10 Diabetes Symptoms You Should Never Ignore

Introduction

Diabetes affects over 537 million people worldwide, with millions more living with the condition undiagnosed^[9]. This chronic disease can lead to serious complications if left untreated, making early detection and management crucial. In the United States alone, approximately 1 in 10 people have diabetes, and 1 in 5 of those individuals are unaware they have the condition^[2].

1. Importance of Early Detection and Treatment

Recognizing the early warning signs of diabetes is essential for timely diagnosis and treatment. Studies have shown that early intervention can significantly reduce the risk of developing diabetes-related complications, such as heart disease, kidney damage, nerve damage, and vision problems^[1][8]. In some cases, early treatment of type 2 diabetes can even lead to remission^[7].

2. Overview of Diabetes and its Complications

Diabetes is a metabolic disorder characterized by high blood sugar levels. The two main types are type 1 and type 2 diabetes. Type 1 is an autoimmune condition in which the body does not produce insulin, while type 2 occurs when the body becomes resistant to insulin or doesn’t produce enough of it^[10]. Over time, uncontrolled high blood sugar can damage various organs and tissues, leading to serious complications^[2] such as:

• Cardiovascular disease
• Kidney damage (nephropathy)
• Nerve damage (neuropathy)
• Eye problems (retinopathy)
• Foot problems and slow-healing wounds
• Increased risk of infections

10 Diabetes Symptoms

1. Frequent Urination, Especially at Night

One of the most common early signs of diabetes is frequent urination, particularly at night (nocturia). When blood sugar levels are high, the kidneys work harder to filter out the excess glucose, leading to increased urine production. This can cause you to wake up multiple times during the night to use the bathroom^[1][4].

Normally, most people don’t need to urinate more than once during 6-8 hours of sleep. If you find yourself waking up frequently to pee, it could be a sign of diabetes. However, nocturia can also be caused by other conditions such as urinary tract infections or prostate problems, so it’s important to consult your doctor if you experience this symptom^[11].

How Diabetes Affects the Kidneys

To understand why frequent urination occurs in diabetes, it’s helpful to know how the kidneys function. Each kidney contains about a million tiny filtering units called nephrons. In filtration, water and small molecules from the blood enter the nephron. Useful substances like glucose are then reabsorbed back into the bloodstream, while waste and excess water become urine^[12].

Normally, 100% of the filtered glucose is reabsorbed by the kidney tubules. But in diabetes, high blood sugar levels overload and saturate this reabsorption system. The result is glucose in the urine, which draws more water into the urine by osmosis, leading to the production of a larger volume of urine^[12].

In summary, frequent urination, especially at night, is often one of the first noticeable symptoms of diabetes due to the diuretic effect of high blood glucose. If you experience this sign along with others like excessive thirst, fatigue, or blurred vision, it’s important to see your doctor to get tested for diabetes.

2. Excessive Thirst

Excessive thirst, also known as polydipsia, is another classic early warning sign of diabetes. When blood sugar levels are high, the body tries to get rid of the excess glucose through frequent urination. This can lead to dehydration, triggering intense thirst as your body attempts to replenish lost fluids^[1][5].

It’s normal to feel thirsty when you’re dehydrated from exercise, eating salty foods, or spending time in the heat. But with diabetes, you may feel excessively thirsty all the time, even if you’re drinking plenty of water. No matter how much you drink, you may still feel like you can’t quench your thirst^[5].

Other causes of excessive thirst include diarrhea, vomiting, blood loss, and certain medications. But persistent, unexplained thirst that lasts for days or weeks can be a symptom of diabetes or another underlying health condition^[13].

In diabetes, excessive thirst often goes hand in hand with frequent urination. As your kidneys work overtime to flush out excess sugar through urine, you lose more fluids and electrolytes, which can leave you feeling parched. You may have a dry mouth and find yourself drinking large amounts of water, juice, or other beverages to try to satisfy your thirst^[14].

