Diabetes mellitus Symptoms Causes Types Stats in pak in urban and rural areas The signs a patient presents with Diagnosis Treatment
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"diabetes mellitus" AND epidemiology
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Pakistan diabetes prevalence urban rural population national survey latest
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https://pubmed.ncbi.nlm.nih.gov/30082350/
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ADA Standards of Care 2026 diagnosis diabetes criteria treatment type 2 diabetes official
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Diabetes mellitus
Diabetes mellitus (DM) is a chronic condition in which blood glucose is persistently high because the body produces too little insulin, cannot use insulin effectively, or both.
Symptoms reported by a patient
Some people, especially with type 2 diabetes, have no symptoms initially.
Common symptoms:
- Polyuria: frequent, large-volume urination
- Polydipsia: excessive thirst
- Polyphagia: increased hunger
- Unexplained weight loss, particularly in type 1 diabetes
- Tiredness and reduced concentration
- Blurred vision
- Recurrent infections, such as skin, urinary, genital yeast, or gum infections
- Slow healing of wounds
- Tingling, burning, numbness, or pain in feet and hands
- Sexual dysfunction
Severe acute presentation may include nausea, vomiting, abdominal pain, deep rapid breathing, dehydration, confusion, or drowsiness. This can indicate diabetic ketoacidosis or hyperosmolar hyperglycaemic state and needs urgent hospital care.
Causes and risk factors
Type 1 diabetes
An autoimmune process destroys the insulin-producing beta cells of the pancreas, leading to absolute insulin deficiency. Genetic susceptibility and environmental triggers contribute, but it is not caused by eating sugar.
Type 2 diabetes
Caused by a combination of:
- Insulin resistance in muscle, liver, and fat
- Progressive failure of pancreatic beta cells to produce enough insulin
Important risk factors:
- Overweight or central obesity
- Physical inactivity
- Family history of diabetes
- Increasing age
- High blood pressure or abnormal blood lipids
- Previous gestational diabetes
- Polycystic ovary syndrome
- Smoking
- Certain medicines, especially glucocorticoids
- South Asian ethnicity, where risk may occur at a lower BMI
Types of diabetes
| Type | Main mechanism | Usual presentation | Main treatment |
|---|---|---|---|
| Type 1 DM | Autoimmune beta-cell destruction, little or no insulin | Often childhood or young adulthood, but can occur at any age; may present abruptly | Lifelong insulin |
| Type 2 DM | Insulin resistance plus declining insulin secretion | Usually gradual; often adults, increasingly younger people | Lifestyle measures, glucose-lowering medicines, sometimes insulin |
| Gestational DM | Diabetes first recognized during pregnancy | Usually screened for at 24-28 weeks | Diet, activity, glucose monitoring, medicines/insulin when needed |
| Other specific types | Genetic diabetes, pancreatic disease, endocrine disorders, medication-induced diabetes | Variable | Treat cause plus glucose management |
Signs found on examination
A clinician may find:
- Overweight or increased waist circumference
- Raised blood pressure
- Dehydration, dry mouth, rapid pulse, or low blood pressure in severe hyperglycaemia
- Acanthosis nigricans: dark, velvety skin thickening, commonly on the neck or armpits, suggesting insulin resistance
- Skin or genital fungal infection
- Foot ulcers, calluses, reduced pulses, or reduced sensation
- Peripheral neuropathy: reduced vibration, pinprick, or monofilament sensation in feet
- Retinal changes on eye examination
- Unintentional weight loss and muscle wasting in severe untreated diabetes
Diagnosis
Diabetes is diagnosed by any one of the following laboratory criteria:
| Test | Diabetes-range result |
|---|---|
| HbA1c | ≥6.5% |
| Fasting plasma glucose | ≥126 mg/dL or 7.0 mmol/L |
| 2-hour plasma glucose after 75-g OGTT | ≥200 mg/dL or 11.1 mmol/L |
| Random plasma glucose with classic symptoms or hyperglycaemic crisis | ≥200 mg/dL or 11.1 mmol/L |
In a person without clear symptoms, an abnormal result should generally be repeated on another day to confirm the diagnosis. HbA1c can be unreliable in some conditions affecting red blood cells, such as significant anemia, hemoglobin disorders, recent blood loss, or some kidney diseases. The medical textbook source notes that diagnosis uses fasting glucose, 75-g oral glucose tolerance testing, and HbA1c, with confirmation by two abnormal results when appropriate.
Prediabetes is an intermediate high-risk state:
- HbA1c 5.7%-6.4%
- Fasting glucose 100-125 mg/dL
- 2-hour OGTT glucose 140-199 mg/dL
Diabetes statistics in Pakistan: urban and rural areas
The best nationally representative comparison is the Second National Diabetes Survey of Pakistan (NDSP), 2016-2017, in adults aged 20 years and older. These figures are important but should be described as survey-period estimates, not current 2026 prevalence.
| Measure | Overall Pakistan | Urban | Rural |
|---|---|---|---|
| Diabetes prevalence | 26.3% | 28.3% | 25.3% |
| Prediabetes prevalence | 14.4% | 15.5% | 13.9% |
| Known diabetes | 19.2% | Not shown here | Not shown here |
| Newly detected diabetes | 7.1% | Not shown here | Not shown here |
Thus, diabetes was more prevalent in urban than rural communities in this survey, but the rural burden was also very high. The survey found higher risk associated with age 43 years or older, family history, hypertension, obesity, and dyslipidaemia. See the Pakistan national survey for the full methods and provincial data.
Treatment
Treatment is individualized according to diabetes type, glucose level, weight, kidney function, pregnancy status, complications, cost, and risk of hypoglycaemia.
1. Lifestyle and self-management
For most people with type 2 diabetes:
- Reduce sugary drinks and refined carbohydrates
- Choose vegetables, pulses, whole grains, lean proteins, and appropriate portions
- Aim for regular physical activity, often at least 150 minutes/week of moderate aerobic activity if safe
- Reduce body weight when overweight
- Stop smoking
- Learn home glucose monitoring where advised
- Foot care: inspect feet daily, avoid walking barefoot, and seek care promptly for ulcers or infection
2. Medicines for type 2 diabetes
- Metformin is frequently used when suitable, especially if kidney function permits.
- Other options include:
- SGLT2 inhibitors, especially useful when heart failure or chronic kidney disease is present
- GLP-1 receptor agonists or dual GIP/GLP-1 agents, which can help glucose control and weight loss, and may benefit people with cardiovascular risk
- DPP-4 inhibitors
- Sulfonylureas
- Pioglitazone
- Insulin
The choice should not be based on glucose alone. Current ADA guidance recommends including medicines that reduce cardiovascular and kidney risk for people with type 2 diabetes and established or high-risk cardiovascular disease, heart failure, or chronic kidney disease, even irrespective of glycaemic level in relevant cases, as described in the 2026 ADA Standards.
3. Insulin
- Essential for all type 1 diabetes
- Used in type 2 diabetes when glucose is very high, symptoms are severe, during acute illness, pregnancy when indicated, or when non-insulin treatment is insufficient
- Requires education on injection technique, glucose checks, meal timing, and prevention/treatment of hypoglycaemia
4. Prevention and complication screening
At diagnosis and regularly thereafter, assess:
- Blood pressure and cholesterol
- Kidney function and urine albumin
- Eye disease with retinal examination
- Foot sensation, pulses, ulcers, and neuropathy
- Cardiovascular risk
- Vaccination status
Do not start, stop, or select diabetes medicines without a clinician, particularly insulin, sulfonylureas, and drugs used during pregnancy or kidney disease.
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