Diabetes: From ancient Egypt to modern pandemic

History​

Diabetes is not a new disease, being first documented in 1550BC in Egypt. Back then diabetes, or what the historians believe was diabetes, was described as a rare disease. According to an exhibition on diabetes and endocrinology by the Royal College of Physicians of Edinburgh (Scotland), an Egyptian manuscript mentions “the passing of too much urine”​, which historians take as the first reference to diabetes.

We had to wait a further 1600 years for a complete clinical description and name for the condition, when the Greek physician Aretaeus used the word diabetes (from the Greek meaning ‘siphon’) and noted “the excessive amount of urine which passed through the kidneys”​.

The condition may have been rare 3,500 years ago, but it is not anymore. According to the World Health Organisation (WHO), diabetes affects over 220 million people globally and the consequences of high blood sugar kill 3.4 million every year. If such statistics weren’t scary enough, the WHO is predicting deaths to double between 2005 and 2030.

The total costs associated with the condition in the US alone are thought to be as much as $174 billion, with $116 billion being direct costs from medication, according to 2005-2007 American Diabetes Association figures.

Types​

The condition exists in various types, most notably type-1, type-2, and gestational. All types are characterized by excessive levels of glucose in the blood because the pancreas does not produce enough or any insulin, a hormone that facilitates the uptake of glucose by the cells. It may also be that the insulin does not function adequately, a condition known as insulin resistance.

Type-1 diabetes occurs when people are not able to produce any insulin after the cells in the pancreas have been damaged, thought to be an autoimmune response. The disease is most common among people of European descent, with around two million Europeans and North Americans affected.

The development of high blood sugar levels during pregnancy, called gestational diabetes, is known to boost a woman’s risk of subsequently developing type-2 diabetes, as well as putting the offspring at increased risk of childhood obesity and diabetes as they get older.

Type-2 diabetes – which reportedly accounts for at least 90 percent of cases – traditionally occurs in people over 40, a statistic that is changing:

A recent article in The Lancet​ by scientists from Australia, Denmark, and Canada noted that: “Until 1990, type-2 diabetes was seldom seen in young people and in pregnant women, but this is no longer the case.​

“In some countries type 2 diabetes is still rare in children and adolescents, for instance in Germany, where prevalence is 2.3 per 100 000 in people aged 0-20 years. The incidence of type-2 diabetes in young people has, however, become greater than that of type-1 diabetes in some ethnic groups, as seen in the USA (12.1 vs 7.4 per 100 000 in Asians and Pacific Islanders aged under 20 years, and 19.0 vs 15.7 per 100 000 in African Americans aged 0-19 years).​

“In young people type-2 diabetes associated with obesity frequently remains undiagnosed and is difficult to manage”​. (July 2011, Vol. 378, Pages 169-181)

How to stop it​

Diet and exercise are seen as key to the prevention of developing type-2 diabetes. The WHO states simply: “Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type-2 diabetes”.​

Studies have indicated that specific nutrients may offer benefits for people at risk of diabetes, or already living with the condition. To date, the most widely reported nutrients include chromium, magnesium, calcium, potassium, vitamin B3, and antioxidants such as vitamin C, E and selenium.

Oxidative stress has been reported to be a key driver in the onset of insulin resistance, while diabetes itself is associated with increased levels of oxidative stress, and this can promote the development of diabetes-related complications (Journal of Biochemical and Molecular Toxicology​, 2003, Vol. 17, pp. 24-38).

There is also some evidence on the importance of vitamin D to reduce the risk of diabetes. For example, a study published in Maturitas ​(2010, Vol. 65, pp. 225-236) suggested that the highest blood levels of the vitamin were associated with a 55 per cent reduction in the risk of type 2 diabetes​, with researchers pointing out that the potential mechanism is not fully understood.

Another interesting area of research concerns coffee: A meta-analysis published in the Archives of Internal Medicin​​e in 2009 concluded that consumption of three to four coffee may reduce the risk of developing diabetes by 25 per cent. The potential bioactive compounds in the beverage responsible for the reported benefits may include magnesium, antioxidant lignans or chlorogenic acids.

The Glycemic Index (GI) is also highlighted as a means of controlling blood sugar levels, since slow release carbohydrates – those with a low GI – may help balance blood sugar levels.

Commenting on supplements versus foods, the American Diabetes Association states: “There isn’t research that clearly points to supplementation, so always think first about getting your nutrients from foods”​.

Gut feeling​

There has also been a proposed microbial element to diabetes. Preliminary data from Denmark​ indicated that bacterial populations in the gut of diabetics differ from non-diabetics.

The study, reportedly the first to look at intestinal microbiota in humans with and without type-2 diabetes, was published in the open-access peer-reviewed journal PLoS ONE.

“Our data suggest that the levels of glucose tolerance or severity of diabetes should be considered while linking microbiota with obesity and other metabolic diseases in humans,”​ wrote researchers from the University of Copenhagen.

“It is especially important for developing the strategies to modify the gut microbiota in order to control metabolic diseases, since obesity and diabetes might be associated with different bacterial populations,”​ they added.

The dietary and nutritional approaches to benefit people at risk from diabetes, and people already living with the condition, will be considered tomorrow in part two of NutraIngredients’ special edition on diabetes.