The Diabetes Thirst and Urine Cycle

Uncontrolled diabetes can lead to a vicious cycle of thirst and urination. High blood sugar causes your kidneys to produce more urine to help excrete the excess glucose. The increased urine output then leads to dehydration and thirst. As you drink more fluids to quench your thirst, you’ll urinate even more, and the cycle continues^[14].

This excessive thirst and urination cycle is seen in both type 1 and type 2 diabetes when blood sugar levels are not well managed. In type 1 diabetes, the thirst and frequent urination may come on suddenly as the body stops producing insulin. In type 2 diabetes, these symptoms may develop more gradually over time as insulin resistance worsens^[14].

Some signs that your thirst may be related to high blood sugar include:

• Persistent thirst that doesn’t improve with drinking water
• Dry, sticky mouth
• Headaches
• Fatigue
• Blurred vision
• Frequent urination, especially at night^[14]

If you have diabetes and find yourself feeling excessively thirsty, it’s a good idea to check your blood sugar levels. Unquenchable thirst can be a sign that your blood glucose is too high and your treatment plan may need to be adjusted. Speak with your doctor if the problem persists.

3. Unexplained Weight Loss

Unexplained weight loss is another potential silent symptom of diabetes, particularly type 1 diabetes. Despite eating normally or even having an increased appetite, you may lose weight rapidly without trying. This occurs because your body is not able to properly use glucose from food for energy^[1][3].

Normally, insulin helps transport glucose from your bloodstream into your cells, where it can be used for fuel. But in diabetes, either your body doesn’t produce enough insulin (type 1) or your cells become resistant to insulin’s effects (type 2). As a result, glucose builds up in your blood while your cells are starved for energy^[3].

To compensate, your body starts breaking down fat and muscle for energy, leading to weight loss. In type 1 diabetes, this process happens quickly and can cause rapid, significant weight loss over a few weeks. In type 2 diabetes, unexplained weight loss may occur more gradually^[6].

How Much Weight Loss Is Concerning?

Losing a few pounds here and there is usually no cause for alarm. But if you lose a significant amount of weight without changing your diet or exercise habits, it could be a sign of an underlying health problem like diabetes.

According to experts, unintentionally losing more than 5% of your body weight over 6 to 12 months is considered a cause for concern. For example, a 150-pound person who loses more than 7.5 pounds over a 6 month period without trying should see their doctor^[6].

Other potential causes of unexplained weight loss include thyroid problems, cancer, depression, and digestive disorders. But in people with diabetes, the weight loss is directly related to the body’s inability to use glucose properly^[6].

When Weight Loss Is a Good Sign

On the flip side, intentional weight loss through lifestyle changes can actually help improve blood sugar control in people with type 2 diabetes. Losing just 5-10% of excess body weight can significantly lower blood sugar, blood pressure, and cholesterol levels^[7].

For some people with type 2 diabetes, losing weight can even lead to remission of the disease. Studies have shown that following a very low calorie diet under medical supervision can put type 2 diabetes into remission, reducing the need for medications^[7].

However, it’s important to note that not everyone with type 2 diabetes is overweight, and unexplained weight loss is still a concerning symptom that shouldn’t be ignored. If you’re losing weight without trying, talk to your doctor to rule out diabetes or other underlying health issues.

4. Increased Hunger

Increased hunger, also known as polyphagia, is another common diabetes symptom that often goes along with unexplained weight loss. Even though you’re eating more than usual, you may still feel constantly hungry because your body is not able to effectively use the energy from food^[1].

Normally, after you eat a meal, your blood sugar rises and your pancreas releases insulin to help transport the glucose into your cells. This signals to your brain that you’re full and satisfied. But in diabetes, this process is disrupted^[3].

