Why have diabetes rates doubled over the past 30 years – and what can be done about it?

From theguardian.com 

Rates of diabetes in adults have risen to 14%, an epidemic enabled by unhealthy lifestyles and an ageing population

Diabetes rates worldwide have more than doubled over the past three decades, with more than half of cases untreated, a global study has found. 

What is diabetes?

Diabetes is a chronic disease caused when the pancreas does not produce enough (or any) insulin (a hormone that regulates blood glucose) or the body cannot effectively use the insulin it produces. Uncontrolled diabetes can cause hyperglycaemia, or raised blood sugar, which over time can cause serious damage to many of the body’s systems, especially the nerves and blood vessels.

What’s the difference between type 1 and type 2 diabetes?

Type 1 diabetes is an autoimmune disease in which the body destroys the cells in the pancreas that produce insulin. Type 2 diabetes is a metabolic disorder which stops the body using insulin properly. More than 95% of people with diabetes have type 2 diabetes. Unlike type 1, type 2 diabetes can be prevented. Being overweight, eating unhealthily and not exercising enough, as well as genetic factors, can increase the risk of developing diabetes.

How many people have diabetes?

The Lancet study found that rates of diabetes in adults doubled from approximately 7% to about 14% between 1990 and 2022. In all, it calculated 828 million people over 18 have the condition, up approximately 630 million people over the three decades.

While India accounted for more than a quarter of all cases and has a diabetes rate of more than 20%, diabetes rates in the UK (8.8%) are second only to the US (12.5%) in the G7.

Why are cases of diabetes growing so much?

Growing levels of obesity are fuelling an epidemic in type 2 diabetes. According to the World Obesity Federation, nearly 1 billion adults and 159 million children are living with obesity. As you are more likely to develop diabetes as you get older, an ageing global society is also increasing the prevalence of the condition. A healthy lifestyle is unaffordable for some people. In many countries, unhealthy food is cheap, convenient and heavily advertised, while healthy food can be increasingly difficult to get and more expensive in the face of the droughts, floods and rising seas caused by climate change, according to the World Health Organization. Meanwhile, in some places, it is difficult to exercise safely.

How is diabetes treated?

People with type 1 diabetes need insulin injections or a pump to survive. While those with type 2 diabetes may need insulin or glucose-reducing medications; diet and lifestyle changes also help to manage blood sugar levels.

Why are so many people in lower and middle income countries not getting the medication they need?

Nearly 450 million people with diabetes are untreated, the Lancet study found, three-and-a-half times the number in 1990. Most of these people are undiagnosed. Despite the availability of effective glucose-lowering medication, millions of people with diabetes in low- and middle-income countries (LMICs) are untreated. According to Leif Fenger Jensen, managing director of the World Diabetes Foundation, “complex barriers to accessing health services” in lower and middle income countries make tackling diabetes more difficult. “These challenges lead to under-diagnosis and limited access to diabetes care, with major human and economic costs for both individuals and societies.”

What can be done about it?

Improving access to a doctor will make both prevention and getting diagnosis easier. Reducing the cost of diabetes drugs, especially in LMICs, would also make a difference. In addition, there is widespread consensus that more action is needed to reduce obesity.

A study published last month, found that reducing the sugar children receive in the womb and as toddlers can protect them against diabetes and high blood pressure in adulthood.

Johanna Ralston, chief executive of the World Obesity Forum, said countries should take a systematic approach “focusing on prevention, public health measures and policies that limit exposure to unhealthy food marketing, especially to children.”

https://www.theguardian.com/society/2024/nov/13/why-have-diabetes-rates-doubled-over-the-past-30-years-and-what-can-be-done-about-it

Living Well: Diabetes Prevention and Management

From conehealth.com

In the U.S. about 1 in 10 people have diabetes and about a third have prediabetes. While having a family history of diabetes, being over 45 years old or from certain ethnic backgrounds and being diagnosed with certain medical conditions can increase a person’s risk, monitoring glucose levels, eating healthy, being physically active and managing stress are ways to reduce diabetes risk within everyone’s control. 

