Most of us love to eat and find a lazy life just too good to resist. But the combination of fattening foods and inactivity is making us unhealthier than ever and our lifestyles are triggering what the International Diabetes Federation (IDF) is calling a “health tsunami” of non-communicable diseases, of which diabetes is one.
Diabetes and obesity are a dangerous combination and prevalence of both is increasing at an alarming rate with up to 400 million people likely to develop diabetes (mostly type 2) in the next 15 to 20 years, unless action is taken.
Diabetes is not just a disease of the affluent – the World Health Organisation warns that developing countries will be hardest hit in decades to come and that even now, 70 percent of those living with type 2 diabetes live in low or middle income countries.
South Africa’s rocketing obesity rates are also fuelling a rise in diabetes and the prevalence in some population groups has reached almost 12 percent.
The good news is that diabetes type 2 in obese people can be very successfully controlled with diet and exercise.
A study by Newcastle University in the UK made international headlines this year with the claim that, with a low-calorie diet and exercise, type 2 diabetes could be “reversed”.
Some experts believe that reversal is not possible and that “remission” is more accurate – but as long as weight loss and exercise are maintained, blood glucose levels can be well controlled.
Dr Aslam Amod, a Chatsworth-based endocrinologist and diabetologist, estimates that 70 to 80 percent of type 2 diabetes could be prevented if we tackled obesity.
“In patients in whom obesity is the main driver for diabetes, significant weight loss (by diet or surgery), can result in diabetes being ‘reversed’ as long as the weight loss is maintained, for up to 10 years,” he says.
“There is insufficient data in the long term to say for certain whether this effect will last for ever – it is impossible to say whether the diabetes will return after 15 to 20 years, even if weight loss is maintained.”
If it is that simple, why are more type 2 diabetics not nibbling on nuts and pounding the pavements?
“Most people find it difficult to maintain permanent lifestyle changes – they lose weight initially over six months and regain it rapidly.
“Most type 2 patients will need insulin therapy seven to 10 years after diagnosis but intensive lifestyle modification and weight loss at diagnosis can make a huge impact on the progression in obese people, to the extent that they may require no or very little medication, if they maintain the lifestyle change.”
Amod stresses that this applies only to diabetics who are obese.
Reducing calories and stopping treatment in non-obese type 2 patients or type 1 patients could have fatal consequences, so professional medical advice should always be sought.
Pre-diabetes is also on the increase and Amod says this is the most important stage where lifestyle modification can make a difference.
“If an obese person manages to lose weight and maintain his or her weight loss at this stage (the target is a waist circumference of smaller than 90cm in men and smaller than 80cm in women), they can reverse the pre-diabetes stage and diabetes can be prevented in 60 to 80 percent of cases, provided weight loss is maintained.”
Some people develop type 2 diabetes because the pancreas does not make enough insulin – this is called primary pancreatic beta cell failure, says Amod.
“These people tend to be of normal weight or less overweight than usual, and weight loss does improve the ability of the pancreas to make insulin.
“This is in contrast to obese diabetics who actually make more insulin than normal, but even this extra insulin is not enough to keep their blood sugar normal because their bodies resist the effects of insulin. This is the body’s attempt to stop gaining weight (insulin causes you to store glucose and fat).
“This is a huge misconception – many people believe that they are obese because they have insulin resistance. In fact, they are insulin resistant because they are obese, and this is exactly what the Newcastle study showed – that insulin resistance and pancreatic function are improved when a person loses weight.
“If we try to treat the insulin resistance with medication, without the person losing weight, then by making them more sensitive to insulin, they actually gain more weight.”
Jenny Russell, branch manager of Diabetes South Africa Durban, says she is seeing excellent results from weight loss and exercise in support groups run by the organisation.
“Unfortunately, many people only make contact with us after a cardiac event, stroke or amputation.
“We would like them to make contact sooner so we can help prevent complications.
“It is imperative that diabetics are educated about this devastating silent killer.” - Daily News
* Call Diabetes South Africa at 084 7177 443 or 0861 222 717 or go to www.diabetessa.co.za.
Gut hormone treatment offers diabetics new hope
For those who are unable to manage their diabetes with lifestyle changes, there are some promising new therapies on the horizon, says Pankaj Joshi, professor of medicine at Medunsa and director of the Diabetes Care Centre in Pretoria.
A new class of medications, known as incretin-based therapies, work in a different way from insulin replacement and oral anti-diabetic drugs. These treatments target a gut hormone called GLP-1 which is known to be low in diabetics.
“Other treatments of diabetes don’t address these low levels of GLP-1,” says Joshi. “The incretins are, therefore, poised to add a new dimension to diabetes therapy in the future.
“There are several pharmaceutical treatments available that help address insulin resistance (including metformin, which is usually the first drug prescribed), but insulin deficiency requires insulin replacement therapy.”
He emphasises, however, that diet and lifestyle modification – eating correctly and exercising regularly – remain the cornerstone of treating insulin resistance type 2 diabetes.
“In the diabetes prevention study, patients who ate correctly and exercised regularly showed better results than those who only took metformin,” he says.
“There is clear evidence that incretins help preserve the pancreas’ functioning, thus maintaining the body’s own source of insulin. They also have benefits on the heart and blood vessels, and are associated with lowering body weight. Most other diabetes treatments, apart from metformin, have a tendency actually to promote weight gain. So, this is a particularly encouraging development, given that excess weight and obesity are risk factors for type 2 diabetes.” - Daily News
FACT FILE
Type 1 diabetes usually occurs in children and young adults and is the result of the body’s defence system attacking insulin-producing cells. These patients require insulin injections every day to control the levels of glucose in their blood.
Type 2 diabetes, sometimes referred to as non-insulin-dependent diabetes or adult-onset diabetes, accounts for at least 90 percent of cases. It can remain undetected for many years and is often associated with obesity.
Gestational diabetes is characterised by high blood glucose levels during pregnancy, usually disappearing after the birth.
Risk factors for type 2 diabetes:
Obesity, poor diet and physical inactivity, increasing age, insulin resistance, family history and ethnicity. In South Africa, those of Indian descent appear to have a gene pool that makes them unusually susceptible to diabetes. Changes in diet and activity related to rapid development and urbanisation have led to sharp increases in diabetes, especially among black South Africans.
Symptoms:
Type 2 diabetes often has no, or minimal, symptoms, and may be present for a long time before it is diagnosed. Where symptoms are present, they can include:
* Frequent urination
* Excessive thirst
* Increased hunger
* Unexplained weight loss, tiredness/fatigue
* Lack of interest and concentration
* Vomiting and stomach pain
* A tingling sensation or numbness in the hands or feet
* Blurred vision
* Frequent infections; and/or slow-healing wounds
Complications:
Type 1 and type 2 diabetes are chronic, lifelong conditions that require careful monitoring and control. Uncontrolled high blood sugar levels can cause long-term damage to various organs and tissues, including the heart and blood vessels (potential heart attack and stroke), kidneys (potential for kidney failure), nerves (possible limb amputations) and eyes (potential for loss of vision). – Sources: International Diabetes Federation and Novo Nordisk