When your cells are starved of glucose due to lack of insulin or insulin resistance, your body thinks it needs more energy, even if you’ve just eaten. This triggers intense feelings of hunger as your brain tries to get you to eat more to raise blood sugar levels^[3].

The Hunger Paradox in Diabetes

The increased hunger in diabetes can seem paradoxical, since blood sugar levels are actually higher than normal. But the problem is that the glucose is not getting into the cells where it’s needed. It’s like your body is starving in the midst of plenty.

Over time, high blood sugar levels can also damage the nerves that control your digestive system. This can lead to gastroparesis, a condition that slows down the movement of food from your stomach into your small intestine. Gastroparesis can make you feel full quickly, but then hungry again soon after eating as food sits in your stomach^[3].

Differentiating Diabetes Hunger from Normal Appetite

It’s normal to feel hungry when your stomach is empty or you haven’t eaten for a few hours. But the hunger associated with diabetes tends to be more intense and persistent, even after meals. Some signs that your hunger may be related to high blood sugar include:

• Feeling hungry all the time, even shortly after eating
• Craving sugary or carbohydrate-rich foods
• Eating more than usual but still losing weight
• Feeling tired, irritable, or shaky between meals
• Having trouble concentrating or focusing due to hunger^[3]

If you find yourself constantly raiding the fridge or feeling like you’re never fully satisfied after meals, it’s worth getting checked for diabetes. Increased hunger can come on gradually, so you may not notice it at first. But it’s an important symptom that shouldn’t be ignored, especially if you have other risk factors for diabetes.

5. Fatigue and Weakness

Feeling tired, sluggish, or weak is a common symptom of diabetes that many people brush off as normal aging or stress. But persistent, unexplained fatigue can be a sign that your body is not properly using glucose for energy^[1].

When you eat, your body breaks down carbohydrates into glucose, which is then transported into your cells by insulin. Your cells use this glucose to produce energy in the form of ATP. But in diabetes, this process is disrupted due to lack of insulin or insulin resistance^[3].

Without enough glucose getting into your cells, your body doesn’t have the fuel it needs to function properly. This can leave you feeling exhausted and weak, even after a full night’s sleep. You may have trouble getting through your normal daily activities or feel like you need to take frequent naps^[3].

Dehydration and Fatigue

In addition to lack of cellular energy, dehydration from frequent urination can also contribute to fatigue in people with diabetes. When your body is trying to flush out excess glucose through urine, you lose a lot of fluids and electrolytes. This can lead to dehydration, which can make you feel tired, dizzy, and weak^[1].

Dehydration can also cause headaches, dry mouth, and dark-colored urine. If you’re urinating more often than usual and feeling thirsty all the time, it’s important to drink plenty of water to stay hydrated. But if your fatigue persists despite adequate fluid intake, it could be a sign of high blood sugar^[1].

Other Causes of Fatigue

Of course, there are many other potential causes of fatigue besides diabetes. These include:

• Sleep disorders like insomnia or sleep apnea
• Anemia (low red blood cell count)
• Thyroid problems
• Depression or anxiety
• Chronic fatigue syndrome
• Certain medications^[3]

But if you’re experiencing fatigue along with other diabetes symptoms like frequent urination, excessive thirst, or blurred vision, it’s important to see your doctor. A simple blood test can diagnose diabetes and help you get the treatment you need to feel better.

6. Blurred Vision

Blurred vision is another potential symptom of diabetes that many people don’t associate with the disease. But high blood sugar levels can cause fluid to build up in the lens of your eye, leading to temporary changes in your vision^[1].

The lens of your eye is normally clear and flexible, allowing it to focus light onto your retina for clear vision. But when glucose levels are high, fluid can accumulate in the lens, causing it to swell and change shape. This can make your vision appear blurry or distorted, especially when looking at objects up close^[3].

Blurred vision from diabetes is usually temporary and will improve once blood sugar levels are brought under control. But if high blood sugar persists over time, it can lead to more serious eye problems like diabetic retinopathy^[3].

Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that occurs when high blood sugar damages the tiny blood vessels in your retina, the light-sensitive tissue at the back of your eye. Over time, these blood vessels can leak fluid or bleed, causing vision problems like:

• Blurred or distorted vision
• Dark or empty areas in your vision
• Vision loss
• Difficulty seeing colors^[3]

Diabetic retinopathy is the leading cause of blindness in adults aged 20-74. But early detection and treatment can help prevent or slow vision loss. That’s why it’s important for people with diabetes to have regular dilated eye exams to check for signs of retinopathy^[3].

Other Eye Problems in Diabetes

In addition to retinopathy, diabetes can also increase your risk of other eye problems, including:

• Cataracts (clouding of the lens)
• Glaucoma (increased pressure in the eye)
• Macular edema (swelling of the macula)
• Dry eye syndrome^[3]

These conditions can cause symptoms like blurred vision, sensitivity to light, eye pain, and vision loss. But like retinopathy, they can often be prevented or managed with early detection and treatment.

If you have diabetes and notice any changes in your vision, it’s important to see your eye doctor right away. Don’t wait for your annual exam, as prompt treatment can help protect your sight.

7. Slow-Healing Sores or Cuts

Slow-healing sores, cuts, or wounds are another potential sign of diabetes that many people overlook. High blood sugar can damage your nerves and blood vessels over time, reducing circulation and impairing your body’s ability to heal itself^[1].

Normally, when you get a cut or scrape, your body’s immune system jumps into action to fight off infection and repair the damage. But in diabetes, this healing process is disrupted. Elevated glucose levels can interfere with the function of white blood cells, making it harder for your body to fend off bacteria and close wounds^[3].

Poor circulation from diabetes can also reduce blood flow to the extremities, depriving wounds of the oxygen and nutrients they need to heal. This is especially problematic in the feet, where nerve damage (neuropathy) can cause numbness and make it harder to detect injuries^[3].

Diabetic Foot Ulcers

One of the most serious complications of diabetes is foot ulcers. These are open sores or wounds that develop on the feet, often as a result of minor scrapes, cuts, or blisters that go unnoticed and untreated.

Diabetic foot ulcers typically occur on pressure points like the ball of the foot or the bottom of the big toe. They can start out small but quickly become infected and spread if not properly cared for. In severe cases, foot ulcers can lead to gangrene (tissue death) and require amputation^[3].

According to the American Diabetes Association, about 15% of people with diabetes will develop a foot ulcer at some point in their lives. But with proper foot care and blood sugar management, many of these ulcers can be prevented^[3].

Preventing Slow-Healing Wounds

If you have diabetes, there are several steps you can take to help prevent slow-healing sores and wounds:

• Keep your blood sugar levels in target range through diet, exercise, and medication
• Check your feet daily for cuts, blisters, redness, or swelling
• Wash your feet daily with warm water and mild soap
• Moisturize your feet to prevent dryness and cracking
• Wear comfortable, well-fitting shoes and socks
• Don’t go barefoot, even indoors
• See your doctor regularly for foot exams^[3]

If you do develop a sore or wound that’s slow to heal, don’t try to treat it on your own. See your doctor right away for proper cleaning, dressing, and monitoring. With prompt treatment, most slow-healing wounds can be managed successfully.

8. Numbness or Tingling in Hands or Feet

Numbness, tingling, or burning sensations in the hands and feet, also known as neuropathy, is a common complication of diabetes. Over time, high blood sugar can damage the nerves that transmit signals between your brain and your extremities, leading to a loss of sensation^[1].

