A STUDY ON COGNITIVE DYSFUNCTION IN EARLY STAGE OF DIABETES

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About Author:
Hiren Sakhiya,
M.Sc in Clinical Research Management,
Prist University, Thanjavur,

India
*sakhiyahiren@gmail.com

ABSTRACT
Diabetes a chronic (lifelong) disease marked by high levels of sugar in the blood. Diabetes is a common disease in older age, affecting about one in five individuals. In 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will almost double. Diabetes is also associated with mortality and significant morbidity, including neurological disability. Diabetes affects both peripheral nervous system and central nervous system. Neuropathy along with retinopathy and nephropathy appears in late stage of diabetes but effect on cognition starts in early stage of diabetes. Although the effects of diabetes on the peripheral nervous system are well established, the effects of diabetes on the central nervous system have been less clear. Several studies have found that diabetes is related to dementia and cognitive function. It is unclear in which stage of diabetes the cognitive decrements become manifest and how they progress over time. Study is conducted to confirm the association of cognitive function with diabetes.

Reference ID: PHARMATUTOR-ART-1306

INTRODUCTION:
Diabetes is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria(frequent urination), polydipsia(increased thirst) and polyphagia(increased hunger).

There are three main types of diabetes:

Type 1 diabetes:  It results from the body's failure to produce insulin, and presently requires the person to inject insulin (Also known as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes).

Type 2 diabetes:It results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes)

Gestational diabetes:is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

Sign and symptoms
The main symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more slowly and may be subtle or absent.

Prolonged high blood glucose causes glucose absorption that leads to changes in the shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected. People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a rapid, deep breathing known as Kussmaul breathing, nausea, vomiting and abdominal pain, and altered states of consciousness.

A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss. A number of skin rashes can occur in diabetes that are collectively known as diabetic dermadromes.

Pathophysiology
Insulin is the important hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells). Therefore deficiency of insulin or the insensitivity of its receptors plays a main role in all forms of diabetes mellitus. Humans are capable of digesting some carbohydrates, in particular those most common in food; starch, and some disaccharides such as sucrose, are converted within a few hours to simpler forms most notably the monosaccharide glucose, the principal carbohydrate energy source used by the body. The rest are passed on for processing by gut flora largely in the colon. Insulin is released into the blood by beta cells (β-cells), found in the Islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon which acts in the opposite manner to insulin. Glucose thus forcibly produced from internal liver cell stores (as glycogen) re-enters the bloodstream; muscle cells lack the necessary export mechanism. Normally liver cells do this when the level of insulin is low (which normally correlates with low levels of blood glucose).

Higher insulin levels increase some anabolic processes such as cell growth and duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat burning metabolic phase).

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not have its usual effect so that glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.

When the glucose concentration in the blood is raised beyond its renal threshold (about 10 mmol/L, although this may be altered in certain conditions, such as pregnancy), reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst.

Epidemiology
In 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will almost double. Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030. The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at present, though there is much speculation, some of it most compellingly presented.

For at least 20 years, diabetes rates in North America have been increasing substantially. In 2010 nearly 26 million people have diabetes in the United States alone, from those 7 million people remain undiagnosed. Another 57 million people are estimated to have pre-diabetes.

The Centers for Disease Control has termed the change an epidemic. The National Diabetes Information Clearinghouseestimates that diabetes costs $132 billion in the United States alone every year. About 5%–10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs. Most of this difference is not currently understood. The American Diabetes Association cite the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion (Centers for Disease Control and Prevention) that 1 in 3 Americans born after 2000 will develop diabetes in their lifetime.

According to the American Diabetes Association, approximately 18.3% (8.6 million) of Americans age 60 and older have diabetes. Diabetes mellitus prevalence increases with age, and the numbers of older persons with diabetes are expected to grow as the elderly population increases in number. The National Health and Nutrition Examination Survey (NHANES III) demonstrated that, in the population over 65 years old, 18% to 20% have diabetes, with 40% having either diabetes or its precursor form of impaired glucose tolerance.

Indigenous populations in first world countries have a higher prevalence and increasing incidence of diabetes than their corresponding non-indigenous populations. In Australia the age-standardized prevalence of self-reported diabetes in Indigenous Australians is almost 4 times that of non-indigenous Australians. Preventative community health programs such as Sugar Man (diabetes education)are showing some success in tackling this problem.

Currently in the United States 7.8% of the population or around 23.6 million people have diabetes with 5.7 million being undiagnosed. Most of those diagnosed have Type-2 diabetes and are usually 45 years of age or older. But this snapshot is changing as more children and adolescents are increasingly being diagnosed with this type of diabetes.

Studies show that the most common complication of Type-2 diabetes is cardiovascular and it is also the most costly complication at a cost of approximately $7 billion of the $44 billion annual direct medical costs for diabetes. This figure is from 1997 and many estimate that these figures could have doubled by now.

As of 2000 it was estimated that 171 million people globally suffered from diabetes or 2.8% of the population. Type-2 diabetes is the most common type worldwide.

Figures for the year 2007 show that the 5 countries with the largest amount of people diagnosed with diabetes were India (40.9 million), China (38.9 million), US (19.2 million), Russia (9.6 million), and Germany (7.4 million).

Currently, India is the diabetes capital of the world. It is estimated that over 40 million of those with diabetes are currently in India and that by 2025 that number will grow to 70 million. In other words, 1 in every 5 diabetics in the world will live in India. Diabetes is the number one cause of kidney failure, is responsible for 5% of blindness in adults and 1 million limb amputations.

Because of the chronic nature of diabetes, the relentlessness of its complications and the means required to control both diabetes and its complications; this disease is very costly, not only for affected individuals and families but also for the healthcare systems. Studies done in India estimate that for a low income family with an adult having diabetes, as much as 25% of the family's income may need to be devoted to diabetes care.

Stress also seems to be a greater risk factor in India for diabetes. It is important to de-stress according to each one's disposition - for example spending quality time with friends and family, Yoga, breathing exercises, walking, meditation, aerobics and other fitness regimen can ward off diabetes.

Preliminary findings of a recent study in India among school children in the higher socio-economic group in Chennai showed child obesity is growing higher and girls were found to be disproportionately "heavier" than boys.

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