are unaware of their condition, as it can remain silent for a very long time, and we are currently underdiagnosing it. Obesity increases the need for insulin to regulate blood sugar levels, while the pancreas secretes less of it. Too many people still discover they have the disease when they arrive at the emergency room after a serious diabetes-related event, such as a heart attack or stroke. Type 2 diabetes is often associated with obesity, high blood pressure, or high cholesterol. This combination of conditions increases the risk of serious complications, particularly cardiovascular complications. These can be macrovascular, affecting the arteries of the heart, brain, or legs, or microvascular, affecting the blood vessels of the retina or kidneys.
Type 1 diabetes, on the other hand, with its accompanying symptoms of fatigue, weight loss, thirst, and frequent urination, is easily diagnosed but accounts for only 10% of cases. How can we better prevent the onset of diabetes?

It is important to have your blood sugar levels checked regularly if you are at risk, i.e., if you are obese and have one or two parents with type 2 diabetes. This test can diagnose the disease if the value is > 1.25 g/l; a definition common to both types of diabetes, with a non-fasting blood sugar level > 2 g/l. It is also possible to measure glycated hemoglobin (HbA1c), i.e., the percentage of sugar that has been deposited in hemoglobin over the last three months.
Early detection of diabetes helps to limit or delay the most serious complications. The risk of developing or seeing the disease progress also decreases by adopting a low glycemic index diet (the ability of a food to raise blood sugar levels), which is therefore lower in fast-acting sugars, and by combating a sedentary lifestyle. Eating five portions of fruit and vegetables a day, in line with the PNNS (National Nutrition and Health Program), and doing 30 minutes of physical activity (or 7,000 steps) every day are good guidelines. Similarly, the NUTRISCORE, with its simple color-coded system, has the advantage of being easy to read and understand for everyone.
The situation is different for people with type 1 diabetes, which is an autoimmune disease unrelated to lifestyle, with antibodies that quickly destroy certain cells in the pancreas, which then no longer produce insulin. This disease affects young people. The main risk factor for developing complications in these patients is associated tobacco use. In all cases, regular check-ups, especially after ten years of living with diabetes, allow complications to be detected earlier and better managed.

Is the risk of developing type 2 diabetes higher for women? There is no evidence to support this, and diabetes even tends to "erase" the differences between men and women in terms of complications. There is one exception, however: gestational diabetes, which occurs during pregnancy. The risk increases with age and weight gain. Screening can be carried out in "borderline" cases by having the patient drink a certain amount of sugar and then measuring their blood sugar levels. After pregnancy, about one in two women who have reported gestational diabetes will remain diabetic, and all will have a greater risk factor for developing the disease in the years following pregnancy. This is why, here too, regular blood sugar monitoring must be carried out after pregnancy. The same applies to high blood pressure.
Furthermore, type 2 diabetes is similar to a societal disease, since precariousness and vulnerability—which more often affect women—reduce the chances of receiving appropriate care and increase the risk of developing complications.
And the possible withdrawal of health insurance coverage for long-term conditions (ALD) (i.e., 100% coverage) could no longer apply to diabetes without complications, further distancing patients from care.

What about drug therapies? Much progress has been made in recent years. For type 1 diabetes, more suitable insulins have appeared, such as very long-acting insulins, and the mode of administration is advancing with external or implanted pumps. We are now at the stage of communication between the convenient blood glucose sensor on the shoulder (which avoids pricking the fingertip) and the pump to "automate" treatment, so to speak. For type 2 diabetes, while older treatments lowered blood glucose levels without reducing the number of complications, recent products reduce cardiovascular events.
Some of these products cause weight loss, among other things, which has earned them a lot of publicity, but above all they reduce cardiovascular risk to such an extent that the weekly injection is a minor inconvenience given the results obtained, and tablets are now available. While heart attacks and strokes are in sharp decline, kidney failure, with a relatively stable frequency, remains the leading cause of dialysis in France.
Other recently developed treatments, which initially reduce blood sugar levels by acting on renal elimination, can slow down kidney damage. It should be noted that the effects are such that these products are also used in "non-diabetics," particularly in cases of heart failure.
In conclusion, it is important to screen regularly for diabetes by testing blood sugar levels, especially if you are at risk, and to adopt a healthy lifestyle. For established disease, regular screening for complications, treatment with new therapies, and management of risk factors associated with diabetes will help limit serious complications.