Dr. Takira Glasgow BSc, MBBS, MSc Diabetes, MSc Internal Medicine, PGDip Obesity and Weight Management.

As seen in the Voice newspaper on 7/11/26

What is diabetes, you ask?
A chronic metabolic condition that manifests as high blood glucose. But what is the extent and impact of this disease on the human body? The answer is a bit more complicated.

Early Action in Diabetes Management

Prediabetes can progress to type 2 diabetes, especially when impaired fasting glucose occurs with impaired glucose tolerance. Cardiovascular disease and mortality are increased by estimated 13% to 16% with the diagnosis of prediabetes. This compels us to look at the broader cardiometabolic picture which includes hypertension, visceral obesity, abnormal cholesterol, MASLD (fatty liver), heart failure, CKD and retinopathy risk, which also increase across the spectrum of dysglycaemia. Early action in type 2 diabetes is essential to improve the potential for remission and to reduce the complications that may occur. Prescribed medications and lifestyle modifications protect cells of the pancreas that produce insulin from dysfunction.

Persons with type 1 diabetes also benefit from early action. This illness is now managed as a staged disease, with antibody screening for persons with a family history in a first degree relative or other autoimmune condition. In addition, further research on the monoclonal antibody Teplizumab demonstrated that this medication can delay progression from the second to third stage of type 1 diabetes – from abnormal blood glucose and antibodies to symptomatic – and preserve beta cells for two to three years.

Heads Up

There is an association between cognitive decline and dementia in the elderly and diabetes, with a 43% higher risk of Alzheimer’s dementia. This seems to correspond with duration of diabetes, particularly from mid-life, and poor glycaemic control. Poorly managed diabetes with multiple episodes of hypoglycaemia, is also associated with cognitive decline. Diabetes can also independently double risk of ischaemic strokes as well as peripheral artery disease, death due to cardiovascular disease and heart failure (HFpEF). Ask your diabetes physician about medications such as SGLT-2 inhibitors and GLP-1 (Dapagliflozin and Semaglutide) that have demonstrated benefits to heart health.

Progressive ischemic changes to the blood vessels of the eye contribute to diabetes-related retinopathy and macular edema. Diabetes in pregnancy—not gestational diabetes—and rapid improvements in A1C or dramatic weight loss, while healthy, may worsen existing eye disease (proliferative retinopathy) temporarily or permanently.

Some dental conditions may not be painful while silently disrupting health. Diabetes worsens periodontal disease and periodontal disease worsens blood glucose control. Dry mouth increases dental caries.

Middle of the Road

Lung diseases are more severe for persons with diabetes, including COPD, asthma, (COVID) viral pneumonia with increased hospitalisation and mortality risk.
Type 2 diabetes and MASLD (formerly fatty liver) are also clinically linked with increased risk of liver fibrosis. Glycogenic hepatopathy of Type 1 diabetes causes dysregulated blood glucose. Further, type 1 and type 2 diabetes both increase the speed of progression of chronic kidney disease. Ask about medications that slow the progression of CKD.

Persons with type 1 diabetes have reduced microbiome diversity and increased gut
permeability. Nerve damage of the stomach (autonomic, vagal) can delay gastric emptying, promote constipation by decreasing gastrointestinal motility. This impairs blood glucose control and prevents the use of weight management medications such as Ozempic. There is altered incretion signaling in the first part of the intestine, a common type 2 diabetes target for medications that allow glucose-dependent blood glucose control.

The pancreatic beta cells that produce insulin decrease in volume in type 1 diabetes and there is greater risk of fibrosis. Meanwhile type 2 diabetes is associated with β-cell failure due to insulin resistance that is progressive and defines the progression of diabetes and the need for higher doses of medications.

Below the Belt

Up to 75% of men with diabetes can experience erectile dysfunction. Females complain about dryness and dyspareunia. There is increased risk of yeast infections both of the genitals – candidiasis and balanitis and of the skin – intertrigo. Certain medications with cardiovascular benefits can increase the risk of urinary tract infections and rarely Fournier’s gangrene. These side effects should be reported to your physician if they occur.

Diabetes is also associated with greater risk of bone fractures after glycation of type 1 collagen and other mechanisms. This is particularly concerning for children and the elderly. Finally, peripheral neuropathy, trauma and deformity of the feet can predispose to foot ulcers. High blood glucose is a nutrient supply for bacteria that directly increases their growth and their resistance to innate immune cells. High blood glucose also promotes biofilm formation in an environment of chronic inflammation and antibiotic resistance. This leads to amputations.

Summary

Diabetes causes harm covertly with plausible deniability before subjective symptoms, feelings of illness and dysfunction occur. The severity of the complications depend on the duration of diabetes and the success of glycaemic control along with critical cardiometabolic considerations. Kidney disease, retinopathy, neuropathy, autonomic neuropathy, infection risk and cardiovascular changes may be silent. We can reach our destination through screening, early diagnosis and diligent management guided by your diabetes physician.