Education and awareness key to managing the world's diabetes epidemic

Johannesburg, 12 November 2008: World Diabetes Day, which is observed globally every year on 14 November, is once again this year focusing on diabetes in children and adolescents. The objectives of this day include raising awareness of the warning signs of diabetes, improving access to education and appropriate care and promoting healthy lifestyles to help prevent type 2 diabetes. Organising bodies, including the International Diabetes Federation (IDF) and World Health Organisation (WHO), aim to spread this message to over one billion people globally.

Diabetes is a disease that develops when one's body cannot use the energy from food consumed. It is closely related to how the body makes or uses insulin, a substance produced in the pancreas, which helps the body to keep blood sugar within a normal range. In type 1 diabetes, the body makes little or no insulin. In type 2 diabetes, the body produces insulin, but is unable to utilise it adequately. As time goes by, the body's ability to make insulin also decreases gradually. In both type 1 and type 2 diabetes, sugar builds up in the bloodstream because it is unable to enter the cells. Without this sugar for fuel, the body lacks energy while the sugar stays in the bloodstream causing high blood sugar levels. High blood sugar levels can damage blood vessels, and over long periods of time, can result in serious health problems.

The World Health Organisation (WHO) estimated the global burden of diabetes to be at 135 million in 1995 and predicts that this number will reach 299 million by the year 20253. According to the International Diabetes Federation (IDF), prevalence estimates of diabetes in South Africa in 2007 ranged between four and six percent of the population. More alarming, however, are the prevalence estimates of those in South Africa with impaired glucose tolerance.

Impaired glucose tolerance (IGT) is an asymptomatic condition defined as elevated, but not diabetic, blood glucose levels and is now a recognised stage in the transition from ‘normality' to diabetes.

In South Africa, approximately 8-10% of the adult population had impaired glucose tolerance last year, with this figure expecting to increase to between 10 and 14% by 2025.

“Awareness about the importance of how to live healthily when one has diabetes, as well as how to avoid developing type 2 diabetes when one is at risk , is essential amongst the youth in South Africa - where the diabetes "epidemic" is reaching worrying proportions. That being said, people with the condition can lead normal and relatively unaffected lives if they know how to administer their treatment optimally and how to eat and exercise so as to give their bodies the best chance to maintain a healthy balance. Good support from their families is also an important factor,” says Professor François Bonnici, a diabetes specialist, who is on both the International Diabetes Federation (IDF) and World Health Organisation (WHO) Expert Panels.

As highlighted in this year's World Diabetes Day theme, the incidence of childhood onset diabetes in increasing globally. Worldwide, there are close to 500 000 children under the age of 15 with type 1 diabetes. Every day, 200 children develop type 1 diabetes. Every year, 70 000 children under the age of 15 develop type 1 diabetes.

Although type 1 diabetes still represents the predominant form of the disease in youth in South Africa, due to the marked increase in childhood obesity in most regions in the world, type 2 diabetes is becoming much more common and is now being labeled as an “epidemic”. In the United States alone, it is estimated that type 2 diabetes represents between 8 and 43% of new-onset diabetes cases in children. Type 2 diabetes, once known as ‘adult onset' disease, is growing rapidly and is expected to increase by up to 50 percent over the next 15 years.

Despite treatment, though often suboptimal, over 50 percent of children with diabetes develop complications about 12 years after diagnosis. Early diagnosis, lifestyle intervention and intensified treatment are vital.

With appropriate care, access to medications, education and support, children with diabetes should not only be able to survive, but should thrive and live productive, meaningful and healthy long lives. But this is not the case for hundreds of thousands of children around the world. Those without access to medical care or basic supplies, such as insulin, can succumb to the disease shortly after, or even before, diabetes is diagnosed.

Another objective of World Diabetes Day and the IDF is to attract sufficient resources to the International Diabetes Federation's Life for a Child Programme, to support an additional 500 children by the end of next year. Another objective is to encourage global initiatives to reduce diabetic ketoacidosis, a build-up of excess acids in the body as a result of uncontrolled diabetes, a condition which is the major cause of death in children with type 1 diabetes.
With early diagnosis and access to care, the development of severe diabetic ketoacidosis should be preventable.

Vital to the management of diabetes is the education and knowledge regarding the symptoms of diabetes. These symptoms include unusual thirst, frequent urination, unusual weight loss, extreme fatigue or loss of energy, blurred vision, frequent or recurring infections, cuts or bruises that are slow to heal, boils and itching skin and tingling and numbness in hands and feet. Increased hunger, vomiting and stomach pains (often mistaken as ‘flu) may also be symptoms of this disease.

Type 1 diabetes, which usually accounts for only a minority of the total burden of diabetes, is the most predominant form of the disease in younger age groups. This is increasing in incidence in both developing and developed countries.

Type 2 diabetes constitutes about 85 to 95% of all diabetes in developed countries and accounts for an even higher percentage in developing countries. It is now a common and serious global health problem. In most countries around the world, this has evolved in association with rapid cultural and social changes, ageing populations, increasing urbanisation, dietary changes, reduced physical activity and other unhealthy lifestyle and behavioural patterns.

In general, risk factors for developing type 2 diabetes include:
Being over 35 years of age
Being overweight (especially if you carry most of your weight around your middle)
Being a member of a high-risk group (in South Africa, if you are of Indian or mixed ethnic descent, you may be at particular risk)
A family history of diabetes
Having given birth to a baby that weighed over 4 kg at birth, or if you had gestational diabetes during pregnancy
High cholesterol or other fats in the blood
High blood pressure or heart disease

People with type 1 diabetes require daily injections of insulin to survive. Insulin, which was discovered over 85 years ago, has been giving life to many people with diabetes ever since.

Scientists believe that lifestyle and type 2 diabetes are closely linked. This means that lifestyle is one area which individuals can focus on to help prevent or delay the onset of the disease.
A healthy diet, weight control, exercise, reduction in stress and no smoking are important preventative steps. Some type 2 patients might also require diabetes tablets and/or insulin to assist the body in making or using insulin more effectively.

In summary, diabetes is:
Common - At least one in fourteen people globally suffer from diabetes
Controllable - Though there is no cure for diabetes, it can be managed by keeping blood sugar close to normal, through proper meal planning, exercise, the reduction of all cardiovascular risk factors such as elevated cholesterol, blood pressure, overweight, sedentary lifestyle, smoking and medication where needed
Life-long - While one's blood sugar levels may become controlled, it does not mean that the diabetes has disappeared
Self-managed - While a healthcare team will advise and support the patient, control depends on the patient
Progressive - It is common for a doctor to change a patient's medication or treatment plan over time