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All eyes on diabetes

Monday, 14 November is World Diabetes Day 2016 and the statistics are startling:

An estimated 7 to 9% of the South African population between the ages of 20 and 79 years have diabetes.1 Based on South Africa’s current population figure of 55, 6 million, 2 this translates into nearly 5 million people possibly living with diabetes.  However, given the fact that proportionately Africa has the highest number of people with undiagnosed diabetes (over two-thirds of people unaware that they have the condition 1), many more South Africans may actually have diabetes.

The International Diabetes Federation (IDF) predicts that the global prevalence of diabetes is expected to rise exponentially over the next 25 years – by 2040, 1 adult in 10 (642 million) will have diabetes3.

World Diabetes Day 2016

Screening to ensure early diagnosis and treatment of type 2 diabetes, to prevent possible serious diabetes-related complications, is essential. With diabetes-related eye disease being a leading cause of blindness in many countries, World Diabetes Day on the 14 November 2016 will focus on the eyes with the theme, “All eyes on Diabetes”.4

World Diabetes Day (WDD) was created in 1991 by the IDF and the World Health Organisation, in response to growing concerns about the escalating health threats posed by diabetes.4 The aim of this day is to promote the importance of taking coordinated and concerted actions to confront diabetes as a critical global health issue.

In support of World Diabetes Day 2016, South Africa’s leading diabetes management organisation, the Centre for Diabetes and Endocrinology (CDE), will join forces with the Johannesburg Zoo for the Johannesburg Zoo Trot – a 5 km walk at the Zoo, taking place on Sunday the 13th of November 2016.

Members of the public are invited to join in the fun at the zoo and do the trot to reduce stress, build stamina and keep fit, thus contributing to a healthier lifestyle. Further details can be obtained via this link: www.cdediabetes.co.za/home/diabetes/diabetes-events.html.

What is diabetes?

Diabetes is a chronic health condition that occurs when the pancreas is no longer able to make the blood glucose lowering hormone (chemical messenger) insulin, or when the body cannot optimally use the insulin it produces. Glucose, a simple sugar, and a major fuel used to provide energy for our bodies, is obtained from the digestion of the food that we eat. It is then absorbed into our bloodstream and transported to cells that make up our organs and tissues. Insulin acts like a key to allow the glucose to pass from the blood stream into the cells where it is used to produce energy.5

Not being able to produce insulin and / or use it effectively, leads to raised glucose levels in the blood (hyperglycaemia). Insulin is vital because it enables the metabolism of carbohydrates, fats and proteins. We need insulin to survive 6. Over the long-term, high glucose levels are associated with damage to the body and failure of various organs and tissues.5

There are two common types of diabetes, known as ‘type 1 diabetes’ and ‘type 2 diabetes’. These two conditions are generally considered to be distinct, so it is important to understand the differences between the two.

Type 1 diabetes

About, 5-10% of people with diabetes have type 1 diabetes. In type 1 diabetes, the immune system attacks the insulin-producing beta cells in the pancreas. When this happens, the pancreas no longer produces insulin. Every person with type 1 diabetes needs to inject themselves with insulin multiple times daily, first to survive and secondly to achieve good diabetes control. However, insulin injections have advanced greatly from previous years and are now virtually painless and simple to do. Various types of insulin are available, and a number of different insulin treatment regimens (daily injection schedules) can be used to tailor insulin therapy to the lifestyle of the person with diabetes.6

There is no cure for type 1 diabetes, says Registered Dietitian, Hamish van Wyk, Clinical Consultant and Product Manager at The Centre for Diabetes and Endocrinology in Johannesburg. “Some studies suggest that people with type 2 diabetes can develop normal blood glucose levels again if they follow a healthy lifestyle and eating plan and lose excess weight, particularly around the abdomen. It is important to note that there is still permanent damage to the pancreas; thus there is no cure and it merely becomes diabetes in ‘remission’.” 7

Type 2 diabetes

Type 2 diabetes is the most common type of diabetes. Of all people with diabetes, 90-95% have type 2 diabetes11. In recent years, in tandem with the pandemic of overweight and obesity, increasing numbers of younger people, and sometimes even children, develop type 2 diabetes.

Many people live with type 2 diabetes for a long period of time (sometimes over a decade) without being aware of their condition. By the time of diagnosis, complications of uncontrolled diabetes may thus already be present. Up to 70% of type 2 diabetes cases can be prevented or delayed by adopting healthier lifestyles (an equivalent of up to 160 million cases by 20404).