“A combination of annual check-ups, healthy eating choices and more daily movement and physical activity can improve overall health,” says Cone Health registered dietitian Kate Watts. “Managing stress, which makes it more difficult to make positive lifestyle choices and contributes to inflammation in the body, can also improve outcomes.”

“Managing diabetes is a marathon, not a sprint,” encourages Cone Health registered dietitian Alexis Scotece. “Small, consistent changes can lead to lasting results."

Test A1C annually: If you are over 45 years old or have a family history of risk factors, test A1C or average blood glucose levels annually. By checking blood sugar levels, doctors can diagnose and monitor prediabetes and Type 2 diabetes. Symptoms of high or low blood sugar issues include fatigue, appetite changes, grogginess, thirst and frequent urination.

Get moving: Incorporate moderate aerobic activity and strength training into your weekly workout. Both the CDC and American College of Sports Medicine recommend adults 18 – 65 take a brisk walk, cycle, swim or participate in other cardiovascular activities for half an hour five days a week and work on all major muscle groups a couple of times a week.

Eat healthy: Balanced eating patterns like Mediterranean, vegetarian/vegan or the Dietary Approaches to Stop Hypertension (DASH), which emphasize lean proteins, fruits and vegetables, are recommended.

Manage stress: Take breaks, get enough sleep, connect with others and resist the urge to overcommit. In addition to the negative impact of stress on exercise and nutrition, long-term stress can cause the body to release hormones, which can increase blood glucose levels.

“To manage blood sugar and overall health, consider meeting with a registered dietitian for individualized nutrition guidance,” adds Scotece, who works with Cone Health Nutrition and Diabetes Education Services, which has outpatient offices in Greensboro, Burlington and Reidsville.

https://www.conehealth.com/employer-health-and-wellness-solutions/employer-health-solutions/news/living-well-diabetes-prevention-and-management/ 

Diagnoses of Type-2 Diabetes are increasing. Know the symptoms and how to reverse it

From bronx.news12.com

One sign that someone could develop Type 2 Diabetes is increased thirst and urination

As the number of people who are diagnosed with Type-2 Diabetes continues to increase, doctors say there are several steps people can take to avoid or reverse their diagnosis.

Doctors say first need to find what their blood sugar level is. If they do not know, they should visit a doctor for the routine test. They say if someone's blood sugar level is high, that could be a red flag.

Dr. Brent Smith with the American Academy of Family Physicians says even before people begin to see symptoms of the disease, it's important they visit their doctor annually to be screened and evaluated for diabetes risk.

"We would all be a lot happier treating and preventing it than we would be dealing with the consequences of uncontrolled diabetes or other medical conditions. For a long time, diabetes and hypertension were both known as what are called silent diseases, meaning they are affecting your body and causing long term damage before you start to have a lot of physical symptoms," says Smith.

One sign that someone could develop Type-2 Diabetes is increased thirst and urination.

"When you're a diabetic and you have this extra sugar floating around in your system, your body tends to either tends to get rid of it through your urine," says Dr. Brent Smith with the American academy of family physicians.

Other signs to watch out for include sluggishness, general malaise and not feeling like yourself.

Managing your weight can also reduce the risk of Type-2 Diabetes, along with eating a healthy diet, cutting out sugar as much as possible and exercising regularly.

"The recommendation for exercise is a total of 100 and 50 minutes over the course of the week which breaks down to about 30 minutes of a brisk walk or cardiovascular exercise five days a week," says Smith.

https://bronx.news12.com/diagnoses-of-type-2-diabetes-are-increasing-know-the-symptoms-and-how-to-reverse-it 

Top 4 lifestyle changes for managing diabetes effectively

From news.llu.edu

Diabetes is a chronic condition that affects how the body manages blood sugar. There are two primary types: Type 1 and Type 2.

Type 1 Diabetes: An autoimmune condition, typically diagnosed in childhood, where the beta cells do not produce insulin. This requires a person to give themselves insulin shots for their entire life.

Type 2 Diabetes: More common in adults, this type involves insulin resistance, where the body produces insulin but cannot use it effectively, or the pancreas doesn’t produce enough insulin. Some research shows that by the time Type 2 diabetes is diagnosed, up to 50% of the cells are already not working. Type 2 progresses over time, often causing blood sugar to build up in the bloodstream, which can damage blood vessels, especially in organs like the eyes and kidneys. 

