Diabetes mellitus today: A comprehensive review of epidemiology, mechanisms, diagnostics, technology, and therapeutic futures with implications for Thailand
คำสำคัญ:
Diabetes mellitus, Epidemiology, Pathophysiology, Digital health, Therapeutic advances, Thailandบทคัดย่อ
Diabetes mellitus (DM) is a major and growing global health challenge driven by urbanization, population aging, and lifestyle changes. This study was conducted as a narrative review, synthesizing evidence from major databases and clinical guidelines. A narrative review was conducted using major scientific databases and clinical guidelines. Findings indicate a shift toward predictive, personalized, and technology enabled care, including advances in pharmacological therapies and digital health tools. In Thailand. challenges such as underdiagnosis and unequal access to care highlight the need for strengthened health system integration and improved early detection strategies.
เอกสารอ้างอิง
Himathongkam, T. (2019). Evaluation of a community-based diabetes prevention program in Thailand: A cluster randomized controlled trial. Journal of Primary Care & Community Health, 10, 2150132719847374.
https://doi.org/10.1177/2150132719847374
American Diabetes Association Professional Practice Committee. (2025). Introduction and methodology: Standards of care in diabetes—2025. Diabetes Care, 48(Supplement_1), S1–S5. https://doi.org/10.2337/dc25-SINT
Atun, R., Davies, J. I., Gale, E. A. M., Bärnighausen, T., Beran, D., Kengne, A. P., Levitt, N. S., Mangugu, F. W., Nyirenda, M. J., Ogle, G. D., Ramaiya, K., Sewankambo, N. K.,Sobngwi, E., Tesfaye, S., & Wild, S. H. (2017). Diabetes in sub-Saharan Africa: From clinical care to health policy. The Lancet Diabetes & Endocrinology, 5(8), 622–667. https://doi.org/10.1016/S2213-8587(17)30181-X
Battelino, T., Danne, T., Bergenstal, R. M., Amiel, S. A., Beck, R., Biester, T., Bosi, E.,Buckingham, B. A., Cefalu, W. T., Close, K. L., Cobelli, C., Dassau, E., DeVries, J. H., Donaghue, K. C., Garg, S., Heinemann, L., Hirsch, I. B., Hovorka, R., Kovatchev, B., ... Phillip, M. (2019). Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the international consensus on time in range. Diabetes Care, 42(8), 1593–1603. https://doi.org/10.2337/dci19-0028
Beckman, J. A., Creager, M. A., & Libby, P. (2002). Diabetes and atherosclerosis:Epidemiology, pathophysiology, and management. JAMA, 287(19), 2570–2581.https://doi.org/10.1001/jama.287.19.2570
Biessels, G. J., & Despa, F. (2018). Cognitive decline and dementia in diabetes mellitus:Mechanisms and clinical implications. Nature Reviews Endocrinology, 14(10), 591–604. https://doi.org/10.1038/s41574-018-0048-7
Brownlee, M. (2005). The pathobiology of diabetic complications: A unifying mechanism. Diabetes, 54(6), 1615–1625. https://doi.org/10.2337/diabetes.54.6.1615
Craft, S. (2005). Insulin resistance syndrome and Alzheimer’s disease. Neurobiology of Aging, 26(Suppl. 1), 65–69. https://doi.org/10.1016/j.neurobiolaging.2005.08.021
DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., Hu, F. B., Kahn, C. R., Raz, I., Shulman, G. I., Simonson, D. C., Testa, M. A., & Weiss, R. (2015). Type 2 diabetes mellitus. Nature Reviews Disease Primers, 1, 15019. https://doi.org/10.1038/nrdp.2015.19
Dejkhamron, P., Santiprabhob, J., Likitmaskul, S., Deerochanawong, C., Rawdaree, P.,
Tharavanij, T., Khlairit, P., Sahakitrungruang, T., Wacharasindhu, S., Thongtang, N.,