Van Wyk confirms that many people with type 2 diabetes do not develop symptoms until they have had diabetes for 10 years or more. “Thus, it is vital that high-risk people are screened for diabetes rather than waiting for symptoms to occur.”7

Although diabetes is a life-long condition, it is manageable if detected and treated early. On the other hand, it can be devastating if diagnosed late or not properly treated. The importance of early diagnosis can therefore not be over-emphasised, 7 stresses Van Wyk.

Symptoms, diagnosis

“If you are urinating excessively, have extreme thirst and a dry mouth, increased hunger, blurred vision, profound fatigue and rapid, unintentional weight loss, you should be checked for diabetes,” Van Wyk advises. 7

However, in many people with type 2 diabetes, blood glucose does not go high enough to cause identifiable symptoms, which is why so many people with diabetes remain undiagnosed, he adds.7

“Diagnosis is relatively simple. A screening finger-prick blood test which can be done at your pharmacy, community clinic or general practitioner will indicate whether or not a laboratory fasting blood glucose test should be done to diagnose or exclude the presence of diabetes.”7

Potential Complications of diabetes

The good news about complications of diabetes is that any potential complications of diabetes can be prevented or delayed through early diagnosis and good control of diabetes and associated cardiovascular risk factors (e.g. blood pressure and cholesterol).

Long-term complications of untreated or poorly managed diabetes develop gradually and mainly affect the heart and blood vessels, resulting in cardiovascular disease. The longer you have diabetes — and the less controlled your blood glucose — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.9

Possible cardiovascular disease complications include (heart attack, narrowing of limb arteries, stroke); nerve damage, which untreated could result in the loss of all feeling in affected limbs, and kidney damage or even failure.  Diabetes also damages the light-sensing retina in the eyes increasing the risk of visual problems and blindness and the risk of other serious vision conditions, such as cataracts and glaucoma. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications, which initially affect health and daily activities and ultimately may require toe, foot or leg amputation.9

Diabetes care and treatment needs team work

Both type 1 and type 2 diabetes are complex conditions, requiring specialised expertise and a team approach, which is fundamental to the proper management of diabetes.

The CDE, through its Diabetes Management Programme, provides person-centred, holistic and comprehensive diabetes services based on international standards of diabetes best-practice.9

The skilled and accredited members of the CDE Diabetes Team provide diagnosis, counselling, coaching, education, treatment and lifestyle options, support and motivation. In addition to doctor advice, input from other key practitioners should also be sought. Input from a diabetes educator, dietician, podiatrist, ophthalmologist, pharmacist, biokineticist and psychologist (amongst others), is necessary either routinely or on a need basis to maximise care and quality of life.9

Community Diabetes Associations such as Diabetes South Africa and Youth With Diabetes are a vital part of the team to provide support where most diabetes care occurs – in the community.9

Besides team care and support, good diabetes care and management comprises a number of other key components including individualised care, empowerment to practice self-care, diabetes education and ongoing monitoring, all of which assist in reducing sickness, death, hospitalisation and costs due to diabetes.9

“As type 2 diabetes is primarily a lifestyle condition (with risks including being overweight, having poor eating habits, physical inactivity and stress), prevention should start at home.  Even among people with a family history of the condition, losing weight and increasing physical activity can help to prevent or delay the onset of diabetes. In people who already have diabetes, lifestyle changes can help in the quest to prevent and delay the development of diabetes-related complications,” concluded Van Wyk.

The recently launched CDE Club

To assist people with diabetes in the management of their condition and to make living with diabetes a little easier, the CDE recently established the CDE Club. The CDE Club offers various rewards and benefits to the entire South African community living with diabetes, and not just CDE members.

Anyone can join the CDE Club – all members of any of the CDE Diabetes Management programmes automatically receive CDE Club Membership. Every CDE Club member receives an informative monthly newsletter which showcases diabetes health achievers, offers tips for healthier living and informs members of any up-coming events. The newsletter also includes healthy lifestyle shopping vouchers that offer significant discounts on lifestyle related purchases.

In 2017, the CDE Club will launch a new CDE Club App, a web and mobile compatible programme which will be freely available to anyone. The focus of the CDE App will be to implement the four pillars of the CDE Club, namely to learn, act, share and be rewarded.

To join the Club, visit www.cdediabetes.co.za/home/diabetes/join-cde-club/about-cde-club.html and complete the Application Form.