Diabetic neuropathy most often affects the peripheral nerves in the feet and legs, but it can also impact the hands and arms. Symptoms typically start gradually and may include:

• Numbness or reduced ability to feel pain or temperature changes
• Tingling or burning sensations
• Sharp pains or cramps
• Increased sensitivity to touch
• Muscle weakness or loss of reflexes
• Serious foot problems, such as ulcers, infections, and bone and joint pain^[3]

According to the National Institute of Diabetes and Digestive and Kidney Diseases, about half of all people with diabetes have some form of nerve damage. But like many diabetes symptoms, neuropathy develops slowly and may go unnoticed in the early stages^[3].

Types of Diabetic Neuropathy

There are four main types of diabetic neuropathy:

1. Peripheral neuropathy: This is the most common type, affecting the feet and legs first, followed by the hands and arms. Symptoms include numbness, tingling, burning, and pain.
2. Autonomic neuropathy: This type affects the nerves that control involuntary body functions like heart rate, blood pressure, digestion, and bladder function. Symptoms may include dizziness, fainting, nausea, constipation, diarrhea, and sexual dysfunction.
3. Focal neuropathy: This type affects specific nerves, most often in the head, torso, or legs. It can cause sudden muscle weakness or pain.
4. Proximal neuropathy: This type causes pain in the thighs, hips, or buttocks and leads to weakness in the legs. It is more common in older adults with type 2 diabetes^[3].

Preventing and Managing Neuropathy

The best way to prevent or delay diabetic neuropathy is to keep your blood sugar levels as close to your target range as possible. This involves a combination of healthy eating, regular exercise, and medication as needed^[3].

If you already have neuropathy, there are several things you can do to manage your symptoms and prevent further damage:

• Keep your feet clean, dry, and moisturized
• Inspect your feet daily for cuts, blisters, or sores
• Wear soft, loose-fitting socks and padded shoes
• Avoid extreme temperatures
• Exercise regularly to improve circulation
• Manage pain with over-the-counter medications, topical creams, or prescription drugs as recommended by your doctor^[3]

If you experience any signs of neuropathy, don’t ignore them. Talk to your doctor right away to determine the underlying cause and develop a treatment plan. Early intervention can help prevent the progression of nerve damage and lower your risk of serious complications.

9. Frequent Infections

People with diabetes are more prone to infections due to the impact of high blood sugar on the immune system. Elevated glucose levels can impair the function of white blood cells, making it harder for your body to fight off invading bacteria and viruses^[1].

Common infections associated with diabetes include:

• Yeast infections: Yeast thrives on sugar, so high blood glucose can create an ideal environment for overgrowth. Women with diabetes are especially prone to vaginal yeast infections, while both men and women can develop yeast infections in the mouth (thrush), skin folds, and nailbeds^[3].
• Urinary tract infections (UTIs): Diabetes can damage the nerves that control bladder function, allowing urine to pool in the bladder and increasing the risk of bacterial growth. UTIs are more common in women but can occur in men as well^[3].
• Skin infections: Bacterial and fungal skin infections are more common in people with diabetes due to poor circulation and elevated glucose levels in the skin. Common types include staph infections, folliculitis, and carbuncles^[3].
• Respiratory infections: People with diabetes are more likely to develop and be hospitalized for respiratory infections like pneumonia and influenza. High blood sugar can weaken the immune response in the lungs and make it harder to clear infections^[3].

Preventing Infections with Diabetes

While infections are more common in people with diabetes, there are several steps you can take to lower your risk:

• Keep your blood sugar levels as close to target range as possible
• Wash your hands frequently, especially before eating or touching your face
• Practice good hygiene, including daily showers and regular dental care
• Stay up to date on vaccinations, including flu and pneumonia shots
• Treat cuts and scrapes promptly and keep them clean and covered
• Wear moisture-wicking socks and breathable shoes to prevent fungal growth
• Drink plenty of water to flush out bacteria from the urinary tract
• See your doctor regularly for check-ups and screenings^[3]

If you do develop an infection, it’s important to treat it promptly to prevent complications. See your doctor at the first sign of symptoms, such as fever, chills, pain, redness, or swelling. You may need antibiotics or antifungal medications to clear the infection.

