New Vistas in Diabetes Management: New Age Early Detection Markers, Diet, Nutrition and Herbal Supplements

With the number of people with diabetes and pre-diabetes increasing at an alarming rate, diabetes has become a major global concern. Although the pathophysiology and long-term effects of diabetes-related complications, such as diabetic retinopathy, diabetic kidney disease, and cardio-metabolic changes, are better understood, more knowledge is still required for a goal-directed management program that aims to stop the progression of these complications. Catching diabetics while they are still in their pre-diabetic stage would be the obvious course of action (1) . While the fasting blood glucose (FBG), post-prandial blood glucose (PBG) and HbA1c have been the mainstay of diabetes diagnosis and management, there are several challenges with these biomarkers which have been illustrated in several researches over time. HbA1c is particularly prone to issues related to Hb variants, hepatic disorders and any disorder that shortens the lifespan of red blood cells, iron deficiency anemia (2). The challenges of standardization and interference with HbA1c assays are another challenge that makes it difficult to totally trust the values (3) (4). There is a need to explore new age markers to catch the diabetics early and several candidates like fructosamine, glycated albumin and 1,5 anhydroglucitol have shown promise. The two main theories put forth to explain the sharp increase in diabetes rates globally are aging and urbanization, which result in sedentary lifestyles. Switching to a Western diet has been proposed as a substitute motivator (5). The prevalence of diabetes may be significantly influenced by the consumption of sugar and similar sweeteners rather than merely total joules. According to new research on the insulin-modifying qualities of refined sugars, sugar and similar sweeteners have a statistically significant impact on diabetes that is separate from the impact of weight on diabetes. The associations between diabetes and increasing incomes and urbanization statistically vanish when the impacts of sugar and similar sweeteners are considered, suggesting that sugar intake could be a contributing factor to urbanization. With the rise in diabetes and increasingly larger numbers and earlier onset put a huge burden on economies. This is especially important for emerging economies as the rapid development, changing diet and lifestyle and sedentary living conditions pose a bigger disease burden without the infrastructure and per capita spending on health as in developed economies (6). This calls for newer markers for earlier detection of diabetes and catching more people in their prediabetes stage. Medication may not always be the best option in such a stage and the role of diet, nutrition, supplements and herbs can play a major role in the addressing the ever-increasing burden of diabetes.