November 30, 2006

The International Diabetes Federation (IDF) has made 'Diabetes Care for Everyone' its campaign for 2006. One of the reasons for the campaign is because many individuals suffer avoidable, serious type 2 diabetes health complications due to a lack of care. This is not just a lack of care for those diagnosed with the condition, but also a lack of care for the even larger number of people who are not in contact with health service providers.

There are many reasons for the lack of care for many of those with type 2 diabetes, and those with impaired glucose tolerance, a condition that can be undetectable due to the lack of external symptoms. Irrespective of the cause, lack of care is one of the key contributing factors to the adverse health complications of type 2 diabetes. 

One of the essential, prerequisite steps to address the problem is to raise public awareness on how, when and why access to health care services for prevention and treatment of type 2 diabetes is important. Better public understanding can help achieve the goal of improving access to diabetes care in many ways. For example, better public understanding can increase rates of early detection and diagnosis; increase the individual's ability and motivation to access appropriate medical care and advice; as well as extend the reach and impact of medical advice on beneficial dietary and lifestyle habits for the prevention and management of type 2 diabetes.

In support of IDF's campaign, AFIC is launching two new resources designed to improve individuals' understanding of type 2 diabetes and what they can do to avoid developing complications associated with type 2 diabetes. This article is based on extracts from one of these resources, the fully revised and updated 'What You Should Know About Type 2 Diabetes' leaflet. 

What is Type 2 Diabetes?

Diabetes is a condition characterized by high blood sugar levels and undesirable changes in blood fats. Type 2 diabetes is the most common type of diabetes. 85 - 95 % of all diabetes cases are type 2 diabetes. It usually occurs in adulthood, although a small but increasing number of children and adolescents who are overweight are developing the condition also. 

How Many People are Affected by Type 2 Diabetes?

India has the highest number of people with diabetes in the world (35.5 million persons), followed by the People's Republic of China in the second place with 23.8 million diabetics. In 2003, 39.3 million people in the South-East Asian region were estimated to be diabetic, which is equivalent to 5.6% of the population. 

The Diabetes Atlas of the World Diabetes Foundation estimates that over 5% of the adult population worldwide has diabetes, and that a further 8% has impaired glucose tolerance, a condition which can contribute to many of the health implications of diabetes and in many instances if left unchecked will progress to type 2 diabetes.

What are the Symptoms of Type 2 Diabetes?

Type 2 diabetes advances very slowly, sometimes without external symptoms. 1 in 3 of those diagnosed with diabetes has already developed complications. In these instances, some of the effects may be irreversible.  

The most common external symptoms of type 2 diabetes are excessive thirst, frequent passing of urine, hunger, unintentional weight loss, lack of energy, blurred vision, slow healing of cuts or bruises, tingling or loss of feelings in hands or feet, recurring infection of the skin, gum, vagina, or urinary tract. 

How can I Prevent or Minimize Type 2 Diabetes Complications?

To avoid complications, it is important to detect diabetes as early as possible. For those who are overweight or obese and over 45 years of age, it would be wise to request a simple diabetes test from the doctor once a year.   

For those diagnosed with type 2 diabetes, maintaining good control of blood glucose, blood fats and blood pressure are priority goals. To achieve good control of blood glucose, both medications and lifestyle changes may be needed. Lifestyle changes include a healthier eating plan and physical exercise.

Regular visits to the doctor's office will also ensure early detection of any developing health complications. 

Who is at Risk of Type 2 Diabetes?                                                                                   

·         Those with a family history of type 2 diabetes: Genetics play a role in type 2 diabetes. If one or more direct family members has type 2 diabetes, the risk of developing diabetes is significantly increased.

·         Overweight and obese people: More than 8 out of 10 type 2 diabetics are either overweight or obese.

·         Inactive persons: type 2 diabetes usually affects the more sedentary persons. Being physically active can reduce the chance of developing type 2 diabetes by half.

·         Advancing age: 1 in 5 persons over 65 years old has type 2 diabetes. 

How can I Prevent or Delay The Onset of Diabetes?                                                                          

·         For those who are overweight, reducing excess body fat by 7 - 10% of the current weight halves the chance of developing type 2 diabetes.

·         Fat accumulated around the abdominal area particularly increases the risk of developing diabetes and associated complications. Fat around the abdomen can be measured by measuring waist circumference. To do this, use a tape measure midway between the lowest rib and the upper part of the hip bone. Waist circumference of less than 90 cm for men and less than 80 cm for women indicates a lower risk. For those with more abdominal fat, the risk increases proportionately with increasing girth.

·         Active use of muscle increases the muscle's ability to absorb glucose and to use insulin, both of which will benefit those with, or at risk of type 2 diabetes. A combination of aerobic exercise, strength training, and flexibility exercise is recommended. 

Exercise Tips

a)       Aerobic exercise: Recommended at least 5 times a week for about 30 minutes a day. If you need to lose weight, more exercise time is beneficial. Consult your physician before increasing exercise levels.

b)       Strength training: Building up muscle mass is good for diabetics to burn more calories and improve the body's own ability to lower blood sugar levels. Weight lifting is an example of strength training.

c)       Flexibility exercises like stretching helps to keep the joints flexible and reduces the risk of getting injured during exercise. 

Tips to increase your physical activity:

• Park at the far end of the parking lot.

• Do some gardening at home.

• Get involved in active play with your children or grandchildren.

• Take the stairs instead of the lift or elevator.     

• Or climb the elevator.

• Wash your vehicle.

• Stop a few blocks away from your usual bus stop/station and walk the distance.

Diet Tips

The two most important dietary strategies that can reduce type 2 diabetes risks are choosing high fibre and unrefined carbohydrate food sources and choosing foods that are low in fat, especially saturated fats.  

Choose wholegrain, high fiber carbohydrate sources and limit consumption of highly refined carbohydrates. Wholegrain high-fiber carbohydrates are slowly absorbed, which limits increase of blood glucose levels and reduces insulin demand. Good choices include brown rice, oats, wholegrain bread, soba noodles, mung bean vermicelli, most beans, nuts and bulgur.  

Use unsaturated fats instead of saturated and trans fats. Unsaturated fats, such as canola, olive, peanut, sunflower, or corn oil help in preventing type 2 diabetes. Coconut, palm and palm kernel oil which contain higher levels of saturated fat and hard and semi-hard margarines, as well as lard, which contain both saturated and trans fats, may accelerate the development of type 2 diabetes and complications.  

Further Reading:

1)       Diet, Nutrition and The Prevention of Chronic Diseases: Report of a Joint WHO/ FAO Expert Consultation, 2003

2)       World Diabetes Foundation: Diabetes Atlas 2nd Ed. 2003

3)       International Diabetes Foundation www.idf.org