Additionally, prediabetes –– the precursor to Type 2 Diabetes –– happens when there is insulin resistance, but sugar levels in the bloodstream are not high enough to be considered Type 2 diabetes. This is becoming dangerously common, with the Centers for Disease Control and Prevention reporting that more than 1 in 3 American adults have prediabetes, and more than 8 in 10 adults with prediabetes don’t know they have it. 

Karen Studer, MD, chair of the Department of Preventive Medicine, provides the following lifestyle changes for individuals with any form of diabetes, including prediabetes.

1. Eliminate all sugary beverages

One of the most effective and important ways to manage blood sugar is to eliminate sugary drinks from your diet. This includes: 

• Sodas

• Fruit juices such as orange, apple, and grape juice

• Sports drinks

• Energy drinks

• Coffee sweetened with syrups, sugars, or creamers

• Milkshakes

• Alcohol

Even beverages that seem healthy, like fruit juice, can cause rapid blood sugar spikes because they’re packed with concentrated sugars without the fibre found in whole fruit.

Instead of drinking surgery beverages, Studer suggests the following alternatives:

• Water: Plain or sparkling

• Fruit-infused water: Adding fresh fruit can add flavour without excess sugar

• Unsweetened tea: As long as you skip the sugar and cream, tea is a good choice 

2. Exercise after eating

There are two primary ways for glucose to enter cells: insulin or physical activity. Studer explains that physical activity is crucial for managing blood sugar levels, especially after meals. 

“After eating, light exercise can mimic insulin’s effect by opening cells for glucose to enter,” Studer says. “For people with prediabetes or diabetes, if they do some form of exercise after eating, even if it’s just walking, it will open the cells for the sugar to go into, which reduces the amount of sugar left in the bloodstream.” 

3. Consider eating only two meals a day

For some people –– specifically those not on insulin –– Studer says that reducing daily meal frequency from three to two may improve blood sugar control. A controlled diabetes study found that eating fewer, larger meals, such as breakfast and lunch, can be beneficial for people with Type 2 diabetes. 

However, this approach may not be suitable for everyone. If you are taking insulin or other medications that lower blood sugar, consult your doctor first to ensure that this change is safe for you. 

4. Reduce saturated fats and processed foods

Saturated fats and processed foods worsen insulin resistance and contribute to high blood sugar levels. Saturated fats, such as red meat, full-fat dairy products, and fried foods, can raise cholesterol levels, increasing the risk of heart disease — a common complication in people with diabetes. 

Processed foods, such as fast food, frozen meals, and candy, are often high in refined sugars and unhealthy fats, which can cause rapid spikes in blood sugar, making it harder to maintain stable glucose levels. 

Studer recommends eating a whole food, plant-based diet. Whole foods not only help improve insulin sensitivity and blood sugar control, but this eating pattern can potentially put prediabetes into remission. 

https://news.llu.edu/health-wellness/top-4-lifestyle-changes-for-managing-diabetes-effectively

How Diabetes Can Impact Eye Health

From news.cuanschutz.edu

Just like in the rest of the body, blood vessels in the eyes can be affected by diabetes, explains CU ophthalmologist Niranjan Manoharan, MD.

In 2021, researchers estimated about 11.6% of the U.S. population had diabetes, according to the Centres for Disease Control and Prevention (CDC).

This chronic metabolic disease, which happens when the body’s glucose, or blood sugar, is too high, can affect organs across the body, including the eyes. Niranjan Manoharan, MD, assistant professor of ophthalmology at the University of Colorado School of Medicine, often treats patients who experiences these vision changes or ocular problems that manifest along with diabetes.

Sometimes he can be the first to spot diabetes, which doctors often say is a “silent” disease, in a patient.

“I've noticed this many times. Patients don't know they have diabetes until we find a problem in the eyes, but they don’t suspect they have diabetes because they haven't had routine care with their primary care doctor,” he says.

Manoharan explains some of the ways diabetes affects ocular health and why managing blood sugar and keeping up with primary care is crucial for vision and keeping the eyes healthy.

