Diabetes, a progressive disease

In Paris, in March 2020, a patient with type 1 diabetes uses the flash glucose self-monitoring system, with the FreeStyle Libre 2 sensor.

The prevalence of diabetes (type 1 and type 2, diagnosed and undiagnosed) has been steadily increasing for the past twenty years. It affected 537 million people worldwide in 2021, 4.5 million in France. Nearly one in ten adults could be affected by 2045, according to the International Diabetes Federation. Diabetes can be a serious disease causing complications if left untreated, killing nearly 2 million people a year. Diabetes corresponds to a prolonged elevation of the concentration of glucose in the blood. In the case of type 1 diabetes, this disorder is due to a lack of insulin production. While type 2 diabetes is linked to the body’s poor use of insulin.

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In France, the prevalence of diabetes has increased from 4.6% in 2012 to 5.3% in 2020, i.e. more than 3.5 million people treated pharmacologically, according to the Weekly Epidemiological Bulletin (BEH) of Public Health France ( SPF) of November 2021, based on data from Medicare, of which 850,000 are treated with insulin. To these figures are added the people identified but not treated, or who are unaware of each other. The disease is more common among the most socioeconomically disadvantaged people, adds SPF.

Type 2 diabetes is by far the most common (90%). The prevalence increases by 2.5% to 3% each year, in connection with the aging of the population. It is often linked to changes in lifestyles, an overly rich or unbalanced diet and a lack of physical activity. Thus, there are more and more among children, adolescents and young adults, due to obesity.

Epigenetic factors

For type 1 diabetes, approximately 225,000 people are affected in France. It has been increasing by around 4.5% per year for the past ten years. 2,500 people are diagnosed each year, mainly children or young people, according to the BEH. “The challenge of diagnosis remains major, you have to be vigilant about the warning symptoms of the disease, when the child starts to wet the bed again, has frequent urine, drinks a lot because even today, it is often detected too late “, insists Carine Choleau, of the association Aid to young diabetics (AJD).

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If the reasons for this increase are not very clear, “several epigenetic, environmental factors [déterminants de santé et perturbateurs endocriniens] can explain it”indicates Jean-François Thébaut, vice-president of the French Federation of diabetics. “An explanation holds the rope at the moment: some put forward a hygienist hypothesis, that is to say that having a very sanitized environment would make the immune system less sharp”, says Jean-Pierre Riveline, head of the University Center for Diabetes and its Complications (CUDC) at Lariboisière Hospital (APHP). Studies have also suggested the role of viral infections in the occurrence of type 1 diabetes, such as the Coxsackie B virus.



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