The main goals of the World Health day April 7, 2016 are to increase the awareness on the rise of Diabetes and its staggering burden and consequences on public health. This will include mainly the steps to prevent diabetes and diagnose, treat and long term care for the people with diabetes.
The latest regional statistics of diabetes:
Diabetes is now one of the most common non-communicable diseases globally. It is the fourth or fifth leading cause of death in most high-income countries and there is substantial evidence that it is epidemic in many low- and middle-income countries.
Complications from diabetes, such as coronary artery and peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure and blindness are resulting in increasing disability, reduced life expectancy and enormous health costs for virtually every society. Diabetes is certain to be one of the most challenging health problems in the 21st century. It is now recognized that it is the developing countries that presently face the greatest burden of diabetes.
New figures from International Diabetes Federation (November 14 2015) suggests that 415 million people have diabetes in the world and more than 35.4 million people in the Middle East and North Africa region and by 2040 this will rise to 72.1 million.
There were over 1 million cases of diabetes in U.A.E in 2015. The U.A.E is ranked 16th worldwide, with 19% of the U.A.E population living with diabetes. These statistics indicate that the region has high risk factors for diabetes, mostly related to rising obesity rates and physical inactivity. This sedentary lifestyle and the globally increasing unhealthy diet have contributed to the rise in obesity and have increased diabetes prevalence in the region.
Current practice by the Doctors
We come across a lot of Type 2 Diabetes patients especially which are newly diagnosed. Patients often come with borderline blood sugars also known as Pre -Diabetes. There is a close association between diabetes and hypertension, they are diagnosed sometimes simultaneously. The risk factors are essentially same and so it needs to be screened when the diagnosis of one is made.
Diabetes in pregnant women also known as Gestational diabetes (GDM) is encountered frequently, the screening for this has to be done by standard OGTT at around 24-28 weeks of gestation. Women with a history of GDM should have lifelong screening for the development of diabetes or pre diabetes at least every 3 years.
We see the adverse complications of diabetes, mainly because of poor control of blood sugars. The most severe among them are cardiovascular and kidney complications. The earlier and the more intensive sugar control treatment remarkably postpones and reduces these morbid complications.
Most effective preventive measures.
At present, type 1 diabetes cannot be prevented.
However, there is a lot of evidence that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes.
Obesity, particularly abdominal obesity, is linked to the development of type 2 diabetes. Weight loss (7% body weight) improves insulin resistance and reduces hypertension. People who are overweight or obese should therefore be encouraged to achieve and maintain a healthy body weight.
Physical activity is one of the main pillars in the prevention of diabetes. Increased physical activity is important in maintaining weight loss and is linked to reduced blood pressure, reduced resting heart rate, increased insulin sensitivity, improved body composition and psychological well-being.
A balanced and nutritious diet is essential for health. A healthy diet reduces risk factors for cardiovascular diseases.
Smoking: a well-established risk factor for many chronic diseases, including diabetes and its complications. As well as other harmful effects, smoking increases abdominal fat accumulation and insulin resistance. All smokers should be encouraged to quit smoking.
Stress and depression: There is evidence of a link between depression and both diabetes and cardiovascular disease, hence steps towards decreasing stress help prevent diabetes.
Sleeping patterns: Both short (<6h) and long (>9h) sleep durations may be associated with a higher risk of developing type 2 diabetes. Sleep deprivation may impair the balance of hormones regulating food intake and energy balance.
Long term care and mobile apps
Education helps people with diabetes initiate effective self-management and cope with the stress of diabetes when they are first diagnosed. Care of diabetes has shifted to an approach that is more patient centered and places the person with diabetes and his or her family at the center of the care model working in collaboration with doctors. The long term care to get best results we should respect and respond to individual patient preferences, needs, and values and ensure that patient’s values guide all decision making.
People with diabetes should perform at least 150 min/week of moderate-intensity aerobic physical activity, spread over at least 3 days per week with no more than 2 consecutive days without exercise.
The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.
Saturated fat intake should be, less than 7% of total calories, also reducing intake of trans-fat lowers LDL cholesterol and increases HDL cholesterol.
If adults with diabetes choose to use alcohol, they should limit intake to a moderate amount (one drink per day or less for adult women and two drinks per day or less for adult men) and should take extra precautions to prevent hypoglycemia.
Regular glucose monitoring using HBA1C has been recommended to perform twice in a year for patients with stable glucose control and at least every quarterly when treatment goals are not met.
Check of blood glucose at home using a glucometer device is very effective in monitoring therapy, especially in patients using multiple insulin doses in a day. However, it is imperative that patients learn the proper technique and the way to interpret the results.
The therapy has to be individualized as per the patient’s age, lifestyle and other co-morbid illnesses.
As the smartphone has become such an important part of our personal and social life, it is needless to say the idea of apps related to diabetes will have an impact. These apps are excellent self-awareness tools, they help in better monitoring and serve as a constant source of continued education about diabetes.
A study published in the journal Clinical Diabetes concludes that “the use of mobile apps leads to improved A1C and self-management in diabetes care.”
It is recommended to choose apps based on individual goals. For some people with diabetes, that’s weight control; others need help tracking blood glucose or remembering to take medication. It is equally important to remember that unused apps stored on a smartphone do not change behavior or improve health.
Once Diabetes is diagnosed, then patients need to continue with the medicines and not stop the medicines abruptly once the sugars are controlled. We need to understand that Diabetes is a chronic disease and in order to “Beat Diabetes “regular monitoring of the blood sugar levels , compliance with therapy and lifestyle modification and continued education about the disease are important.
Dr. Srikanth Badavath Narayana
Aster Clinic, Al Butina