Diabetes mellitus, usually shortened to diabetes, is a chronic disease affecting millions of people worldwide, ranked as the seventh leading cause of death and the fourth leading cause of disability-adjusted life years in 2021[1]. It is characterized by elevated blood glucose levels, or hyperglycemia[2], [3]. Due to impaired insulin production or action, the glucose remains in the bloodstream and cannot be properly used by the cells, which seriously affects the cell function and survival[2].
Hyperglycemia directly or indirectly leads to a variety of symptoms and conditions and is regarded as the initiation of tissue damage through acute metabolic changes or the gradual accumulation of glycated molecules and advanced glycation end products (AGEs)[4], [5]. These AGEs result from the glycation of glucose with proteins or lipids, and promote oxidative stress and inflammation, connecting diabetes to complications like cardiovascular disease, nephropathy, neurological disorders, anemia and others, which collectively increase mortality in diabetes patients[5], [6], [7], [8]. Additional conditions linked to diabetes include diabetic foot, diabetic ketoacidosis, diabetic retinopathy, heart disease, kidney damage, nerve damage, nonketotic hyperosmolarity, poor wound healing[4].
According to the World Health Organization (WHO), an estimated 830 million individuals were living with diabetes in 2022; In 2021, over 2 million deaths were caused by diabetes and diabetes-related kidney disease, and high blood glucose accounted for 11% of cardiovascular deaths[9].
[1] World Health Organization, “Global Health Estimates: Life expectancy and leading causes of death and disability.” Accessed: Sept. 03, 2025. [Online]. Available: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates
[2] G. Roglic, “WHO Global report on diabetes: A summary,” Int. J. Noncommunicable Dis., vol. 1, no. 1, p. 3, 2016, doi: 10.4103/2468-8827.184853.
[3] M. Z. Banday, A. S. Sameer, and S. Nissar, “Pathophysiology of diabetes: An overview,” Avicenna J. Med., vol. 10, no. 4, 2020.
[4] J. Moini, Epidemiology of Diabetes. San Diego: Elsevier, 2019.
[5] A. Negre-Salvayre, R. Salvayre, N. Augé, R. Pamplona, and M. Portero-Otín, “Hyperglycemia and Glycation in Diabetic Complications,” Antioxid. Redox Signal., vol. 11, no. 12, pp. 3071–3109, Dec. 2009, doi: 10.1089/ars.2009.2484.
[6] J. Lee, J.-S. Yun, and S.-H. Ko, “Advanced Glycation End Products and Their Effect on Vascular Complications in Type 2 Diabetes Mellitus,” Nutrients, vol. 14, no. 15, p. 3086, July 2022, doi: 10.3390/nu14153086.
[7] M. D. Burman, S. Bag, S. Ghosal, and S. Bhowmik, “Glycation of Proteins and Its End Products: From Initiation to Natural Product-Based Therapeutic Preventions,” ACS Pharmacol. Transl. Sci., vol. 8, no. 3, pp. 636–653, Mar. 2025, doi: 10.1021/acsptsci.4c00684.
[8] A. B. Uceda, L. Mariño, R. Casasnovas, and M. Adrover, “An overview on glycation: molecular mechanisms, impact on proteins, pathogenesis, and inhibition,” Biophys. Rev., vol. 16, no. 2, pp. 189–218, Apr. 2024, doi: 10.1007/s12551-024-01188-4.
[9] World Health Organization, “Diabetes.” Accessed: Sept. 04, 2025. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/diabetes
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