Medicines alone don’t work; a bit of physical exercise and getting out of the house too hold the key to a diabetes-free life
DIABETES has emerged as a major health problem around the world. The estimates of the World Health Organization and International Diabetes Federation give prevalence figures in 2003 of 194 million people with diabetes globally.
This estimate is expected to increase to about 333 million by 2025. What is most alarming is that 75 per cent of these people will be from the developing countries. By this time, the Southeast Asian Region is anticipated to have about 82 million people with diabetes.
Type 2 diabetes has a major share in the diabetic population. It constitutes about 85 to 95 per cent of all diabetes in developed countries. The developing countries, including Pakistan it consists of 98 per cent.
In earlier times, type 2 diabetes was presumed to be a disorder of middle age and of the affluent society. But now it is also been observed, that the age of onset has declined and even the poor have not spared.
Additionally, the condition of Impaired Glucose Tolerance (IGT), which precedes diabetes, is as serious as diabetes itself. All the chronic complications can take root in this phase. The prevalence of IGT is also high, especially in Asian countries. The Pakistan National Diabetes Survey conducted in all the four provinces of the country by Diabetic Association of Pakistan showed 11.47 per cent of the population above 25 years age to have diabetes and 10 per cent IGT.
With the rising trend of diabetes around the world, the incidence of complications will also increase. As the age of manifestation of diabetes is declining, the chronic complications, which usually develop in a decade’s time, will appear in the prime of the productive life. This can, not only cause suffering and disability for the individual but also a tremendous burden on the family and the state.
It is an established fact that diabetes is the leading cause of blindness, kidney failure, amputations and cardiovascular deaths in the world.
A very important observation worldwide, is the rising incidence of diabetes in children and adolescents. The figures of type 1 diabetes vary from area to area with South East Asian regions contributing more than a quarter of the prevalent cases. Type 1 diabetes mainly has an auto-immune cause and the potential risk factors initiating the process include blood group incompatibilities and maternal viral infections during pregnancy.
Type 2 diabetes in the young is also ever increasing globally. The age of onset is declining with reports of 8-year-olds developing the disorder. In Japan type 2 diabetes in junior high school students has doubled in the last decade and now outnumbers type 1 diabetes in children.
Analyzing the important risk factors for type 2 diabetes, the principal one is obesity. In the past years, the rates of obesity and overweight have escalated rapidly in many parts of the world. This is due to wrong eating habits and consuming food containing dense energy, rich in fats and sugars, together with low levels of physical activity.
It has been established that an excess of body fat, especially if it is concentrated within the abdomen causes insulin resistance. This places a greater demand on the pancreas to produce insulin, which is eventually exhausted. The raised insulin in the blood cannot act normally as the receptors are blocked by fat and levels of protective hormones decline due to the expanding fat cells.
As recommended by the Who, obesity can be measured as general obesity, by the Body Mass Index formula. BMI is calculated by dividing weight in kilogrammes by the square of height in meters. A BMI of 25 or more is overweight and above 30 is obesity.
Central or abdominal obesity is measured by waist circumference, the general limit recommended is 102 cm in men and 88 cm in women.
Diabetes Atlas, 2003, a publication of the International Diabetes Federation, reports that high levels of overweight and obesity exist particularly among women in Egypt, the Gulf states and Saudi Arabia.
Kuwait, United Arab Emirates, Bahrain and Tehran in Iran have obesity rates around 30 per cent. Obesity is a risk factor for other diseases also, which include different types of cancer and osteoarthritis. The adverse effects of obesity are seen as raised cholesterol and triglyceride levels, blood pressure and an increased risk for strokes and heart attacks.
The present world scenario on diabetes with its rising numbers and the threat of the complications, call for immediate intervention in the form of prevention. The International Diabetes Federation states that by promoting diabetes prevention, it will be ensured that those millions who already have diabetes will not face the nightmare of a regression in the quality of care they deserve while, on the contrary, there is a great need in many parts of the world to improve it.
Prevention can be implemented by constant efforts on raising awareness on diabetes, educating the people with diabetes, healthcare professionals, public and media and health improvement.
Education has the most important role in prevention of diabetes. It is important that methods and techniques for preventing diabetes are widely discussed. School children need to be addressed from a very early age. The advantages of a healthy diet, physical activity and keeping a normal body weight should be highlighted.
The print and electronic media plays an important role in educating the masses. Articles emphasizing the role of a healthy life style, should be used for conveying the message. Effective programmes on health on the television, definitely have an impact on the viewers.
In the city residential areas, space should be provided for physical activity. Parks with walking tracks need to be constructed and sufficient incentive provided to the members of the public to use them.
For persons who have developed diabetes, the same rules apply along with regular monitoring and professional consultation. This will not only provide a good quality of life, but will also prevent the onset of acute and chronic complications.
Diabetes is a major health challenge and is not a disorder to be handled alone by the individual. To stop the incidence from rising and to curb the development of complications in the manifest diabetics, a joint effort has to be made by the people affected by diabetes, healthcare professionals, and healthcare policy makers.
Medicines alone don’t work; a bit of physical exercise and getting out of the house too hold the key to a diabetes-free life 
