Diabetes is now a global problem
382 million adults (8.3% of the world’s population) live with diabetes and, according to the estimates of the International Diabetes Federation, this number is expected to rise to 592 million by 2035. In 2013 over € 100 billions were spent in Europe in terms of health expenditure attributable to this condition [1].
What is it?
Diabetes is a chronic disease that occurs when the body cannot produce enough insulin or when it cannot use insulin effectively. Insulin is a hormone produced by the pancreas that allows glucose to enter tissue cells. If not properly absorbed, glucose remains in the bloodstream causing hyperglycemia, which in turn causes numerous complications both in the short and in the long term.
There are three types of this condition:
Type 1
Type 2
Gestational diabetes
The first one is caused by an autoimmune reaction against beta-cells, which produce insulin in the pancreas. Why this happens is not yet clear. Type 1 diabetes can affect people of any age, but usually occurs in children or young adults; in fact, it was once known as the “juvenile” form. People affected by this condition need insulin injections every day. Without the latter, they could not survive [2]. In most high-income countries, type 1 diabetes is the most common form in children and adolescents [1].
Type 2 diabetes is the most common form (85 to 95% of all cases). It usually occurs in adults but it is increasingly frequently diagnosed in children and adolescents as well. The organism of type 2 diabetic subjects is able to produce insulin, but in an amount that is insufficient. Alternatively, insulin is produced but the subject’s tissues are not able to respond to its effects [3].
As suggested by the name, gestational diabetes affects women during pregnancy. It is estimated that in poor countries, over 90% of pregnant women suffer from hyperglycemia.
Diabetes is the fourth or fifth cause of death in most high-income countries. Many politicians and public health experts, especially in the poorest countries, are not aware of the risks associated with this disease. Diabetic patients require constant medical care that many developing countries cannot afford to provide.
One of the most troubling aspects of this disease is that many diabetic people are not aware of being affected by this disease. Worldwide, the percentage of undiagnosed cases varies from 24% in South America to over 60% in Africa. In the WHO European Region (which also includes Russia) this percentage is around 34%. These are worrying numbers, especially if we think about the long-term consequences [4]:
Cardiovascular diseases.
Diabetic patients need to be educated to manage their disease independently since this improves their health and reduces healthcare costs. However, health professionals play a key role in improving access to quality health care and education to all diabetic patients. General practitioners, in particular, need to be informed not only about the risks of this disease, but they should also be instructed about how to effectively communicate with their diabetic patients so that the latter can learn how to correctly manage their condition autonomously.
Both care and prevention of this disease are put into practice first and foremost through proper nutrition. A review published in 2014 by The Lancet [5] summarized the scientific evidence regarding the prevention and management of diabetes through diet. According to this meta-analysis, the quality of fats and carbohydrates is more important than their quantity. Specifically, fat from nuts (walnuts, almonds, hazelnuts, etc.) and fish are recommended, while the recommended sources of carbohydrates include those with a low glycemic index, such as whole grains, fruit and legumes (pulses). Alcohol should be consumed in limited quantities, for example one or two glasses a day. The Mediterranean diet, rich in vegetables, fruit, nuts, fish and unsaturated fats, but poor in animal foods such as meat and dairy products (with the exception of yoghurt which is inversely associated with the risk of diabetes) is still a “must” in terms of diabetes prevention and management.
Unfortunately, official dietary recommendations vary from country to country and there is no precise agreement, for example, on what is the precise amount of carbohydrates to be included in the diabetic diet [5].
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The growing global prevalence of non-communicable diseases is placing huge and growing demands on health systems. Diabetes is one of the most common chronic diseases. An intervention to curb this new epidemic can no longer be postponed. Particularly, to help under-developed countries to manage this growing (and expensive) emergency is a moral obligation.
References
[1] International Diabetes Federation Atlas. (6th edn.) 2013. (last accessed Nov 2014).
[2] Eisenbarth GS, Buse JB. Type 1 diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 32.
[3] ADA. Standards of medical care in diabetes — 2014. Diabetes Care. 2014;37 Suppl 1:S14-S80.
[4] ADA. Standards of medical care in diabetes — 2013. Diabetes Care. 2013;36 Suppl 1:S11-S66.
[5] Ley et al. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014; 383: 1999-2007.