Vichitwong, P., Pongchaiyakul, C., Krittiyawong, S., Sriphrapradang, C., Boonchaya-Anant, P., Srichomkwun, P., Anutrakulchai, O., Unachak, K., Nitiyanant, W., & Reutrakul, S. (2022). Young-onset diabetes patients in Thailand: Data from Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN). Journal of Diabetes Investigation, 13(5), 796–809. https://doi.org/10.1111/jdi.13732
Donath, M. Y., & Shoelson, S. E. (2011). Type 2 diabetes as an inflammatory disease. Nature Reviews Immunology, 11(2), 98–107. https://doi.org/10.1038/nri2925
Fowler, M. J. (2008). Microvascular and macrovascular complications of diabetes. Clinical Diabetes, 26(2), 77–82. https://doi.org/10.2337/diaclin.26.2.77
Gulshan, V., Peng, L., Coram, M., Stumpe, M. C., Wu, D., Narayanaswamy, A.,Venugopalan, S., Widner, K., Madams, T., Cuadros, J., Kim, R., Raman, R., Nelson, P. C., Mega, J. L., & Webster, D. R. (2016). Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. JAMA, 316(22), 2402–2410. https://doi.org/10.1001/jama.2016.17216
Gurung, M., Li, Z., You, H., Rodrigues, R., Jump, D. B., Morgun, A., & Shulzhenko, N.(2020). Role of gut microbiota in type 2 diabetes pathophysiology. EBioMedicine, 51, 102590. https://doi.org/10.1016/j.ebiom.2019.11.051
Herold, K. C., Bundy, B. N., Long, S. A., Bluestone, J. A., DiMeglio, L. A., Dufort, M. J., Gitelman, S. E., Gottlieb, P. A., Krischer, J. P., Linsley, P. S., Marks, J. B., Moore,W., Moran, A., Rodriguez, H., Russell, W. E., Schatz, D., Skyler, J. S., Tsalikian, E.,Wherrett, D. K., ... Type 1 Diabetes TrialNet Study Group. (2019). An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes. The New England Journal of Medicine, 381(7), 603–613. https://doi.org/10.1056/NEJMoa1902226
Insel, R. A., Dunne, J. L., Atkinson, M. A., Chiang, J. L., Dabelea, D., Gottlieb, P. A.,Greenbaum, C. J., Herold, K. C., Krischer, J. P., Lernmark, Å., Ratner, R. E., Rewers, M. J., Schatz, D. A., Skyler, J. S., Sosenko, J. M., & Ziegler, A.-G. (2015). Staging presymptomatic type 1 diabetes: A scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care, 38(10), 1964–1974. https://doi.org/10.2337/dc15-1419
International Diabetes Federation. (2026). IDF Diabetes Atlas: Global diabetes data & statistics. https://diabetesatlas.org/
Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes. The Lancet, 383(9922), 1068–1083. https://doi.org/10.1016/S0140-6736(13)62154-6
Kannel, W. B., & McGee, D. L. (1979). Diabetes and cardiovascular risk. JAMA, 241(19), 2035–2038. https://doi.org/10.1001/jama.1979.03290450033020
Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S.,Korytkowski, M. T., Munshi, M. N., Odegard, P. S., Pratley, R. E., & Swift, C. S.
(2012). Diabetes in older adults: A consensus report. Journal of the American
Geriatrics Society, 60(12), 2342–2356. https://doi.org/10.1111/jgs.12035
Lynch, S. V., & Pedersen, O. (2016). The human intestinal microbiome in health and disease.
The New England Journal of Medicine, 375(24), 2369–2379.
https://doi.org/10.1056/NEJMra1600266
Mahikul, W., White, L. J., Poovorawan, K., Soonthornworasiri, N., Sukontamarn, P.,Chanthavilay, P., Pan-ngum, W., & Medley, G. F. (2019). A population dynamic
model to assess the diabetes screening and reporting programs and project the burden
of undiagnosed diabetes in Thailand. International Journal of Environmental
Research and Public Health, 16(12), 2207. https://doi.org/10.3390/ijerph16122207
Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F. E., Nauck, M.
