By Helen Grange
Johannesburg - Diabetes is one of the largest global health emergencies of the 21st century.
Worldwide, it is a leading cause of heart attacks and strokes, blindness, kidney failure and lower limb amputation.
In South Africa last year, 2.28 million diabetes cases were reported, according to the International Diabetes Federation, affecting about 8.39 percent of South Africa’s population.
“This is consistent with the percentage globally, the difference being that in South Africa, we are experiencing a higher rate of increase in the disease than elsewhere in the world,” says Dr Shenaz Seedat, a diabetes specialist and endocrinologist at Novo Noridsk SA.
“The reason for this is the dramatically changing lifestyles of people who move from rural to urban areas, where fatty, processed foods are far more available and day-to-day living is far more sedentary,” she says. “This lends itself to obesity, and if you look at diabetes, 80 percent of diabetes sufferers are obese.”
Between 60 and 80 percent of patients with diabetes die before the age of 60 in sub-Saharan Africa, and it accounts for almost one out of every three deaths among the economically active age group of 30 to 40 years.
So how can we stop this frightening epidemic?
What can you do?
Diabetes Type 2 is the most common diabetes - 90 percent of all diabetes diagnoses - developing in adulthood and usually in obese people who practise poor lifestyle habits.
Overeating foods high in starch and fat, and living a sedentary life with little exercise, are the main culprits in the metabolic malfunctions that cause diabetes.
If you tend to carry your weight around your abdomen as opposed to your hips and thighs, unfortunately your risk of getting diabetes is higher. This is because belly fat surrounding the abdominal organs and liver is closely linked to insulin resistance and diabetes. If this is you, it’s time for a lifestyle change.
Rather than a restrictive diet, most dieticians recommend an eating plan that is low in fat and starchy carbohydrates - like bread, potatoes and white rice - but rich in protein and nutrients found in vegetables, certain fruits and wholegrains.
The amount and type of carbs you eat is a key focus in diabetic diets. The rule of thumb is, have wholegrain breads and rice, and wholewheat pasta instead of white bread, rice and regular pasta, as these tend to spike your blood sugar levels. And keep the portions relatively small (quarter of your plate).
As to saturated fats found in meat, dairy and eggs, there is heated debate around whether they should be cut back, but natural fats found in raw nuts, olive oil, fish oils, flax seeds, or avocado are nonetheless recommended.
Cutting down on sugar is key, however, as calories in sugary beverages and processed foods like doughnuts, muffins, cereal and chocolate bars are more likely to add weight around your abdomen.
Then do some exercise. Moderate aerobic exercise, like walking briskly, for 20 minutes, four or five times a week, is generally enough.
What can companies do?
Most company canteens have menus heavy in carbs and fat, and offer little in the way of lean and sugar-free eats and drinks. If they want their medical aid costs to be lower, they should work with canteen managers and contractors to develop healthier menus.
The proliferation of junk food outlets greatly contributes to the country’s obesity problem and has prompted concerned retailers to call for regulations on food advertising directed at children.
“Obesity and diabetes are critical health issues in South Africa. We require a concerted effort by the government in partnership with the private sector to promote healthy eating and proper nutrition,” said Pick * Pay chairperson Gareth Ackerman recently.
To this end, the Consumer Goods Forum has published marketing communications guidelines for children. Member companies and organisations are expected to agree to these at its next meeting in Cape Town, scheduled for next month.
Companies operating in the medical fraternity are also doing their bit. Earlier this month, pharmaceutical company Novo Nordisk held the first New Generation Insulin Summit in Cape Town, where local and international diabetes experts shared advancements in the understanding of diabetes and its management with over 200 healthcare providers.
Instilling healthy eating habits from early on is the preventative answer, of course, and companies like the snack producer Mondelez is investing money in school initiatives teaching children healthy eating habits and skills like vegetable gardening.
What can the government do?
According to Discovery Life, 23.88 percent of all claims paid out last year related to heart and artery problems, at a cost of R333.77-million, the second-highest payout by the insurer for a disease after cancer.
The cost of treating this disease in state hospitals, therefore, is massive, remembering too that a nation’s economic health is dependent in part on the health of its population.
The government’s strategic plans include promoting healthy lifestyles, as reversing the diabetes tide is about embedding healthy eating habits.
The recent introduction of sugar tax is a good start, but Dr Dominque Stott, a medical standards executive at PPS Insurance, suggests the Department of Health goes further, following the new NHS diabetes prevention programme in the UK.
“Doctors in the UK are now on full alert to nip diabetes in the bud, with the roll-out in April of this programme, a worldwide first. It is expected to yield a huge saving in the costs of treating this chronic disease in the UK,” she says.
Through 27 clinics countrywide, the UK programme targets people most at risk of getting diabetes, mostly obese people.
“They are given diet sheets and an exercise programme, and a goal weight is set. Then they are monitored as they lose weight. This is the kind of preventive approach that we should introduce in public clinics in South Africa,” says Dr Stott.
WHAT IS DIABETES?
Diabetes is classified as a metabolism disorder, that is, a malfunction in the way our bodies use digested food for energy and growth. It is characterised by abnormally high levels of sugar (glucose) in the blood, either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both.
