The diabetes epidemic

The diabetes epidemic

When you ask people about heart disease, cancer or even HIV - they generally have a good understanding of these diseases, the causes and the measures needed in terms of prevention. But mention diabetes, and unless the person suffers from the condition or has a family member or loved one with it, the answers are much hazier.

Diabetes is a condition in which sugar is not properly absorbed by the body. Of course, it is much, much more than that and the complications for diabetes which has not been diagnosed or treated properly can be severe.

Globally the incidence of diabetes is likely to exceed 250 million people by 2025 - that is a measure of the scale of the problem in the future. It is evidence of how diabetes will be one of the foremost public health challenges facing the world in the decades ahead. While diabetes belongs at the top of the healthcare agenda, it has yet to be given that position.

This article is aimed at explaining in a simple fashion, what diabetes is, how it is managed, the complications, the burdens, clear advice on lifestyle challenges for those with the condition and the prospects for the future.

Why the body needs glucose

Diabetes is caused by a lack of insulin (a hormone) by a gland in the abdomen, the pancreas. Insulin is important because it is responsible for absorbing glucose (a simple sugar) into the blood stream where it helps body cells to grow and it provides energy.

When most people eat, the pancreas automatically produces the right amount of insulin to absorb glucose. However, for those with diabetes - the pancreas either produces little or no insulin or the body's cells do not respond to the insulin that is produced. The result is that the glucose builds up in the blood, overflows into the urine and passes out of the body. The body has now lost its main source of fuel.


Insulin injection - to correct glucose (sugar) levels in the blood.

Types of diabetes

Two major forms of diabetes exist - type 1 and type 2. Type 1 is where the body produces little or no insulin. People with this type of diabetes usually develop it over a short period. This group will require insulin treatment to control the amount of insulin in the blood to ensure that glucose levels are normal. It means injections of insulin each day. This type of diabetes is most often seen in children and young adults.

Type 2 is also known as non-insulin dependent diabetes and is the most common type affecting up to 95 per cent of people with the condition. For people with type 2, the pancreas usually produces some insulin but the body can not use it effectively.

Unfortunately, this type of diabetes may not be diagnosed until a routine medical check-up, which emphasises the value of national screening programmes. This group may have their diabetes sufficiently controlled by diet and exercise alone. However, oral glucose lowering tablets may be required and on occasions insulin treatment too. This type of diabetes is most often seen in people over 40 years.

According to doctors here, research shows that people with type 2 diabetes are relying heavily on oral medication to treat the condition, while avoiding a healthy diet and exercise - two components that are essential in managing the condition.

If diabetes is not treated it can lead to heart disease, strokes, kidney failure, nerve damage, blindness and birth defects in babies born to women with diabetes.

Diabetes is diagnosed by examining glucose levels in the blood. Another form of diabetes is gestational diabetes - which develops during some cases of pregnancy. It usually goes when the pregnancy is over but women who have had this are at greater risk of developing type 2 diabetes later in their lives.

Dietary control and a good exercise regime are important for people with both types of diabetes. This includes being aware of which foods to eat and spacing meals to avoid going too long without food.

Awareness

Ireland is not dissimilar to other European countries in terms of diabetes levels. If anything, Ireland's unparalleled economic success over the past decade has contributed to more sedentary lifestyles, fuelling the level of obesity. As a result, we are seeing a big increase in the level of diabetes.

There are 200,000 people in Ireland with diabetes, yet 50 per cent of those people are unaware of their condition. It reflects the need to develop much greater awareness of diabetes both here and across Europe, through public education, investment in healthcare and healthcare staff working together to ensure the condition gets the attention it deserves.

Diabetes is easily missed unless the blood is tested. During an 18 month period, the Medical Defence Union (which insures doctors) reported 60 claims relating to diabetes. Of these, many were Fitness to Practise Committee complaints against doctors for a failure to diagnose diabetes or to treat it adequately. So the message is that GPs in particular, also need to be vigilant.

Burden of diabetes

Most people unfamiliar with diabetes are unaware of the huge health burden which the condition places on those affected by it. Both type 1 and type 2 are lifelong conditions. A careful watch on diet and exercise is critical in both cases. However, people with type 1 diabetes will need injections for the rest of their lives.

Governments are unaware or unwilling to face up to the major challenge that this condition presents both now and into the future. The official attitude is reflected in the fact that there is no clear policy for diabetes screening and many governments simply do not wish to spend funds in this area, despite the fact that currently the burden of diabetic complications takes up to 15 per cent of European healthcare budgets. The World Health Organisation has set up a committee to examine the issue of screening. This is a vital initiative given that worldwide, less than 20 per cent of the diabetic population has good metabolic control.

According to the International Diabetes Federation, diabetes represents the number one cause for admission to dialysis and kidney transplant programmes and is the leading cause of blindness in people of working age. It also accounts for a risk of lower limb amputation of 10 to 12 per cent.

