Alverston Bailey | Access to diabetes care

Diabetes is described by the World Health Organization (WHO) as a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. However, the most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. Over the past three decades, the prevalence of type 2 diabetes has risen dramatically in countries of all income levels.

EPIDEMIOLOGY

About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. Unfortunately, both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.

Statistics from the Jamaica Health and Lifestyle Survey III 2016/2017 show that 12 per cent of Jamaicans 15 years and older are living with diabetes, a prevalence which increases with age, and interestingly, women are more affected than men. It is also important to note that diabetes is the second leading cause of death in Jamaica and is the top ranked cause of death for women and the third for men.

RISK FACTORS

There are many risk factors for diabetes. Some are modifiable (changeable) while others are non-modifiable.

The risk factors for type one diabetes include:

• Family history: Anyone with a parent or sibling with type 1 diabetes has a slightly higher risk of developing the condition.

• Genetics: Having certain genes increases the risk of developing type 1 diabetes.

• Geography: The number of people who have type 1 diabetes tends to be higher as you travel away from the equator.

• Age: Type 1 diabetes can appear at any age, but it appears at two noticeable peaks. The first peak occurs in children between four and seven years old. The second is in children between 10 and 14 years old.

The non-modifiable risk factors for type 2 diabetes are:

• Age: The prevalence of diabetes increases as you age

• Race or ethnicity: African Americans are more likely to develop diabetes than whites. In addition, for Native Americans, the rates of diagnosed diabetes range from 5 per cent to 50 per cent in different tribes and population groups.

• Family history (genetic predisposition): Diabetes runs in families

• History of gestational diabetes: Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy.

• Low birth weight: Low birthweight is when a baby is born weighing less than five pounds, eight ounces (2.49Kg)

The modifiable or lifestyle risk factors include;

• Increased body mass index (BMI): BMI is a person’s weight in kilograms (or pounds) divided by the square of height in metres (or feet) -a normal BMI is between 18.5 - 24.9, overweight is 25.0 - 29.9, and obesity is 30.0 plus

• Physical inactivity: Physical inactivity is a term used to identify people who do not get the recommended level of regular physical activity

• Poor nutrition: A diet high in fat, calories, and cholesterol

• Hypertension: A blood pressure reading of 130/80 millimetres of mercury (mm Hg) or higher

• Smoking, and excess alcohol intake

• Psychosocial factors such as depression, increased stress, and poor social support

PREVENTION

Primary prevention strategies can halt the progression of type 2 diabetes with intensive lifestyle intervention by paying particular attention to:

Healthy diet: Eating the right foods for diabetes means eating a variety of healthy foods from all the food groups, while practising to read food labels on all pre-packaged food items you buy. As a guide, aim to include the following in your daily diet:

• Fruits and vegetables

• Whole grains, such as whole wheat, brown rice, barley, and oats

• Proteins, such as lean meats, chicken, turkey, fish, eggs, nuts, beans, lentils, and tofu

• Non-fat or low-fat dairy, such as milk, yoghurt, and cheese

• Limit high-carb foods and drinks including: Sugary foods, such as candy, cookies, cake, ice cream, sweetened cereals, and canned fruits with added sugar. Drinks with added sugars, such as juice, regular soda, and regular sports or energy drinks. White rice, tortillas, breads and pasta - especially those made with white flour, Starchy vegetables, such as white potatoes, corn, and peas

Increase physical activity: The goal is to get at least 150 minutes per week of moderate-intensity physical activity such as – walking fast. Doing water aerobics. Riding a bike on level ground or with few hills. Playing doubles tennis. Pushing a lawn mower

Consider drug therapy using glucose-lowering agents such as Metformin. Please discuss this option with your doctor.

Know your numbers: it is estimated that the onset of type 2 diabetes occurs an average of about four – seven years before clinical diagnosis, and as a high proportion of individuals exhibit evidence of end-organ damage by that point, screening has been proposed in anticipation that early detection and early treatment would reduce the long-term burden of this disease. So, know your numbers and get your blood sugar checked today.

• Diabetes is diagnosed at an A1C of greater than or equal to 6.5 per cent.

• Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl. (7 mmol/l)

• Diabetes is diagnosed at two-hour blood glucose of greater than or equal to 200 mg/dl. (11.2mmol/l)

Keep your blood pressure tightly controlled: aim for a reading of less than 130/80

Avoid smoking and reduce alcohol intake – Female: No more than one drink in a single day and no more than seven drinks per week. Male: No more than two drinks in a single day and no more than 14 drinks per week.

Seek assistance: if you feel depressed or need support socially or psychologically

As we highlight the health and economic threat posed by diabetes locally and internationally, let us consider the importance of taking coordinated and concerted actions to confront diabetes as a critical global health issue through effective public health policies that create sustainable environments and most importantly, access to quality care for all.

Dr Alverston Bailey is an occupational and family physician and co-chair of the University Diabetes Outreach Programme. Send feedback to ghapjm@gmail.com and columns@gleanerjm.com