A., Nissen, S. E., Pocock, S., Poulter, N. R., Ravn, L. S., Steinberg, W. M., Stockner,
M., Zinman, B., Bergenstal, R. M., Buse, J. B., LEADER Steering Committee, &
LEADER Trial Investigators. (2016). Liraglutide and cardiovascular outcomes in type
diabetes. The New England Journal of Medicine, 375(4), 311–322.
https://doi.org/10.1056/NEJMoa1603827
Orban, T., Bundy, B., Becker, D. J., DiMeglio, L. A., Gitelman, S. E., Goland, R., Gottlieb,
P. A., Greenbaum, C. J., Marks, J. B., Monzavi, R., Moran, A., Raskin, P., Rodriguez,
H., Russell, W. E., Schatz, D., Wherrett, D., Wilson, D. M., Krischer, J. P., Skyler, J.
S., & Type 1 Diabetes TrialNet Abatacept Study Group. (2011). Co-stimulation
modulation with abatacept in patients with recent-onset type 1 diabetes: A
randomised, double-blind, placebo-controlled trial. The Lancet, 378(9789), 412–419.
https://doi.org/10.1016/S0140-6736(11)60886-6
Pagliuca, F. W., Millman, J. R., Gürtler, M., Segel, M., Van Dervort, A., Ryu, J. H., Peterson,
Q. P., Greiner, D., & Melton, D. A. (2014). Generation of functional human
pancreatic β cells in vitro. Cell, 159(2), 428–439. https://doi.org/10.1016/j.cell.2014.09.040
Perkovic, V., Jardine, M. J., Neal, B., Bompoint, S., Heerspink, H. J. L., Charytan, D. M.,
Edwards, R., Agarwal, R., Bakris, G., Bull, S., Cannon, C. P., Capuano, G., Chu, P.-
L., de Zeeuw, D., Greene, T., Levin, A., Pollock, C., Wheeler, D. C., Yavin, Y., ...
Mahaffey, K. W. (2019). Canagliflozin and renal outcomes in type 2 diabetes and
nephropathy. The New England Journal of Medicine, 380(24), 2295–2306.
https://doi.org/10.1056/NEJMoa1811744
Rigby, M. R., Harris, K. M., Pinckney, A., DiMeglio, L. A., Rendell, M. S., Felner, E. I.,
Dostou, J. M., Gitelman, S. E., Griffin, K. J., Tsalikian, E., Gottlieb, P. A.,
Greenbaum, C. J., Sherry, N. A., Moore, W. V., Monzavi, R., Willi, S. M., Raskin, P.,
Keyes-Elstein, L., Long, S. A., ... Ehlers, M. R. (2015). Alefacept provides sustained
clinical and immunological effects in new-onset type 1 diabetes patients. The Journal
of Clinical Investigation, 125(8), 3285–3296. https://doi.org/10.1172/JCI81722
Salisbury, C., Thomas, C., O’Cathain, A., Rogers, A., Pope, C., Yardley, L., Hollinghurst, S.,
Fahey, T., Lewis, G., Large, S., Edwards, L., Rowsell, A., Segar, J., Brownsell, S., &
Montgomery, A. A. (2015). Telehealth in chronic disease: Mixed-methods study to
develop the TECH conceptual model for intervention design and evaluation. BMJ
Open, 5(2), e006448. https://doi.org/10.1136/bmjopen-2014-006448
Schaper, N. C., van Netten, J. J., Apelqvist, J., Bus, S. A., Hinchliffe, R. J., Lipsky, B. A., &
IWGDF Editorial Board. (2020). Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes/MetabolismResearch and Reviews, 36(S1), e3266. https://doi.org/10.1002/dmrr.3266
UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood-glucose control and risk of complications in type 2 diabetes. The Lancet, 352(9131), 837–853.https://doi.org/10.1016/S0140-6736(98)07019-6
Zimmet, P., Alberti, K. G. M. M., Magliano, D. J., & Bennett, P. H. (2016). Diabetes mellitus
statistics and epidemiology. Nature Reviews Endocrinology, 12(10), 616–622. https://doi.org/10.1038/nrendo.2016.105
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M., Devins, T., Johansen, O. E., Woerle, H. J., Broedl, U. C., & Inzucchi, S. E. (2015).Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. The New England Journal of Medicine, 373(22), 2117–2128. https://doi.org/10.1056/NEJMoa1504720