By Professor Ye Myint
Senior Medical Superintendent
Nay Pyi Taw General Hospital (1,000-bedded)
In this 21st century, people are not only facing communicable diseases like COVID-19, tuberculosis, and diarrhoea, but they also have to encounter non-communicable diseases. Non-communicable diseases are the result of a combination of genetic, physiological, environmental and behavioural factors and cause premature death around the world. Among the non-communicable diseases, diabetes accounts for a huge global health problem.
Prevalence of Diabetes
According to the International Diabetes Federation’s 2021 data, approximately 537 million adults (20-79 years) are living with diabetes. The total number of people living with diabetes is projected to rise to 643 million by 2030. Most of the adults with diabetes live in low- and middle-income countries. And about half are not diagnosed. Moreover, the International Diabetes Federation reported 6.7 million deaths worldwide among adults with diabetes as a result of diabetes or its complications, in 2021.
In Myanmar, according to the WHO step survey conducted in 2014, the prevalence of diabetes in adults (25-65) year is 10.5 per cent. In other words, one in every 10 people is having diabetes. The prevalence of Pre-Diabetes is 19.7 per cent. They will become diabetic in a few years.
Diabetes Mellitus
Diabetes is a chronic metabolic disorder in which the body has high sugar levels for prolonged periods of time. It occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose. This increase in blood glucose level causes serious damage to blood vessels resulting in coronary artery disease, stroke, renal failure, blindness, neuropathy and peripheral arterial disease leading to limb amputation. Therefore, people who are at risk of diabetes, should test early, and those who already have the disease, should try to have strict glycemic control, to attain a healthy normal life span.
World Diabetes Day
World Diabetes Day (WDD) was created in 1991 by IDF and the World Health Organization in response to growing concerns about the escalating health threat posed by diabetes. It is marked every year on 14 November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922. WDD is the world’s largest diabetes awareness campaign. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public and political spotlight. The slogan for 2023 is “Know your risk, Know your response”. This year’s campaign focuses on the importance of knowing your risk of type 2 diabetes to help delay or prevent the condition and highlighting the impact of diabetes-related complications and the importance of having access to the right information and care to ensure timely treatment and management.
Who is at risk of having diabetes?
Increasing age (>40 years), family history of diabetes, overweight, unhealthy diet, physical inactivity, high blood pressure, ethnicity, impaired glucose tolerance (IGT), and history of gestational diabetes are the risk factors for diabetes. IDF has created an online diabetes risk assessment which aims to predict an individual’s risk of developing type 2 diabetes within the next ten years and this can be accessed at www.worlddiabetesday.org. Women who had gestational diabetes during pregnancy have a high risk for developing diabetes and thus should maintain healthy body weight and glycemic status should be checked regularly. A baby born to a mother who has gestational diabetes, also has an increased risk of diabetes in later life, thus maintaining a healthy body weight, and healthy lifestyle is of great importance.
How can we prevent diabetes?
Lifestyle changes can help prevent the onset of type 2 diabetes. It includes eating a healthy diet and maintaining an active lifestyle. A healthy diet means, avoiding food high in sugar, high in salt and saturated fat, and eating more fresh fruits and vegetables, lean meat, nuts and fibre. Doing exercises such as jogging, walking, and cycling, approximately 30 minutes per day (at least 150 minutes per week) can prevent the development of diabetes.
Symptoms of diabetes
The symptoms of diabetes can be mild or absent. If anyone has symptoms like frequent urination, excessive thirst, weight loss, fatigue, numbness in feet, or slow healing of wounds, should check the blood sugar level.
Testing for diabetes
Diabetes can be diagnosed by doing a blood sugar test. Criteria for diagnosis are:
- Fasting blood sugar - ≥ 126 mg/dL (or)
- Two hours after drinking 75 grammes glucose - ≥ 200 mg/dL (or)
- HbA1c (glycated hemoglobin) - ≥ 6.5% (or)
- Symptoms of diabetes and random blood sugar - ≥ 200 mg/dL
Pre-Diabetes
- Fasting blood sugar – between 100 to 125 mg/dL (or)
- Two hours after drinking 75 grammes glucose – 140 -199 mg/dL (or)
- HbA1c (glycated hemoglobin) – 5.7 – 6.4%
Prevention of complications
Diabetes can cause a variety of serious complications including coronary artery disease, stroke, renal failure, blindness, amputation etc. Diabetes costs lives. Because of high health care cost, combined with loss of income, forces millions of people into poverty. It imposes a huge burden on families as well as on the nations.
To prevent the development of diabetes complications, people with diabetes should follow the following factors.
1. Adopt healthy lifestyle
2. Strictly follow the instructions provided by the health care persons in managing diabetes
3. Take the medications regularly as directed by the health care providers
4. Monitor regularly to keep the blood sugar level within a target range
5. Maintain blood pressure and blood cholesterol within normal level
6. Check regularly for complications
Ministry of Health taking proactive steps
The Ministry of Health has developed a National Strategic Plan to reduce the prevalence of non-communicable diseases including diabetes, aiming for a 20 per cent reduction in the prevalence of diabetes by 2030. To implement this plan, training of basic health staff, continuing medical education programmes, development of guidelines and standard operative procedures, and public health education through multimedia have been carried out.
Inter-ministerial collaborative efforts to reduce the salt and sugar contents of food, and reduce the consumption of alcohol, tobacco and its products, and saturated fat.
Community health clinics (Wednesday-only Clinics), encompassing a total of (7,476) rural health centres (RHC) and Sub centres have been running as one of the non-communicable disease projects under the Ministry of Health since 2017. These clinics provide testing and treating of diabetes, supplying basic medicine, and health education. The Centre of Excellence for Diabetes has been established in tertiary hospitals under the supervision of specialists.
To enable every citizen to attain full life expectancy and enjoy longevity of life, which is the main objective of the ministry, the prevention of diabetes is of utmost importance. Therefore, as the slogan says, “Know your risk, know your response”, people should know the risk of diabetes, adopt a healthy lifestyle, detect it early, treat it effectively, and prevent complications, which will lead to a better future.
References:
- American Diabetes Association, Standard of Care in Diabetes 2023, https://diabetesjournals.org/care
- IDF Diabetes Atlas 2021 – 10th edition: www.diabetesatlas.org
- WHO Step Survey, 2014
- Myanmar Diabetes Association Bulletin