Can you explain why diabetes and eye health are connected?

Diabetes affects many organs in the body in a similar way. It essentially slowly damages the tiny blood vessels in the body, including the eyes. When those blood vessels are damaged, we can see a whole slew of problems, such as retinal damage to lack of perfusion, bleeding and swelling in the retina, retinal detachment, glaucoma and cataracts.

What are some symptoms patients in later stages of the disease experience?

In more serious cases and late term complications, the patient can experience retinal detachment or bleeding in the eye. This can be harmful to a person’s vision and cause irreversible blindness.

Are these diabetes-related conditions treatable and what does that treatment look like?

It’s critical to catch this disease early so we can work with primary care doctors and endocrinologists to get it under control before it leads to the damage we’ve talked about. If left untreated, a person could experience permanent vision loss.

There is a point in diabetes where there is early damage in the eye but the patient might not necessarily know it because they’ve been able to manage with their vision, but as ophthalmologists we can see the damage in the blood vessels. In these early stages, we can reverse that damage, but there becomes a point where we cannot.

In advanced stages, treatment is often a combination of surgery, laser, or injections in the eye. We see a lot of variability in the disease, so it really depends on the individual patient.

Patient education is crucial in diabetes and eye conditions that can follow. What should people know about screenings and preventative care?

Even if you feel like you're healthy and doing well, hypertension and diabetes are silent diseases. You don't know until there's end organ damage. That's when you start to feel it. By then, a lot of damage could already be done, and it's going to be harder to control.

A quick annual check-up with a primary care provider to check your blood pressure and glucose can go a long way, because if we can catch these early, subtle changes, it’s much easier to treat and manage.

https://news.cuanschutz.edu/ophthalmology/how-diabetes-can-impact-eye-health

USA: Get educated about diabetes and take control of this manageable disease

From eu.pressconnects.com

The numbers are staggering. Diabetes isn’t just a disease – it’s an epidemic, affecting over 38 million Americans with devastating consequences.

• 1.2 million Americans are diagnosed each year
• 11.6% of Americans had diabetes in 2023
• 97.6 million American adults are living with prediabetes

Diabetes is a progressive, chronic disease that you’ll need to manage independently day-to-day for the rest of your life. While that may sound overwhelming, with help from the team at the UHS Diabetes Center, it doesn’t have to be. Located at 93 Pennsylvania Ave. in Binghamton, the Diabetes Center has served the region since the 1970s. The center manages care for patients with Type 1, Type 2 and gestational diabetes who are 18 and older, whether they’re newly diagnosed or have lived with diabetes for many years. November is National Diabetes Month, a great time to make sure you are informed.

Types of diabetes

There are three main types of diabetes: Type 1, Type 2 and gestational diabetes (diabetes while pregnant).

Type 1 Diabetes

Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). This reaction stops your body from making insulin. Approximately 5-10% of the people who have diabetes have Type 1. Type 1 diabetes can be diagnosed at any age, and symptoms often develop quickly. If you have Type 1 diabetes, you’ll need to take insulin every day to survive. Currently, no one knows how to prevent Type 1 diabetes.

Type 2 Diabetes

With Type 2 diabetes, your body doesn’t use insulin well and can’t keep blood sugar at normal levels. About 90-95% of people with diabetes have Type 2. It develops over many years and is usually diagnosed in adults (but more frequently in children, teens, and young adults). You may not notice any symptoms, so it’s important to get your blood sugar tested if you’re at risk. Type 2 diabetes can be prevented or delayed with healthy lifestyle changes, such as:

• Losing weight
• Eating healthy food
• Being active

Gestational Diabetes

Gestational diabetes develops in pregnant women who have never had diabetes. If you have gestational diabetes, your baby could be at higher risk for health problems. Gestational diabetes usually goes away after your baby is born. However, it increases your risk for Type 2 diabetes later in life. Your baby is more likely to have obesity as a child or teen and develop Type 2 diabetes later in life.

