Diabetes treatment

Testosterone is the principal sex hormone in men. It is important not only for normal sexual function but also for maintaining bone and muscle strength, mental and physical energy, and overall well-being. Low testosterone is associated with diminished libido, erectile dysfunction, increased fat mass, decreased muscle, bone mass and energy, depression, and anaemia. Type 2 diabetes may be one of the commonest causes of  hypogonadism – a lack of function in the testes, which adversely affects testosterone production.

Vitamin D is naturally present in a few foods and produced in the body when ultraviolet rays from sunlight come into contact with the skin. This fat-soluble vitamin is also available as a dietary supplement. The principal biological function of vitamin D is to maintain levels of calcium and phosphorus in the blood, aiding the absorption of calcium, and helping to form and maintain strong bones. Recent research findings have suggested that vitamin D also may provide protection from osteoporosis, high blood pressure, some cancers, and several autoimmune diseases, including diabetes.

Rates of diabetes continue to increase rapidly around the world. The current prevalence of about 5.1% is set to rise to 6.3% by 2025 – 333 million people with the condition. Further huge numbers of people are unaware that they have undiscovered diabetes and pre-diabetes conditions. The number of people with impaired glucose tolerance will increase from 314 million to 472 million over the next 15 years or so. These people are at dangerously high risk both for future diabetes complications and early death through cardiovascular disease.

Diabetes provokes a range of reproductive and sexual health problems: menstrual changes, fertility disorders, urinary and vaginal infections, urinary incontinence and sexual dysfunction. Early diagnosis and treatment of these problems, with well-planned pre-conception care, can protect maternal and infant health. In this report, Seyda Ozcan and Nevin Sahin call for reproductive and sexual healthcare to be included in women’s diabetes management plan.

The risk to a woman of having diabetes during her reproductive years varies worldwide and compares with the regional risks for the condition in general – on average between 5% and 8%. In all pregnant women, the risk for gestational diabetes should be assessed and screened early if a number of risk factors are present. Indeed, any form of diabetes during gestation, whether it develops during pregnancy or is present before conception, requires excellent multi-facetted management before and during pregnancy, and around the time of delivery.

The period after a woman gives birth provides a window of opportunity to impact on her short- and long-term future health. The end of a pregnancy heralds a transition both physically and mentally, and in terms of self-care. After delivery, most of the hormones that make a woman with gestational diabetes insensitive to the action of insulin are no longer present. In women with pre-existing diabetes, insulin needs drop dramatically; some women requiring insulin therapy to live may not need insulin for up to 72 hours.

Editor-in-chief's editorial

Recent years have seen an expansion in the number of conditions that are recognized as having a link with diabetes. In people with sleep apnoea breathing stops briefly but repeatedly during sleep. It is commonly associated with obesity, and therefore frequently occurs in people with type 2 diabetes. However, recent research demonstrates the likelihood of a relationship between obstructive sleep apnoea and diabetes that is independent of obesity. The links between the conditions are particularly important as both increase the risk of cardiovascular disease.

Type 2 diabetes significantly increases a person’s risk of developing multiple health complications, but the risk of these complications can be significantly reduced with modern, comprehensive diabetes care. This care is inherently complex because of its use of multiple medications in conjunction with lifestyle changes in diet, exercise, and blood glucose self-monitoring.

Because their condition affects every aspect of their daily  life, children and adolescents with diabetes are faced with more problems than are many of their peers without diabetes. The greater part of their day is spent at school, and this is where many of the greatest problems lie. Dealing with diabetes in school is one of the most important topics in the daily life of many families. The 2007 online WebTalk survey, conducted in eight countries as part of the DAWN Youth survey, has contributed to an increased understanding of the issues faced by children and adolescents with diabetes.