10. Skin Changes

Diabetes can cause a variety of skin changes and conditions due to the impact of high blood sugar on circulation, nerves, and the immune system. Some common skin symptoms associated with diabetes include:

• Dry, itchy skin: Poor circulation and dehydration from frequent urination can lead to dry, flaky, or cracked skin that is prone to itching. This is especially common on the feet and lower legs^[1].
• Acanthosis nigricans: This is a condition characterized by dark, velvety patches of skin in the armpits, neck, or groin. It is often a sign of insulin resistance and is more common in people with type 2 diabetes^[3].
• Diabetic dermopathy: Also known as shin spots, these are round, scaly patches that typically appear on the shins. They are caused by changes in the small blood vessels and are harmless but can be a sign of diabetes-related circulation problems^[3].
• Necrobiosis lipoidica diabeticorum (NLD): This is a rare skin condition that causes yellow, waxy plaques on the shins, ankles, or feet. It is more common in women and is associated with type 1 diabetes^[3].
• Bullosis diabeticorum: This is a rare blistering condition that typically affects the hands and feet. The blisters are painless and heal on their own but can be a sign of poor glucose control^[3].

Preventing Skin Problems with Diabetes

To help prevent diabetes-related skin problems, it’s important to:

• Keep your blood sugar levels as close to target range as possible
• Moisturize your skin regularly to prevent dryness and cracking
• Protect your skin from the sun with clothing, hats, and sunscreen
• Avoid hot showers or baths, which can dry out your skin
• Use mild, fragrance-free soaps and detergents to prevent irritation
• Inspect your skin regularly for changes or signs of infection
• See a dermatologist for any concerning or persistent skin issues^[3]

If you notice any unusual changes in your skin, such as rashes, blisters, or discoloration, see your doctor promptly. Many diabetes-related skin conditions can be managed with proper treatment and blood sugar control.

Conclusion

Diabetes is a serious condition that can lead to a wide range of symptoms and complications if left untreated. By being aware of the early warning signs of diabetes, you can take steps to get diagnosed and manage your blood sugar levels before serious problems develop.

1. Seeking Medical Attention

If you experience any of the 10 diabetes symptoms discussed in this article, don’t ignore them. Schedule an appointment with your doctor to discuss your concerns and get tested for diabetes. A simple blood sugar test can diagnose the condition and help you get started on a treatment plan.

Remember, early detection and treatment of diabetes is key to preventing complications and maintaining good health. Don’t wait until your symptoms become severe or disabling to seek medical attention.

2. Importance of Self-Management and Lifestyle Changes

If you are diagnosed with diabetes, your doctor will work with you to develop a personalized treatment plan. This may include medication, insulin therapy, and lifestyle changes such as:

• Eating a healthy, balanced diet low in sugar and refined carbs
• Getting regular exercise to help control blood sugar and maintain a healthy weight
• Monitoring your blood sugar levels regularly
• Taking medication as prescribed
• Attending regular check-ups with your healthcare team
• Managing stress and getting enough sleep^[3]

Making these lifestyle changes can be challenging, but they are essential for managing diabetes and preventing complications. Your doctor, diabetes educator, and other healthcare professionals can provide support and guidance to help you stay on track.

FAQs

What are the most common early signs of diabetes?

The most common early signs of diabetes include frequent urination, excessive thirst, unexplained weight loss, and increased hunger^[1].

Can diabetes symptoms appear suddenly?

In type 1 diabetes, symptoms can appear suddenly and progress quickly. In type 2 diabetes, symptoms tend to develop more gradually over time^[3].

How do I know if my symptoms are due to diabetes or something else?

Many diabetes symptoms can be caused by other health conditions. The only way to know for sure is to see your doctor and get tested. A simple blood sugar test can diagnose diabetes^[3].

Can diabetes be cured?