Prediabetes

In the United States, over 97 million adults — more than 1 in 3 — have prediabetes. More than 8 in 10 of them don’t know they have it. With prediabetes, blood sugar levels are higher than normal but not high enough for a Type 2 diabetes diagnosis. Prediabetes raises your risk for Type 2 diabetes, heart disease and stroke. But there’s good news. If you have prediabetes, a lifestyle change can help you take healthy steps to reverse it.

Secondary Diabetes

Secondary diabetes is a form of diabetes that occurs as a result of another medical condition or treatment, such as surgery or specific diseases. Surgical procedures like a pancreatectomy (partial or complete removal of the pancreas) can significantly reduce or eliminate the body's ability to produce insulin, leading to elevated blood sugar levels and the onset of secondary diabetes. Similarly, cystic fibrosis can damage the pancreas over time, disrupting its normal function and contributing to the development of this condition. Management of secondary diabetes often requires insulin therapy to regulate blood glucose levels, as the body's natural insulin production is insufficient or completely absent due to the underlying cause.

A manageable disease

UHS-registered dietitians and certified diabetes educators note: Diabetes affects most activities of daily living. However, diabetes does not have to limit your dreams or ambitions: With a little planning, a person with diabetes can do anything. Our team helps patients learn techniques to self-manage their disease by monitoring blood sugar, eating healthfully, being active, taking medications, managing stress and prioritizing self-care to prevent or delay diabetes complications.

Diabetes can affect people at any age. Diagnosis usually occurs when an individual presents with symptoms such as blurry vision, increased thirst and urination, fatigue, hunger, drowsiness, slow-healing cuts or wounds, or numbness or tingling in the feet, prompting a provider to order a blood test. Adults 35 and older should be screened for diabetes regularly. It is important to have regular screenings for diabetes from your primary care provider, even if you have no symptoms, as many people do not realize they have elevated blood sugars.

Our Diabetes Center’s team includes endocrinologists, nurse practitioners, diabetes educators and a dietitian. For diabetes-related foot, eye, dental or mental health care, patients can be referred directly to UHS specialists.  The team creates an individualized treatment plan based on each patient’s needs, barriers and personal situation. Routine visits with the endocrinologist or nurse practitioner are scheduled every three to four months, and, between appointments, patients can call with questions or concerns. Direct connections to each patient’s primary care provider ensure that everyone involved in the patient’s care is on the same page.

UHS experts say that the disease process is ever-changing, and factors such as stress, pain, food, physical activity, illness, sleep and medications can affect blood sugar. Communication is key between the patient and their diabetes team – whether it’s to report blood sugars, discuss a concern, or discuss more affordable medication or treatments. UHS’ unique approach means patients can access comprehensive diabetes management and a diabetes education program all under one roof.

Recent advances in diabetes care technology means patients now have more options than ever for managing the disease:

• A continuous glucose monitor is a small sensor worn on the abdomen or back of the arm – it provides a glucose reading without a fingerstick (not all insurance plans cover this, so be sure to check with your carrier). Many continuous glucose monitors send glucose readings directly to a smart phone or receiver.
• Insulin pumps can help increase the time a person’s blood sugar is in range with advanced features such as stopping insulin delivery, increasing insulin delivery off of sensor readings or increasing insulin according to glucose readings.
• New glucose meters use less blood and connect to smart phone apps.
• Improved insulin pens make injections easier and allow concentrated insulin to be easily available. New oral and injectable medications are now available, which provide more treatment options for patients with Type 2 diabetes.
• Diabetes websites and apps help patients monitor and track their progress, provide increased resources for education, and engage patients in self-care.

“Diabetes is a chronic, debilitating disease, but with proper control and management, we can significantly improve outcomes and help patients lead healthier lives.” said Olayinka Wilhelm, MD of the UHS Diabetes and Endocrinology Center.

For more information on UHS Diabetes services, click here.

https://eu.pressconnects.com/story/sponsor-story/uhs/2024/11/04/get-educated-about-diabetes-and-take-control-of-this-manageable-disease/75964551007/ 

Early sugar restriction cuts adult diabetes risk by 35%, study finds

From jpost.com

Researchers analysed health data of 60,000 individuals born during UK sugar rationing after WWII

A new study published in the scientific journal *Science* on October 31, 2023, suggests that reducing sugar intake from conception through the first two years of life can significantly lower the risk of chronic diseases in adulthood. Conducted by a team led by Tadeja Gracner from the University of Southern California, the research found that limiting sugar exposure during this critical developmental period resulted in a 35% reduction in the incidence of Type 2 diabetes and a 20% reduction in hypertension later in life.

