In 2020, this condition was the third leading cause of death in Mexico (only after heart disease and COVID-19); the number of deaths was higher than in previous years. According to INEGI data (July 2021), the three main reasons for death nationwide last year were: from heart disease, 218,885 (20.2 percent); from COVID-19, 201,163 (18.5 percent); and from diabetes mellitus (DM), 151,214 (13.9 percent). In Mexico, the latter has a prevalence of known cases of 10.3 percent according to the National Health and Nutrition Survey 2018; today, it is probably close to or above 15 percent, explains UNAM School of Medicine (FM) academic Francisco Javier Gómez Pérez.

Consumption of high-calorie foods with abundant amounts of sugars (containing high doses of corn syrup or sucrose, such as sweets, cakes, jams, chocolates, bars, cereals, cajeta, industrialized juices, boxed bread, and even tomato sauce) was also identified, which occurs from an early age in up to 85 percent of individuals. In addition to dietary problems, other factors for the increase in the number of cases are genetic predisposition and a sedentary lifestyle, as was also demonstrated in the survey; likewise, smoking -since adolescence- which conditions, among other problems, insulin resistance.

The frequent and abundant consumption of high-calorie foods and the inclusion of sugary drinks, foods rich in saturated fats, and alcoholic substances, increase the prevalence of obesity. In the survey, the sum of overweight and obesity was 76 percent. It is worth mentioning that metabolic syndrome -which includes high weight, central obesity, increased triglycerides, arterial hypertension, and glucose intolerance- has been observed in previous surveys in up to 50 percent of the population.

Another relevant aspect is that the development of complications is greater in patients who start these metabolic problems at an early age, which has to do, in part, with the often defective care provided by doctors with insufficient training, or, what is worse, the lack of access to health systems. The International Diabetes Federation (IDF) estimated for 2019 the prevalence of the condition worldwide at 9.3 percent; that is, 463 million adults, and it is estimated that it will increase to 700 million by 2045, with a frequency of 10.9 percent.

The proportion is higher in the urban population (10.9 percent) than in the rural population (7.2 percent) and it is known that on a global scale, one out of every two people does not know that he or she suffers from it. The reported mortality in the world in 2019 was 4.2 million people and the estimated expenditure of 760.3 billion dollars, which will increase to 845 billion dollars by 2045. In 1993 the prevalence in Mexico was 6.7 percent; in 2006 it more than doubled to 7.3 million people, representing 14.4 percent of the population.

In 2019, the IDF reported 12.8 million diabetics in our country and estimated that by 2045 the figure will reach 22.9 million, occupying in both years the sixth place worldwide, after China, India, United States, Pakistan, and Brazil, as reported at the time by the Center for Research in Food and Development (CIAD), of the System of Public Research Centers Conacyt. World Diabetes Day, which is commemorated on November 14, was established in 1991 by the World Health Organization and the International Diabetes Federation in response to its growing threat to health.

Significant increase

The university professor assures that industrialized products taste good, are cheap, and are rich in calories. The upward curve of their consumption coincides with the increase in the prevalence of the disease; "this does not mean that they cannot be consumed, but they should be consumed in a much smaller proportion".

The also researcher at the National Institute of Medical Sciences and Nutrition Salvador Zubirán recalls that diabetes consists of a series of ailments characterized by insulin deficiency or its action (which raises blood sugar levels). They are accompanied by chronic macro and microvascular complications, such as atherosclerosis that leads to vascular obstruction and tissue damage including myocardial infarction, cerebral thrombosis, or compromised circulation of the lower limbs. Microvascular involvement is responsible for retinopathy, nephropathy, and neuropathy, i.e., retinal, kidney or nerve damage.

Most cases of DM belong to type 2, associated with insulin resistance, and the minority to type 1 (when the pancreas does not produce insulin), and others, adds Gómez Pérez.

The university professor says that type 2 DM generally has a genetic component, but there are also environmental factors that have an important influence on its manifestation. "The prevalence began to grow dramatically from 1970 to the present day. This coincides with the fact that in rural areas the consumption of industrialized foods increased and migration from small towns to large cities increased," he recalls.

