Health Bulletin-June 2016

Do not ignore diabetic symptoms

Diabetes is a silent killer that affects men and women, young and old, rich and poor. A recent report shows that the number of adults worldwide with diabetes has quadrupled in the past 35 years [1]. Climbing from 108 million in 1980 to 422 million in 2014, the increases were particularly severe in countries such as China and India. The price tag for treating and managing the disease and its complications now totals $825 billion a year, the report found. The new estimates are from an analysis of 751 studies that included more than 4 million adults in different regions of the world [1]. "The findings sound the alarm for large-scale, effective action to reduce the health and economic impact of diabetes. Improvements in prevention and management, together with better surveillance, should be prioritized in response to this call", the Lancet editorial said [1].

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes your body does not make enough or use insulin well. Type 2 diabetes is the most common type of diabetes. About 95 percent of people with diabetes have type 2. People can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes develops most often in middle-aged and older people. People who are overweight and inactive are also more likely to develop type 2 diabetes [2].

Type 2 diabetes usually begins with insulin resistance, a condition linked to excess weight in which your body's cells do not use insulin properly. As a result, your body needs more insulin to help glucose enter cells. At first, your pancreas keeps up with the added demand by producing more insulin. But in time, your pancreas loses its ability to produce enough insulin, and blood glucose levels rise.

Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, kidney disease, blindness, dental disease, and amputations. Other problems of diabetes may include increased risk of getting other diseases, loss of mobility with aging, depression, and pregnancy problems.

Blood tests for fasting glucose levels can show if you have diabetes. Another type of test, the A1C, can also check on how you are managing your diabetes.

Can type 2 diabetes be delayed or prevented?

Yes. The results of the Diabetes Prevention Program (DPP) proved that weight loss through even moderate diet changes and physical activity can delay or prevent type 2 diabetes [3]. The DPP was a federally funded study of 3,234 people at high risk for diabetes. This study showed that a 5-to 7-percent weight loss slowed development of type 2 diabetes.

DPP study participants were overweight and had higher than normal levels of blood glucose (also called pre-diabetes). Many had family members with type 2 diabetes. Pre-diabetes, obesity, and a family history of diabetes are strong risk factors for type 2 diabetes.

The DPP tested three approaches to preventing diabetes: 1) Making lifestyle changes. People in this group exercised, usually by walking 5 days a week for about 30 minutes a day, and lowered their intake of fat and calories. 2) Taking the diabetes medicine metformin. In addition to medicine, this group also received information about physical activity and diet. 3) Receiving education about diabetes. This group only received information about physical activity, diet and took a placebo, a pill without medicine in it.

People in the lifestyle change group showed the best outcomes. Pre-diabetics who took metformin also benefited. The results showed that by losing an average of 15 pounds in the first year of the study, people in the lifestyle change group reduced their risk of developing type 2 diabetes by 58 percent over 3 years. Lifestyle change was even more effective in the age 60 and older, who reduced their risk by 71 percent [3].

Randomized clinical trials also have confirmed that structured lifestyle modification can prevent diabetes in people with impaired glucose tolerance [4]. These benefits can be translated into long-term reduction in microvascular and macrovascular complications and all-cause death.

Dr. Bardenheier and team at Center for Disease Control and Prevention, Atlanta, GA, studied the effect of awareness of elevated glucose levels on calorie intake in 3,725 subjects that included diabetics and pre-diabetics. The study showed that men and women who diagnosed with diabetes consumed less sugar and carbohydrates and more protein than men and women with undiagnosed diabetes [5]

The complexity of diabetes transcends biomedical, socio-economical, cognitive, psychological, behavioral, political, and technological domains. The Lancet report calls for multi-sectorial, population-based approaches to help reduce risk factors for diabetes in the general population. It recommends a life-course perspective that instils healthy eating and physical activity from an early age to prevent type 2 diabetes later in life [1].

Final comment

Those who are pre-diabetic and overweight, regular monitoring of fasting blood glucose levels and weight every month may help reduce calorie intake, lose weight and minimize potential diabetic and related complications in the future [6].

References:

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4â€¢4 million participants. Lancet 2016; 387: 1513-30
Introduction to diabetes https://www.nlm.nih.gov/medlineplus/diabetes.html
Diabetes Prevention Program outcomes study: https://dppos.bsc.gwu.edu/
Staimez LR et al. (2014) The Role of Lifestyle Change for Prevention of Cardiovascular Disease in Diabetes. Curr Atheroscler Rep. 16:460
Bardenheier BH et al. (2014) Does Knowing One's Elevated Glycemic Status Make a Difference in Macronutrient Intake? Diabetes Care. 37(12): 3143-3149
Fifty different ways you can control diabetes: http://ndep.nih.gov/media/NDEP71_Choose50Ways_4c_508.pdf