Know the signs and symptoms of diabetes

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Diabetes mellitus is a serious metabolic disease,
affecting people of all geographic, ethnic or racial
origin and its prevalence is increasing globally1.
Burden from this costly disease is high on the low and
middle income countries (LMIC) where the impacts of
modernization and urbanization have caused marked
adverse changes in lifestyle parameters.
In 2013, of the estimated 382 million people with
diabetes globally, more than 80 per cent lived in LMIC.
It was estimated that India had 65.1 million adults with
diabetes in 2013, and had the 2nd position among the
top 10 countries with the largest number of diabetes.
This number is predicted to increase to 109 million by
2035 unless steps are taken to prevent new cases of
diabetes1. Primary prevention of diabetes is feasible
and strategies such as lifestyle modication are shown
to be effective in populations of varied ethnicity2,3.
However, for implementation of the strategies at the
population level, national programmes which are
culturally and socially acceptable and practical have
to be formulated which are currently lacking in most
of the developed and developing countries. Early
diagnosis and institution of appropriate therapeutic
measures yield the desired glycaemic outcomes and
prevent the vascular complications4.
Type 2 diabetes which accounts for 85-95 per cent
of all diabetes has a latent, asymptomatic period of
sub-clinical stages which often remains undiagnosed
for several years1. As a result, in many patients the
vascular complications are already present at the
time of diagnosis of diabetes, which is often detected
by an opportunistic testing. Asian populations in
general, particularly Asian Indians have a high risk of
developing diabetes at a younger age when compared
with the western populations5. Therefore, it is essential
that efforts are made to diagnose diabetes early so that
the long term sufferings by the patients and the societal
burden can be considerably mitigated.
Risk factors for diabetes
Many studies have shown that awareness about the
diabetes and its complications is poor among the general
population specially in the rural areas6,7. There is an
urgent need to create awareness among the population
regarding diabetes and about the serious consequences
of this chronic disorder. Epidemiological data from
India have shown the presence of a number of risk
factors which can be easily identied by simple non-
invasive risk scores8,9. The major risk factors are listed
in Box 1.
Signs and symptoms of diabetes
The signs and symptoms of diabetes are disregarded
by many because of the chronic progression of the
Indian J Med Res 140, November 2014, pp 579-581
Editorial
Know the signs and symptoms of diabetes
579
This editorial is published on the occasion of World Diabetes Day – November 14, 2014
Box 1. Major risk factors for type 2 diabetes in Indians
Positive family history of diabetes1.
Age >35 yr2.
Overweight (Body mass index ≥23 kg/m3. 2 ) and obesity
(Body mass index ≥25 kg/m2 )
Enlarged waist or upper body adiposity (>90 cm for 4.
men and >80 cm for women)
Presence of hypertension5.
Recent weight gain6.
Sedentary lifestyle7.
Gestational diabetes8.

580 INDIAN J MED RES, NOVEMBER 2014
disease. People do not consider this as a serious problem
because unlike many other diseases the consequences
of hyperglycaemia are not manifested immediately.
People are not aware that damage can start several
years before symptoms become noticeable. This is
unfortunate because recognition of early symptoms
can help to get the disease under control immediately
and to prevent vascular complications.
Warning signs & classic symptoms of diabetes
Considering the asymptomatic nature of type
2 diabetes in the early stages, it is essential that the
people are educated on its warning signs (Box 2).
The classic symptoms of diabetes such as polyuria,
polydypsia and polyphagia occur commonly in type
1 diabetes, which has a rapid development of severe
hyperglycaemia and also in type 2 diabetes with very
high levels of hyperglycaemia. Severe weight loss is
common only in type 1 diabetes or if type 2 diabetes
remains undetected for a long period. Unexplained
weight loss, fatigue and restlessness and body pain are
also common signs of undetected diabetes. Symptoms
that are mild or have gradual development could also
remain unnoticed.
Screening test for diabetes
A person of Asian origin aged 35 yr or more with
two or more of the above risk factors, should undergo
a screening test for diabetes. An oral glucose tolerance
test (OGTT) is commonly used as the screening test10.
Fasting and 2 h post glucose tests can identify impaired
fasting glucose (IFG) (fasting glucose >110 - <125
mg/dl), impaired glucose tolerance (IGT) (2 h glucose
>140-<200 mg/dl) and presence of diabetes (fasting >
126 and 2 h glucose >200 mg/dl). If a random blood
glucose value is > 150 mg/dl, further conrmation
by an OGTT is warranted. Recently, glycosylated
haemoglobin (HbA1c) has been recommended as the
test for diagnosis of diabetes (>6.5%). Presence of pre-
diabetes is indicated by HbA1c values between 5.7 - 6.4
per cent11.
Screening for undiagnosed T2DM is recommended
at the rst prenatal visit in women with above risk
factors, using standard diagnostic method criteria.
Screening for gestational diabetes (GDM) at 24-28 wk
of gestation is recommended in women who do not
have previous history of diabetes, as GDM remains
asymptomatic11. A history of GDM carries a high risk
for developing diabetes.
Signicance of identifying prediabetes
Even prediabetic stages such as IFG and IGT
carry high risk for vascular complications such as
cardiovascular diseases. The recent estimates by the
International Diabetes Federation (IDF)1 indicate that
globally there are more than 316 million people (6.9%)
with IGT. Among them, more than 70 per cent live in
LMIC1.
It is also important to note that currently one third of
those who have IGT are in the productive age between
20-39 yr and, therefore, are likely to spend many years
at high risk of developing diabetes and/or complications
of diabetes1. Some persons with prediabetes experience
reactive hypoglycaemia 2-3 hours after a meal. This
is a sign of impaired insulin metabolism indicative of
impending occurrence of diabetes. Therefore, periodic
medical check-up in people with such signs or risk
factors for diabetes would reduce the hazards involved
in having undiagnosed diabetes. It would help improve
the health status of a large number of people who
otherwise would be silent sufferers from the metabolic
aberrations associated with diabetes.
Conclusions
Awareness about the signs and symptoms and
periodic screening especially in the presence of risk
factors and warning signs of diabetes, would go a long
way in preventing new cases of diabetes by providing
an opportunity to intervene at the stage of prediabetes.
It is evident that diabetes can be prevented among
Box 2. Warning signs of diabetes
Unexplained weight loss1.
Frequent fatigue2.
Irritability3.
Repeated infections especially in the4.
Genital areas•
Urinary tract•
Skin•
Oral cavity•
Delayed wound healing•
Dry mouth5.
Burning, pain, numbness on feet6.
Itching7.
Reactive hypoglycaemia8.
Acanthoses nigricans-the presence of velvety dark 9.
patches of the neck, arm pit, groin which is an indicator
of insulin resistance
Decreased vision10.
Impotence or erectile dysfunction11.

prediabetic individuals by improvements in physical
activity and diet habits. Such strategies will also prevent
development of diabetic complications to a great extent.
Patient empowerment is vital in diabetes management.
This can be done through patient education and sharing
information on management and preventive aspects of
diabetes.
A. Ramachandran
India Diabetes Research Foundation &
Dr. A. Ramachandran’s Diabetes Hospitals
28, Marshalls Road, Egmore
Chennai 600 008, Tamil Nadu, India
ramachandran@vsnl.com
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