Commonwealth Nurses Federation. Preventing NCDs: A primary health care response Risk factor No 1: Diabetes

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1 Preventing NCDs: A primary health care response Risk factor No 1: Diabetes

2 DIABETES: Definition Diabetes is a group of heterogeneous disorders with the common elements of hyperglycaemia and glucose intolerance due to insulin deficiency, impaired effectiveness of insulin action, or both. Diabetes is a chronic disease that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Insulin is a hormone made by the pancreas that enables cells to take in glucose from the blood and use it for energy. Failure of insulin production, insulin action or both, leads to raised glucose levels in the blood (hyperglycaemia). This I associated with long term damage to the body and the failure of various organs and tissues.

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4 TYPE 1: DIABETES: Types Type 1 diabetes is an autoimmune disease characterised by the destruction of the insulin producing cells in the pancreas, typically due to an auto-immune system reaction, where they are attached by the body s defence system. Consequently, the beta cells of the pancreas of people with type 1 diabetes produce very little or no insulin, the hormone that allows glucose to enter body cells and must take insulin to survive. Type 1 diabetes is most commonly diagnosed in children and young adults.

5 TYPE 2: DIABETES: Types The development of type 2 diabetes is marked by insulin resistance. People with type 2 diabetes cannot use the insulin that they produce effectively. They can often manage their condition through exercise and diet. However, in many cases, oral drugs are needed and often insulin is required. Type 2 diabetes accounts for over 90% of the more than 250 million people living with diabetes worldwide. Both type 1 and type 2 diabetes are serious and both can affect children.

6 DIABETES: Types GESTATIONAL DIABETES Gestational diabetes (GDM) is a condition in which women without previously diagnosed diabetes have high blood glucose levels during their pregnancy. GDM affects about 4% of all pregnant women. It has few symptoms and usually disappears when the pregnancy ends. However, GDM poses a risk to both child and mother. Babies of mothers with GDM are at increased risk of being large for gestational age which can lead to deliver complications and are at higher risk for some other medical complications after delivery and often have an increased life-long risk of glucose intolerance and obesity. Women who have had GDM have a significantly increased risk of developing type 2 diabetes.

7 DIABETES: Symptoms TYPE 1: Often sudden and dramatic and can include symptoms such as: abnormal thirst and a dry mouth; frequent urination; extreme tiredness and lack of energy; constant hunger; sudden weight loss; slow-healing wounds; recurrent infections; blurred vision. TYPE 2: Diagnosis usually occurs after the age of 40 years but can occur earlier. There are increased reports of children developing type 2 diabetes. Can remain undetected (asymptomatic) for many years and diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test.

8 DIABETES: Risk Factors Type 1: Although the onset of type 1 diabetes is typically in childhood it also occurs in adults. People with a strong family history of type 1 diabetes are at increased risk. Type 2: Adults and children who are overweight or obese and are physically inactive. Certain ethnic groups. Individuals with a family history of diabetes. Women who have had gestational diabetes mellitus.

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10 TYPE 1: DIABETES: Management Since the landmark discovery of insulin by Frederick Banting and Charles Best in 1921, huge steps forward have been made in research and development in creating genetically engineered human insulin. Until relatively recently insulin was derived from a limited resource of the pancreas of cattle and pigs. Insulin is the internal secretion of the pancreas formed by groups of cells called the islets of Langerhans. It is the hormone needed to enable glucose to enter the cells and provide energy. Insulin is also important in keeping blood glucose level within acceptable limits.

11 TYPE 2: DIABETES: Management A substantial proportion of type 2 diabetes is preventable or onset delayed by supporting changes in behaviour to reduce weight and increase physical activity; with the use of glucose lowering drugs; control of lipids and blood pressure; high quality foot care; and retinal screening. Insulin is sometimes used by people with type 2 diabetes. In type 2 diabetes, the body needs more insulin than it can produce.

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15 1. Diabetes is a life threatening condition Worldwide, 3.2 million deaths are attributable to diabetes every year. One in 20 deaths is attributable to diabetes; 8,700 deaths every day; six deaths every minute. At least one in ten deaths among adults between 35 and 64 years old is attributable to diabetes. Three-quarters of the deaths among people with diabetes aged under 35 years are due to their condition.

16 2. DIABETES is a common condition and its frequency is dramatically rising all over the world At least 171 million people worldwide have diabetes. This figure is likely to more than double by In developing countries the number of people with diabetes will increase by 150% in the next 25 years. The global increase in diabetes will occur because of population ageing and growth, and because of increasing trends towards obesity, unhealthy diets and sedentary lifestyles. In developed countries most people with diabetes are above the age of retirement, whereas in developing countries those most frequently affected are aged between 35 and 64.

17 3. A full and healthy life is possible with DIABETES Studies have shown that, with good management, many of the complications of diabetes can be prevented or delayed. Effective management includes lifestyle measures such as a healthy diet, physical activity, maintaining appropriate weight and not smoking. Medication often has an important role to play, particularly for the control of blood glucose, blood pressure and blood lipids. Through the provision of optimal health care the risk of developing diabetic complications can be reduced substantially. Helping people with diabetes to acquire the knowledge and skills to manage their own condition is central to their leading a full and healthy life.

18 4. In many cases, DIABETES can be prevented The prevention of type 1 diabetes is not yet possible and remains an objective for the future. The prevention of type 2 diabetes has been shown to be possible and requires action now. Trials have shown that sustained lifestyle changes in diet and physical activity can reduce the risk of developing type 2 diabetes. (For example, the Finnish Diabetes Prevention Study showed that a better diet, increased physical activity and modest weight loss could substantially reduce the development of type 2 diabetes in middle-aged adults at high risk.) In all the studies conducted so far in people at high risk, lifestyle changes have been substantially more effective than the use of drugs. The scale of the problem requires population-wide measures to reduce levels of overweight and obesity, and physical inactivity. Informed policy decisions on transport, urban design, and on food pricing and advertising can play an important part in reducing the population-wide risks of developing type 2 diabetes.

19 WORLD HEALTH ORGANISATION INTERNATIONAL DIABETES FEDERATION WORLD DIABETES FOUNDATION