Diabetes mellitus has become a serious problem and has reached epidemic proportions over the past decade. In the Philippines, the National Nutrition Survey conducted by the Food and Nutrition Research Institute in 2003 estimates that about 7 out of 100 Filipinos may either have prediabetes or diabetes. From an older survey done in 1997, there were about 2.8 million Filipinos with diagnosed diabetes. The number of undiagnosed cases is estimated to be just about the same, or perhaps more, considering that there is a sizeable percentage of the population that may not have easy access to medical care.

In the list of countries with the highest number of estimated cases of diabetes from the year 2000 based on World Health Organization (WHO) data, the Philippines is not included. However, the projection is that by the year 2030, we will be 9th in the list with about 7.8 million cases of diagnosed diabetes.Of note, the majority in the list are the developing countries, which makes diabetes a big healthcare burden in countries with somewhat limited resources to deal with it. On a bigger scale, from an estimated number of about 30 million worldwide in 1985, data from the WHO has shown this figure balloon to about 171 million as of the year 2000. The estimate is that it will reach about 380 million cases worldwide by the year 2030.

Diabetes complications
What about diabetes should we be worrying about? Well, diabetes often leads to a lot of other medical problems. Consider the following:

• Those with diabetes have a very high risk for getting a heart attack. In fact, more than 50 percent of those people with diabetes who die would have heart disease as the cause of death.
• Diabetes is the most common cause of kidney failure that would lead to dialysis or kidney transplantation.
• Diabetes is the leading cause of preventable blindness. Most cases of amputations of the legs or feet, not due to trauma or accidents, are due to diabetes.
• Men with diabetes are more likely to develop erectile dysfunction.

Having gone over the figures of how diabetes has grown over the years and how serious the problem is, what can we do about it?

Types of diabetes
There are two common types of diabetes: type 1 and type 2. Type 1 diabetes is the type that is usually seen in lean and younger people, including children, whereas type 2 diabetes is the one seen more commonly in older patients who may be obese or overweight. However, that age distinction is becoming less clear as more and more people younger than 40 years old, including children and adolescents, are being diagnosed with type 2 diabetes.

In a type 1 diabetic patient, the pancreas, which makes andsupplies the body with insulin, is completely destroyed by the body’s own immune system. Antibodies, which are substances that circulate in the blood and other body fluids, target the pancreas and destroy it, rendering it unable to produce any insulin. Treatment then would be a lifetime of insulin injections, or in some cases, a pancreatic transplant. Unfortunately, with what we know so far, there is not much that we can do to prevent type 1 diabetes.

On the other hand, people with type 2 diabetes have pancreas that still produce insulin. The problem is that they are not able to use this insulin as effectively as normal people do, and they may not be able to produce insulin in amounts sufficient enough to keep the sugars within normal range. Several treatment options are available, which includes diet and exercise, oral medications, and even insulin and other injected medications. Fortunately, the number of patients who have type 2 diabetes far outnumber those with type 1 diabetes by about 9 to 1. Steps can be taken to prevent type 2 diabetes, and this is what we will focus.

Risk factors for diabetes
There are several risk factors for developing type 2 diabetes. Some of them cannot be changed. These would include having family members with diabetes, belonging to certain ethnic groups which, sad to say, include Asians, and being in an older age group. The other risk factors are preventable and these include being overweight or obese, and being inactive. Other conditions that have been associated with the development of type 2 diabetes are high blood pressure, abnormal cholesterol levels, being prediabetic, and having hadgestational diabetes in the past. Smoking has been implicated as a possible risk factor for developing diabetes, but the link is not quite strong and it may be possible that other unhealthy habits of smokers may be the ones that increase the risk.

Since diabetes is associated with many serious complications, it makes perfect sense to try to prevent, or perhaps delay, the onset of this disease. It is important to know that diabetes-related complications start even before the actual diagnosis of diabetes. The risk for getting a heart attack or a stroke starts going up even during the pre diabetic phase.

Prediabetes is the condition wherein the sugars are above normal, but still not high enough to be called diabetic. This is the period when fasting blood sugars go up to 100 mg/dL (5.5 mmol/L), but below the cut-off for diabetes which is at 126 mg/dL (7 mmol/L), or, when the 2-hour glucose value during a glucose tolerance test is beyond 140 mg/dL (7.8 mmol/L), but below 200 mg/dL (11.1 mmol/L).

In a large number of diabetic patients, complications may already be seen at the time of diagnosis, which implies that the diabetes has been brewing for several years before the diagnosis is made. In some cases, it is the appearance of a complication that may lead to the diagnosis of diabetes.

In view of this, efforts at delaying, and even better, preventing diabetes, need to be undertaken. The very first step that needs to be done is to know where you stand as far as risk for developing diabetes is concerned. The fact that we are Asians already puts us at some risk. If other risk factors are present, then it is prudent that screening for diabetes be done. If laboratory studies indicate that you are already diabetic, then you and your doctor would need to work closely together to treat your diabetes with the goal of keeping your sugars as close to normal as possible so that the likelihood of getting diabetes-related complications will be lower. Just because you have diabetes does not necessarily mean that you would develop all those complications. If the test results are normal or in the prediabetes range, then we need to try to keep it normal or even improve on it in the case of prediabetes.

How to prevent diabetes
The most important preventive measure is simple and inexpensive —lifestyle modification. Type 2 diabetes can be considered a lifestyle disease; hence, by making changes to one’s lifestyle, it may be possible to prevent this disease. Studies looking into diabetes prevention have focused on three lifestyle factors, which are diet, exercise, and weight loss.

A diet with a high glycemic index and low fiber content has been linked to a higher risk for diabetes. Glycemic index is the ability of a particular carbohydrate to cause the blood sugar to go up. Foods with a high glycemic index like white rice, potatoes, candy bars, and non-diet soft drinks cause a faster and higher spike in blood sugar levels. Foods that have a lower glycemic index and a higher fiber content, like bran cereals, high-fiber fruits and vegetables, and whole grain bread, appear to lower the risk for diabetes.

As for exercise, many studies have confirmed that a regular regimen, 30 minutes a day, 5 days a week, of moderate-intensity exercise like brisk walking can lower diabetes risk. An improved diet, on top of a regular exercise regimen, that leads to a weight loss of about 7% may reduce the risk of getting diabetes by over 50% as one study has shown. These lifestyle changes appear to produce even better results compared to the results seen with use of medications.

Medications though do have a role as well in diabetes prevention. Many classes of drugs have been studied and several of them appear to lower the incidence of diabetes, especially in the setting of prediabetes. Cost, side effects, and safety issues, however, may limit the use of some of these drugs so it is best to discuss with your doctor which one would suit you best should this approach be considered. Since lifestyle modification is generally the safer and cheaper approach,and apparently more effective, it should be the cornerstone of the management approach for diabetes prevention.

To summarize, the following may help reduce your chances of getting diabetes:

1. If you have several risk factors for diabetes, it is best to undergo screening for diabetes or prediabetes.
2. Eat foods with a lower glycemic index and are high in fiber.
3. Exercise regularly, at least 30 minutes a day, 5 days a week.
4. Lose weight, or at least, try to keep it down.
5. Stop smoking.
6. If you are prediabetic, talk to your doctor about whether medications would be useful.
7. If you have high blood pressure or high cholesterol levels, follow-up with your doctor periodically.

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