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Are you likely to get Diabetes?

Posted on January 19, 2019 | No Comments on Are you likely to get Diabetes?

Whether it’s type 1 or type 2, we all know that diabetes mellitus is a serious ailment with devastating consequences in the heart, eyes, kidneys, limbs, and other organs of our body.

But how would you know if you or any other member of your family is at risk for getting diabetes? Endocrinologist Dr. Gertrude Santos, a member of the Obesity and Nutrition Task Force of the Philippine Chapter of the American Association of Clinical Endocrinologists (AACE–PC) reveals several factors, including “family history of diabetes, cardiovascular disease, overweight or obese state, sedentary lifestyle, previously identified impaired glucose tolerance or impaired fasting glucose, hypertension, increased levels of triglycerides, low concentrations of high-density lipoprotein cholesterol or both, history of gestational diabetes, history of an infant with a birth weight of greater than 8 lbs, polycystic ovarian syndrome and even psychiatric illness.”

The Department of Health (DOH) adds that you are likely to be at risk of having diabetes “if you urinate frequently, if you experience excessive thirst, if you have unexplained weight loss, if your blood sugar level is at or higher than 200 mg/dL and if you have fasting plasma glucose level of 126 mg/dL and above.”

Dr. Santos says that according to the AACE, 20.8 million Americans or 7 percent of the U.S. population already have diabetes while 41 million are considered to have prediabetes or have glucose levels that have not yet reached the cutoff for diabetes. Of this staggering number, 14.6 million have been diagnosed while 6.2 million remain undiagnosed.

In the 6th Philippine National Nutrition and Health Survey done in 2003, the prevalence of diagnosed diabetes in adults aged 20 and above was 4.6 percent. Assuming that only half of people with diabetes are diagnosed due to lack of symptoms or difficulty in health care access, there are about 8 million Filipinos who have diabetes.

However, these numbers may be skyrocketing. In a more recent study done in 2007 and published in 2009, the Philippine Cardiovascular Outcome Study on Diabetes Mellitus (PhiICOS-DM) saw that the prevalence of type 2 diabetes rose to 28 percent in a sample of Filipino adults who were originally included in the 1998 Food and Nutrition Research Institute-National Nutrition Survey. Moreover, an alarming number of 31.3 percent were diagnosed with prediabetes. If so, then a mind-boggling 3 out of 5 Filipinos may have problems with blood sugar.

Age factors
Dr. Santos adds that as per AACE data, there is also an age-adjusted prevalence of diabetes mellitus increased among both sexes and all racial groups examined from 1980 to 2004.

“For individuals born in the year 2000, the estimated lifetime risk for diabetes of both types is 33 percent for males and 39 percent for females. The risk for death among individuals with diabetes mellitus it almost twice that of individuals without diabetes of similar age,” Dr. Santos says. “For patients diagnosed before age 40, the average reduction in life expectancy is 12 years for men and 19 years for women.”

She further reveals that adults aged 65 to 74 years old have the highest prevalence of diabetes approximately 12 times the prevalence of that seen in adults younger than 45 years old. “Of those 60 years and older in the United States, 10.3 million or 20.9 percent of this age group have diabetes mellitus. Of all individuals 20 years or older, 10.9 million men (10.5 percent) and 9.7 million women (8.8 percent) have diabetes mellitus,” she continues. “Findings from recent reports indicate that up to 45 percent of newly diagnosed cases of diabetes among U.S. children and adolescents are classified as type 2 diabetes. The prevalence of type 2 diabetes among American children is expected to continue to increase and exceed that of type 1 diabetes over the next 10 years.”

While only 5 to 10 percent of all diabetes cases are diagnosed with type 1 diabetes (previously known as insulin-dependent or juvenile diabetes), Dr. Santos says that it is the more common type 2 (previously termed non-insulin dependent or adult-onset) diabetes that are attributed to most of the risk factors she mentioned including advancing age. Type 2 diabetes cases comprise 90 to 95 percent of all cases of diabetes.

Screening tests
That is why it is all the more important for people to undergo the necessary screenings to determine if they are developing or have already developed the disease. “All individuals 30 years old and above who are at risk for developing type 2 diabetes should be screened using tests that include fasting plasma glucose concentrations and the 2-hour post-challenge load, the 75-gram oral glucose tolerance test,” she adds.

If the fasting plasma glucose level is 100-125 mg/dL, then this is considered as impaired fasting glucose or prediabetes, while 126 mg/dL or higher is overt diabetes mellitus. In the 2-hour post-challenge load, 140-199 mg/ dL is also considered as prediabetes while 200 mg/dL and above is overt diabetes. Dr. Santos points out that diagnostic criteria should also be established if the patient has symptoms of diabetes like polyuria, polydipsia, and unexplained weight loss plus casual plasma glucose concentration of 200 mg/dL or more as well as fasting plasma glucose of 126 mg/dL and more. “One of the three criteria above is sufficient to establish diagnosis of diabetes mellitus,” Dr. Santos concludes. “These assessments should be confirmed by repeated testing on a subsequent day in the absence of unequivocal hyperglycemia.”

If your family does have 6 history of diabetes, does it automatically mean that you will surely have diabetes too at some point in your life? Are there ways in which this can be avoided? “The diabetic gene may not be expressed if the risk factors are prevented and early screenings of those who are at risk are done,” Dr. Santos explains. “Still it does not hurt if certain lifestyle modifications are made as early as possible.”

Lifestyle changes
First and foremost among the lifestyle adjustments that Dr. Santos highly recommends is “to refer patients to a registered dietitian or credible weight loss program or service for counseling in energy intake reduction and nutritional strategies.”

In entering such a program, the goals should include weight reduction of 5 to10 percent of total body weight including reducing fat intake to less than 30 percent of total energy intake, reducing saturated fat intake to less than 7 percent of total energy intake and increasing fiber intake to 15 grams/1000 kcal or more. The DOH also recommends cutting down on salt and avoiding alcohol. It also cautions that that skipping and delaying meals causes fluctuations in blood sugar levels.

Dr. Santos adds that regular physical activity (walking, running, other sports) is also important and should approximate 150 minutes per week. “Those with cardiovascular risk factors should avoid tobacco use, and if you already have hypertension and dyslipidemia*, then they should be treated aggressively which can be responsive to lifestyle and pharmacologic therapy.”

In stressing the importance of daily exercise in diabetes control, the DOH says “it improves cardiovascular fitness, helps insulin to work better and lower blood sugar and lowers blood pressure and cholesterol levels.” While controlling weight is also beneficial in “lowering your blood sugar as well as improving your lipid profile and blood pressure control”.

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