People with high blood sugar will typically experience frequent urination, tiredness, excessive thirst and frequent bouts of hunger. Untreated, diabetes leads to myriad health complications, including kidney failure, heart disease, stroke, blindness and even lower limb amputation.
Women are affected more than men (39 percent compared to 11 percent men). The highest prevalence of diabetes is in the Indian community (11-13 percent), due to a strong genetic predisposition to diabetes. This is followed by 8-10 percent among coloured people, 5-8 percent in the black community and four percent among white people.
The good news is that unlike diabetes Type 1, which typically develops early in life and results in the sufferer having to regularly inject insulin, diabetes Type 2 (90 percent of diabetics) is reversible with the correct diet and exercise programme.
ACTRESS HLUBI MBOYA IS STAVING IT OFF
Former Rhythm City actress Hlubi Mboya is all too familiar with diabetes. “Growing up in Langa in Cape Town, our diet was traditional - lots of pap and shishanyama (meat),” which definitely contributed to diabetes in her family.
She says: “My mother was insulin dependent, and my auntie passed away from diabetes. I am also predisposed to diabetes.”
Mboya took matters in hand nine years ago. “I wasn’t thinking about what I was eating, and I was eating a fair amount of junk food. Now I’m much more aware. I don’t eat a lot of red meat. I prefer chicken or fish. I still have burgers and pizzas at the weekend, but those treats are limited,” she says.
You may be diabetic and not know it. Annually pharmacies and medical aids offer free testing for untreated diabetics. A finger is pricked and the glucose levels of the blood are measured.
The Star
I GOT A WAKE-UP CALL TO CHANGE MY LIFESTYLE
Elana Dure
When I was at school, a friend approached me during break and said: “When you’re older, you’re going to be really fat. Just look at all the junk you eat.”
I stopped munching, thought of all the sugary treats I’d packed for snacking that day and knew I was guilty as charged. But given my thin physique and fast metabolism, I didn’t worry.
Ten years later, at the age of 22, those eating habits caught up with me.
After visiting my doctor for a check-up a few months ago, I received an alarming call from him: my blood sugar level was elevated; I needed to watch my glucose intake.
In other words, I am prediabetic, and if I don’t significantly decrease my sugar consumption, my body will react in a not-so-pleasant manner.
After a quick Google search, I discovered I am not alone. And I learnt that without weight loss and physical activity, 15 to 30 percent of people with prediabetes will develop Type 2 diabetes within five years.
Prediabetes, also known as impaired glucose metabolism, generally has no symptoms. However, people whose blood sugar level is higher than normal but not high enough to be considered diabetic should be tested for diabetes once a year.
People with certain risk factors are likely to develop prediabetes These factors include being 45 or older, being overweight and having a family member with diabetes.
As a 22-year-old, 1.7m woman who weighs 50kg, I did not expect to find myself on the watch list. But my lack of regular activity and the genetic component of the condition (my grandfather and uncle both had diabetes) set off an alarm, given that full-blown diabetes can cause serious health problems including kidney failure and an increased risk of heart disease or stroke.
Given those risks, I was determined to do what I could to make sure it did not turn into full diabetes. My doctor had already helped me take the first step in that direction.
“We know that a very simple risk test, a series of questions that you can take online or on paper, will give any individual an idea of whether or not they are at risk for developing diabetes. That recognition is critically important because if you don’t suspect you’re at risk, then you’re not going to seek assistance,” said Dr Robert Ratner of the American Diabetes Association.
An intervention - in the form of dietary changes, extra exercise and sometimes medication - can prevent the development of diabetes.
Endocrinologist Nahrain Alzubaidi suggests that people with prediabetes do 30 minutes of activity three to four days a week.
She also said they should adopt a diet with whole-grain carbs; good protein such as fish, tofu and skinless poultry; and food rich in “good” polyunsaturated fats such as olive oil and avocado.
She advises her patients to avoid red meat if possible and to be cautious about some dairy, such as whole milk, butter and rich cheeses, because these foods are high in saturated fat and may raise cholesterol and the risk of cardiovascular disease.
“We never say zero,” Alzubaidi said. “We all have habits and we all have cultures or ethnic-background differences. It’s individualised, so we always say in the beginning to at least cut down (on sugar and refined carbs) and find an alternative that is as satisfying as the original but with less amount of damage.”
Ratner said people with prediabetes who are overweight should aim for a 10 percent reduction of fat content in their meals and an overall decrease in total calories. He said a 5-7 percent reduction in body weight could lead to a 50 percent reduction of the risk of developing diabetes.
Not everyone with moderately high blood sugar levels like me will develop the disease, but it isn’t worth the gamble.
Because diabetes remains the leading cause of blindness in working-age people and the leading cause of limb amputations and kidney failure, its prevention is critically important.
“I guess the cynical way that I would look at it is not everyone who smokes cigarettes gets lung cancer, but the chance that you won’t get lung cancer isn’t really a good reason to continue smoking,” said Ratner.
“In my case, I amped up my exercise - I now walk about 2km every day near where I live - and got rid of a lot of junk food.
“I don’t know if these changes have had any effect on my blood sugar level yet. But I know these changes often improve one’s blood pressure and cholesterol, among other things. More important, I feel a lot healthier, a lesson I wish I’d learnt way back in school.”
The Washington Post