Added to this is the lack of physical activity, the mechanization of work, the hours people spend sitting in front of computers and "smart" phones, the lack of space in schools for exercise, as well as stress. "Before, in children and adolescents, the highest frequency of diabetes corresponded to type 1; now type 2 is on the rise, in children with obesity".

Better treatments

In contrast, in recent years there have been great advances in the control of diabetics, such as the availability of different types of insulin, with rapid, delayed, or long-lasting action, which make it possible to obtain levels closer to the physiological levels of the hormone. Another advance is the development of better systems for continuous glucose monitoring that make it possible to know, among other things, in what proportion the patient has hypoglycemia (or a decrease in the normal amount of glucose in the blood), or acceptable control and at what time of day the insulin dose should be modified. Unfortunately, these medications and systems are expensive and within the reach of few patients.

Francisco Javier Gómez recommends that those who have risk factors, i.e. obesity, pre-eclampsia during pregnancy, a family history of the condition or manifestations of insulin resistance -such as acanthosis nigricans, i.e. dark, thickened areas of the skin- should undergo studies every six months to measure glucose and, if possible, glycosylated hemoglobin (a test that measures the average level of glucose or sugar in the blood during the last three months).

If the person has prediabetes, he emphasizes, it is possible to avoid the disease by following recommendations such as weight reduction, reducing inappropriate foods, and increasing exercise. Sleep is also important since studies indicate that a person who sleeps less than six or more than 10 hours more often develops obesity and is at greater risk of developing it.

In addition, some symptoms such as increased thirst and urination, weight loss, genital fungus, changes in the speed of wound healing, or any obstetric complication should be remembered. An adequate diet low in simple sugars, carbohydrates, and saturated fats; as well as reducing beef.

Diabetes stalks infants

Mexico ranks sixth in the world in the number of people who suffer from it, 542 thousand children are living with type 1 and almost 78 thousand infants develop it every year. In 2016 the incidence of type 2 was 2.05 cases per 100,000 inhabitants and in 2020 the figure rose to 2.9, said the academic of the Faculty of Medicine (FM) of the UNAM, Ana Lilia Rodríguez Ventura.

Speaking at the program "Más Salud" (More Health), organized by the FM on the occasion of World Diabetes Day, which is commemorated on November 14, she said: "Before the 1990s, of every 100 children we had with this disease, only two percent were type 2, and now it has increased up to 22 times. It is serious because the latter is preventable, but type 1 is not, she clarified. The pediatrician and endocrinologist at the Federico Gómez Children's Hospital of Mexico said that type 2 is prevalent in people over 40 years of age, but "the most alarming thing is that children between eight and 10 years of age, as well as adolescents, already suffer from it".

Diabetes is a chronic disease, which causes lipase concentrations to rise in the blood, and although there are four groups or modalities, 1 is the one with the highest incidence in infants. It is multifactorial and is influenced by genetic and environmental factors. In the case of small children, the biological causes are not known with precision. There are several theories, among them early exposure to milk formulas and infections by some viruses, where foreign molecules cause the Beta cells found in the pancreas to "self-destruct", which makes glucose self-regulation impossible.

The academic of the Department of Embryology and Genetics of the FM commented that the environmental factor has a greater influence on the 2, for example, if the mother has gestational diabetes during her pregnancy, which increases the possibilities that her child may also have it. The doctor in Medical Sciences added that the racial aspect also plays a role, or having been born macrosomic, that is, weighing more than four kilograms or less than 2.5 kilograms. Also, prematurity, in addition to the lack of breastfeeding.

Rodriguez Ventura pointed out that in most cases there are no symptoms and this delays the diagnosis. "However, in the case of type 1, there can be an acute picture, sometimes with days or weeks of evolution, with a triad of symptoms: great thirst and appetite, constant desire to urinate, accompanied by weight loss. In the case of type 2, it is more insidious, it occurs little by little".

In type 2, the triggering factor is being overweight or obese. The adiposity that occurs due to excess fat will cause inflammation in the infant's organs, which deteriorates the functioning of the Beta cells, resistance, and even deficiency in the production of insulin, she added. In conclusion, Ana Lilia Rodriguez indicated that 75 percent of Mexican adults suffer from accumulation or excess of fat and 35 percent of infants.