There is no cure for diabetes, but it can be managed through medication, insulin therapy, and lifestyle changes. In some cases of type 2 diabetes, weight loss and healthy lifestyle changes can lead to remission^[7].

How often should I see my doctor if I have diabetes?

If you have diabetes, you should see your doctor at least every 3-6 months for check-ups and monitoring. You may need to see your doctor more frequently if your blood sugar levels are not well controlled or if you develop complications^[3].

Key Takeaways

• Diabetes is a serious condition that can lead to a range of symptoms and complications if left untreated.
• Early warning signs of diabetes include frequent urination, excessive thirst, unexplained weight loss, increased hunger, fatigue, blurred vision, slow-healing sores, numbness or tingling in hands or feet, frequent infections, and skin changes.
• If you experience any diabetes symptoms, see your doctor promptly for testing and diagnosis.
• Early detection and treatment of diabetes is key to preventing complications and maintaining good health.
• Managing diabetes involves a combination of medication, lifestyle changes, and regular check-ups with your healthcare team.
• With proper self-management and medical care, people with diabetes can live long, healthy lives.

References

• American Diabetes Association. (n.d.). Diabetes Symptoms. Retrieved from https://www.diabetes.org/diabetes/type-1/symptoms
• Centers for Disease Control and Prevention. (2021). Diabetes Symptoms. Retrieved from https://www.cdc.gov/diabetes/basics/symptoms.html
• Mayo Clinic. (2021). Diabetes symptoms: When diabetes symptoms are a concern. Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-symptoms/art-20044248
• National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Diabetes and Bladder Control. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/bladder-control
• American Diabetes Association. (n.d.). Diabetes Symptoms. Retrieved from https://www.diabetes.org/diabetes/type-2/symptoms
• Wilding, J. P. H. (2014). The importance of weight management in type 2 diabetes mellitus. International Journal of Clinical Practice, 68(6), 682-691. https://doi.org/10.1111/ijcp.12384
• Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., Rodrigues, A. M., Rehackova, L., Adamson, A. J., Sniehotta, F. F., Mathers, J. C., Ross, H. M., McIlvenna, Y., Stefanetti, R., Trenell, M., Welsh, P., … Taylor, R. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet, 391(10120), 541-551. https://doi.org/10.1016/S0140-6736(17)33102-1
• Nathan, D. M., Davidson, M. B., DeFronzo, R. A., Heine, R. J., Henry, R. R., Pratley, R., & Zinman, B. (2007). Impaired Fasting Glucose and Impaired Glucose Tolerance. Diabetes Care, 30(3), 753-759. https://doi.org/10.2337/dc07-9920
• International Diabetes Federation. (2021). IDF Diabetes Atlas 10th edition. Retrieved from https://diabetesatlas.org/
• World Health Organization. (2021). Diabetes. Retrieved from https://www.who.int/news-room/fact-sheets/detail/diabetes
• Corrao, S., Santalucia, P., Argano, C., Djade, C. D., Barone, E., Tettamanti, M., Pasina, L., Franchi, C., Kamal Eldin, T., Marengoni, A., Salerno, F., Marcucci, M., Mannucci, P. M., Nobili, A., & REPOSI Investigators (2014). Gender-differences in disease distribution and outcome in hospitalized elderly: data from the REPOSI study. European journal of internal medicine, 25(7), 617-623. https://doi.org/10.1016/j.ejim.2014.06.027
• Holt, R. I., & Hanley, N. A. (2012). Essential endocrinology and diabetes. John Wiley & Sons.
• Whiting, D. R., Guariguata, L., Weil, C., & Shaw, J. (2011). IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes research and clinical practice, 94(3), 311-321. https://doi.org/10.1016/j.diabres.2011.10.029
• Chalmers, J., & Cooper, M. E. (2008). UKPDS and the legacy effect. New England Journal of Medicine, 359(15), 1618-1620. DOI: 10.1056/NEJMe0807625