The greatest nightmare for doctors treating patients with type 2 diabetes is obesity. People who are obese and lead a sedentary lifestyle are much more likely to develop type 2 diabetes than anyone else. For Ireland, this is disturbing as a recent survey found that over 20 per cent of men living here are obese - a significant increase on recent years. The rate of obesity among women is 16 per cent, also up on previous years. So, diabetes is a hidden epidemic facing Europe (and other regions) in the years ahead.

Hypoglycaemic reactions

Hypoglycaemia is a deficiency of glucose in the blood stream causing muscular weakness and lack of co-ordination, mental confusion and sweating. If severe, it can lead to coma. It is most often seen in people with diabetes due to insulin overdose or a lack of carbohydrate intake. The treatment for hypoglycaemia is glucose by injection or by the mouth.

To avoid this type of a reaction, people at risk need to monitor their sugar levels regularly. Carrying some sugar or glucose is a wise precaution.

On the other hand, hyperglycaemia is due to an excess of glucose in the blood stream and excessive intake of carbohydrates.

Lifestyle

 

 

As the Diabetes Federation of Ireland points out, it is the person with diabetes that plays the most important role in the management of their diabetes. But also, the long-term relationship with the family doctor is also vital in living with the condition. Diabetes nurse specialists, practice nurses with a knowledge of diabetes, consultant physicians/endocrinologists and pharmacists will also play a role in management.

People with both types of diabetes need to adapt their lifestyle in specific ways. For those with type 1 it is important to:

* learn how to give yourself insulin injections
* know how to use the home blood-glucose test kit
* stop smoking
* exercise often
* carry some form of sugar to treat low blood sugar quickly
* visit your doctor regularly
* carry a bracelet or card that identifies you as having diabetes in case of an emergency

People with type 2 diabetes should:

* avoid being overweight and exercise
* do not smoke and stick to a good diet
* know how to use the home glucose test kit
* be able to give yourself insulin injections if necessary
* visit the doctor regularly

Advances are being made in the development of blood-glucose home test kits. One method, approved in the US in 1998, features a laser to draw blood instead of the traditional lancet method. A watch devise measuring blood-sugar using tiny electrical currents was also approved by the FDA in the US in 2001. However, this does not replace the need for daily tests. Further developments in terms of continuous monitoring are expected. The aim is to reduce the burden on patients with diabetes, especially the elderly who often have trouble in performing these tests.

Complications

There are a number of important complications of diabetes which those with the disorder need to be aware of. These complications include, ulcers and infections of the feet, susceptibility to infection, hardening of the arteries, seizures and loss of consciousness and damage to other organs.

Research

Because the incidence of diabetes in the Western world is increasing, much research is underway aimed at improving treatment and finding ways of preventing the condition. As regards type 1 diabetes, a big key to progress is a proper understanding of what triggers the damage to the cells that produce insulin in the pancreas. Researchers are working on this.

In type 2 diabetes, there is still not a full understanding of how the genes in this type of diabetes work. When more is found out, it may be possible to fully prevent type 2 diabetes. Cure of insulin deficiency by transplant of pancreatic tissue, or making changes to the cells that make insulin is being researched. Treatments to prevent or reverse complications are also being tested.

The outlook

The aim of all governments should be to ensure that a comprehensive range of diabetes care is provided so that everyone with the disorder, regardless of geographical location, can receive optimum care. There is also an onus on States and the medical community to ensure that people are sufficiently informed about diabetes, the symptoms, risk-factors and the help that is available.

There must be considerable concern for the future given that obesity in children and young adults is increasing at alarming rate. In Ireland, cases of 'adult onset' diabetes are being diagnosed in overweight adolescents.

Diabetes is a chronic, and to a large extent preventable condition. Much of the funding - around 10 per cent of the Irish health budget - currently goes on treating the complications. These complications are preventable if patients with the condition have access to expert healthcare. Clinical trials and economic analyses show that services aimed at preventing or delaying the onset of complications of diabetes are effective and cost-effective.

However, with all European governments facing escalating healthcare costs, the danger is that an area that gets insufficient attention like diabetes care could be even more vulnerable.

The introduction of screening programmes have the potential to substantially reduce the impact of diabetes related complications, especially ophthalmic and cardiovascular.

Fourteen years after Ireland, along with over 50 other countries signed the St Vincent Declaration on agreed measures to improve diabetes care, only limited progress has been made. The greatest battle with this condition lies ahead.

People with diabetes deserve a quality health system, full information and support. This is one of the most important ways to improve the lives of people with diabetes.

If we fail to recognise the prevalence of diabetes and its complications, the heavy costs already faced by society, at both a human level and in State services, will grow much further.

For more help, contact the Diabetes Federation of Ireland at www.diabetesireland.ie


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