General informations of diabetes
Definition:
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot make good use of the insulin it produces. (FID2019) This results in an increased concentration of glucose in the blood (hyperglycemia). (WHO 2016)
In another way, it is a metabolic disease, which follows a disturbance of the carbohydrate, protein and lipid metabolisms, this disturbance causes a defect in the secretion of insulin or in the action of this hormone. (AZZI.R)
Epidemiology
Diabetes is no longer a disease of rich countries. In fact, 80% of people with diabetes live in low- and middle-income countries. (WHO)
In 2000, the worldwide estimate of adults living with diabetes was 151 million. In 2009, it had increased by 88% to reach 285 million and today 463 million people living with diabetes. (IDF 2019)
According to the WHO; the global diabetic population was 422 million in 2016 and this figure will exceed 622 million in 2040 (WHO 2016)
In Algeria, 5 million people with diabetes thanks to several factors such as obesity; the stress ; tobacco and food... (FAAD, 2016)
Types of diabetes:
According to ADA AND WHO, diabetes is classified into 4 main types, which is type 1 diabetes; type 2 diabetes; gestational diabetes and secondary diabetes
Type 1 diabetes:
(known as insulin-dependent diabetes or juvenile diabetes or childhood diabetes); (WHO). This type is caused by an autoimmune reaction in which the body's immune system attacks beta cells in the pancreas, which produce either little or no insulin. (IDF; 2019)
Diabetes type 2:
It has different names fatty diabetes, insulin-resistant diabetes (Goldenberg et al, 2013) and since the WHO this type is also called formerly, non-insulin-dependent diabetes or adult diabetes
The most common, it affects approximately 90% of cases and its appearance after the age of 40 and more specifically in obese people (Prasad and Groop., 2015).
This type of diabetes is determined by insulin resistance and a relative deficiency of insulin secretion, its evolution appears by a degree hyperglycaemia sufficient to cause organic and functional damage in different tissues without clinical symptoms Monnier L. Diabétologie. Issy-les-Moulineaux: Elsev.ier Masson, 2010.
Gestational Diabetes (GD)
This form is characterized by hyperglycemia during pregnancy. It can occur at any time during pregnancy (it is most common after 24 weeks, however) and usually goes away once the woman has given birth. IDF 2019
Another type
It is less common, this type is called secondary or specific diabetes due to its relationship to genetic defects of pancreatic ß cells, genetic defects of insulin action, diseases of the exocrine pancreas, endocrinopathies, secondary to taking drugs or chemicals, secondary to infection, uncommon forms of immune diabetes or diabetes associated with genetic syndromes Executive Summary: Standards of Medical Care in Diabetes‐‐2012. Diabetes Care 2011; 35: S4–10.
Diagnostic
Since the ADA there are several ways to diagnose diabetes. Each route usually needs to be repeated on a second day to diagnose diabetes.
The tests must be done in a health care setting (such as a doctor's office or laboratory). If the doctor determines that the blood sugar level is very high, or if there are classic symptoms of high blood sugar in addition to a positive test, the doctor may not require a second test to diagnose diabetes.
A1C
The A1C test measures average blood sugar levels over the past 2-3 months. The advantages of being diagnosed this way are that you don't have to fast or drink anything.
Diabetes is diagnosed at an A1C greater than or equal to 6.5%
Chronic complications due to diabetes
Chronic or long-term complications from diabetes are found in people with type 2 diabetes at the time of diagnosis. They can also occur shortly after the onset of type 1 diabetes. Early detection and appropriate treatment are essential to prevent disability and death. (IDF 2019). These complications include two components:
Microangiopathy: three tissues are particularly the site of this complication: the retina, the renal glomerulus and the peripheral nerve.
Macroangiopathy: arteries of the heart and arteries of the brain (Belhadj et al, 2016)
Diabetes treatments:
Self-monitoring of blood glucose (ASG):
Glycemic self-monitoring is a means of measuring blood sugar, to improve treatment by controlling doses of insulin or diabetic medication in order to fix blood sugar within these normal values. It represents a means of communication between the doctor and the patient (Arbouche et al., 2012; Faure et al., 2013)
People with type 2 diabetes self-monitor their blood sugar levels twice a day and twice a week at different times, fasting blood sugar levels, 2 hours after lunch and at the end of the day at 5 p.m. (Arbouche et al., 2012; Faure et al., 2013; Halimi et al., 2003; Perlemuter et al., 2000)Lifestyle and dietary measures:
Hygieno-dietary measures allow both:
to improve the disturbances of the glycemic balance
prevent the appearance of micro and macrovascular complications.
They must be simple, realistic, adapted to each patient according to his age, his weight and his way of life, he requires
a balanced diet,
weight loss
physical exercises (Blicklé, 2003; Bories, 2012; Louiza, 2008; Oroudji, 2005).Drug treatments:
This treatment of diabetes remains necessary in the event of failure of the measures mentioned above. And there are different oral medications available to normalize blood sugar levels (Graillot et al., 2012)
Insulin secretors:
are sulfonamides and glinides, their role is limited to the increase and stimulation of insulin secretion and have the disadvantage of complication
cardiovascular disease and hypoglycaemia (Holman et al., 2008) example: Carbutamide and Nateglinide (Blicklé, 2004 Holman et al., 2008)
Insulin sensitizers:
They can be classified as glitazones, alpha-glucosidase inhibitors, like all drugs they have serious side effects such as intestinal disorders and also a hepatotoxic effect.
Among these agents are acarboses and miglitol which have the ability to slow down the intestinal absorption of glucose
(Halimi et al., 2000 Godbout and Chiasson, 2007) and Rosiglitazone for improving insulin action (Elte and Bblickle, 2007)
incretinomimetics
Inhibitors of DPP-4 (Dipeptidyl peptidase-4) and Analogs of GLP-1 (Glucagon-like peptide-1), their roles are to regulate the secretion of insulin and glucagon and Stimulate the secretion of insulin by the pancreas example: Sitagliptin, Vildagliptin, Saxagliptin and Exenatide, Liraglutide. they can cause pancreatitis and diarrhea (Fonseca et al., 2010) (Drucker, 2006 Deacon, 2011)
- Use of antidiabetic plants in the treatment of diabetes mellitus:
In recent years, aromatic and medicinal plants have had a lot of interest in the therapeutic field, this means that at least one of its parts (leaf, stem, root etc.) can be used in this sense. Indeed, the natural substances extracted from these plants have allowed great and multiple advances because of their added value in the preparation of many products, particularly in the pharmaceutical fields. (HERZI Nejia 2013)
Worldwide, many ethnobotanical and ethnopharmacological surveys have been carried out, in order to detect or enhance the plants that have the ability to cure the target disease of our work, (diabetes), we already find that these plants have been used in many pharmacopoeias as antidiabetics (Bedekar et al. 2010).