Fast food nations?

So why is this happening? Healthcare Middle East asked Dr Martin Abrahamson and Dr Ramachandiran Cooppan from the Joslin Diabetes Center, Boston, to explain.

A global issue

More than 90% of the world’s diabetics suffer from type 2, or ‘adult onset’, diabetes. Because type 2 diabetes is associated with obesity, it’s only logical to assume that the problem is most prevalent in the United States, the most overweight nation on earth. While the US does indeed carry one of the world’s largest diabetic populations (over 15 million), the International Diabetes Federation (IDF) reports that the five countries with the highest diabetes prevalence in the adult population are Papua New Guinea, Mauritius, Bahrain, Mexico, and Trinidad & Tobago. One in five of the world’s diabetics are Indian. Occurrences could triple in Africa, the Mediterranean, the Middle East, and Southeast Asia over the next 25 years.

Globally, diabetes has risen in tandem with obesity. Dr Martin J Abrahamson from the Joslin Diabetes Centre explains: “It’s a question of obesity and a more sedentary lifestyle,†he says. “As more and more countries become developed and we see this evolution to more fast food, more convenience, and more technologies, we’re seeing decreasing physical activity and increasing overweight and obesity. And the majority of those with type 2 diabetes are overweight or obese.â€

Diabetes: the insulin disease

To understand the connection between obesity and type 2 diabetes, it’s important to understand the role of insulin. Whenever we eat, the carbohydrates from our food are broken down into glucose, a sugar that fuels the body’s cells. That glucose is transported throughout the body through the bloodstream to be delivered to the cells. However, in order to allow the glucose into those cells, a ‘key’ is needed. That key is insulin, a hormone produced by the pancreas.

Diabetes is the result of a body without sufficient insulin supplies. In some cases, the pancreas simply doesn’t produce enough insulin (and in some cases, produces no insulin at all) to meet the body’s needs. This is called type 1, or ‘insulin-dependent’ diabetes, and it usually occurs at a younger age, possibly as the result of an immune reaction.

Type 2 diabetes, on the other hand, occurs when the body is resistant to insulin. While

genetics play an important role in determining who will develop diabetes, certain people develop an insulin tolerance through overeating. “Weight gain corresponds to insulin resistance,†says Abrahamson. “The cells of the pancreas secrete less insulin, and not enough insulin is produced to overcome the body’s resistance.â€

Diabetes and ethnicity

Studies have shown that certain ethnic groups are more susceptible to diabetes. Dr Cooppan explains: “While the US has the largest number of overweight and obese people, as a nation, our diabetes rates vary depending on the ethnic group being studied.â€

The Pima Indians in Arizona, for example, have a disproportionately high rate of type 2 diabetes. Hispanics (living in, and outside of, the US) and African-Americans are considered higher risk groups. While these groups tend to be poorer on average, and thus have less access to quality health care and less time to exercise and prepare healthy foods, Cooppan explains that while “there are certain high risk ethnic groups predisposed to diabetes, to date it has been very difficult to identify any specific genetic markers. In most cases, diabetes is likely a polygenic disorder.â€

“What’s interesting,†adds Abrahamson, “is that the disease is relative. In a country like

China, where diabetes is increasing in prevalence, the people are typically thinner than Americans. The increase in weight is not at the same magnitude, and by our standards, they might not even be considered overweight at all.â€

However, evidence now indicates that visceral or abdominal obesity is more closely associated with insulin resistance and glucose intolerance than other forms. That means that in some parts of the world, such as India and Southeast Asia, people may have a Body Mass Index (BMI) in the desirable range, but the precise location of the body’s fat promotes insulin resistance.

Type 2 diabetes shows no preference for age either. Though the problem has historically affected people aged 40 and higher, more and more adolescents and even younger children are developing the disease, spurred largely by the explosive and growing rise of the world’s overweight child population.

The silent killer

One of the reasons that the disease has been able to spread as it has, is because of its stealth attack. More than half of type 2 diabetics are unaware that they have it. How can that be? Because, Cooppan says, “the disease comes on slowly over years and patients don’t always have symptoms. Symptoms of diabetes occur because of the high blood sugar that results in increased thirst and urination and fatigue. At a later stage, when blood sugars are even higher, there is weight loss. So in a way, the disease needs to progress to be clinically a problem.†Some early, mild symptoms include frequent urination, sudden weight loss, increased thirst, fatigue, and blurred vision.

But when diabetes does become a clinical problem, the results can be shattering. Diabetes is the leading cause of blindness or visual impairment, and non-injury-related limb amputations in adults in the developed world. It is the fourth main cause of death in most developed countries. Type 2 diabetics are twice as likely to develop cardiovascular disease, and carry a higher risk of stroke, kidney failure, and dialysis.

A time for change

While new drug therapies show promising results in helping to regulate the disease (properly treated, many diabetics can live to old age), preventive medicine is still the best medicine. Diabetes is a ‘lifestyle disease’ and its prevention, for many, requires lifestyle changes. Proper diet, regular exercise, smoking cessation, and early diagnosis can all play a critical role in preventing the disease.

The American Diabetes Association also recommends screening high-risk individuals, such as those from certain ethnic groups, who are obese, or have positive family histories. People with high blood pressure, or who have prior abnormal glucose tolerance should also receive regular screening.

“It is only with early diagnosis and intervention at the stage of IGT (impaired glucose tolerance) that we will be able to start to make an impact on this disease,†says Cooppan. “We need to get the message to families and schools, to encourage better nutrition and regular physical activity to reduce the tide of obesity. The best approach to type 2 diabetes is to try and prevent it in the first place.â€