The researchers took advantage of a unique situation in the United Kingdom during and after World War II, where sugar rationing was in place until 1953. This "natural experiment" allowed them to analyse the long-term health effects of early sugar consumption. They examined the health data of over 60,000 individuals born between 1951 and 1956, comparing those exposed to sugar rationing in utero and early childhood to those who were not.

During the rationing period, British adults were allowed up to 40 grams of sugar per day, which is half the current average consumption and comparable to modern dietary guidelines. After the rationing ended, sugar consumption in the UK surged to around 80 grams (about 5.6 tablespoons) per day, nearly doubling almost immediately. This stark contrast in sugar intake provided a clear framework for the study.

The findings indicated that individuals born during the sugar rationing period had significantly lower rates of Type 2 diabetes and hypertension in adulthood. Those who experienced limited sugar exposure in the first 1,000 days after conception had a 35% lower risk of developing Type 2 diabetes and a 20% lower risk of hypertension compared to those born after the rationing ended. Additionally, the onset of these diseases was delayed—diabetes by an average of four years and hypertension by an average of two years.

"We found that early-life [sugar] rationing reduced diabetes and hypertension risk," the researchers wrote. They also noted that "avoiding sugar early in life delayed the onset of high blood pressure by two years and diabetes by about four years, with an average delay of four years for diabetes and two years for hypertension."

Experts highlight that the first 1,000 days are a crucial period for shaping a person's future health and establishing dietary preferences. Early exposure to sugar can influence metabolism and foster a lasting preference for sweet foods, making it harder to avoid sugary foods throughout life. Tadeja Gracner explained that "studies show that, although most humans like sweets, significant exposure to sugar early in life may strengthen that preference."

The protective effect was strongest for individuals whose sugar exposure was restricted both in utero and in the months after birth. Exposure in the womb alone accounted for nearly one-third of the reduction in risk. The researchers stated, "In-utero sugar rationing alone accounted for about one-third of the risk reduction." They also found that reducing sugar exposure after six months of age, likely coinciding with the introduction of solid foods, amplified the protective effects against diabetes and hypertension.

                                                               Boy with doughnuts. (Photo credit: Sharomka. Via Shutterstock)

While the study presents compelling evidence, the researchers acknowledged limitations. The analysis was based on self-reported health data from individuals born in the UK between 1951 and 1956, when "the type and availability of ultra-processed products could be very different from the current ones." Other social and nutritional factors may have also influenced the health outcomes observed.

Despite these limitations, the study adds to the growing body of evidence that nutrition in early life can significantly impact long-term health. It supports existing guidelines that recommend limiting added sugars, especially during pregnancy and early childhood. Current dietary recommendations in the United States advise that children under the age of two should have no added sugars at all, according to the Centers for Disease Control and Prevention.

The researchers called on policymakers to hold "food companies accountable to reformulate baby foods with healthier options and regulate the marketing and tax sugary foods targeted at kids." They emphasized that "with better information, environment, and the right incentives, parents can more easily reduce sugar exposure for their kids and themselves."

Experts not involved in the study found the methodology solid and the results credible. Dr. Paul J. Gertler, one of the authors, emphasized, "Childhood sugar is as harmful to health as tobacco." He added that the research results could be grounds for food companies to make baby food healthier, regulate sugar-related marketing, or impose taxes on high-sugar foods.

The study underscores the importance of early dietary interventions in preventing chronic diseases. By reducing sugar intake during the critical development period from conception to two years of age, there is potential to significantly lower the risk of Type 2 diabetes and hypertension in adulthood. As Tadeja Gracner concluded, "Our results contribute to this debate by linking sugar to health and highlighting the importance of early-life diet to manage the risk of metabolic diseases in the long term."

Sources: Der Standard, BBC, Folha de S.Paulo, ABC News, El Comercio Perú, People, ABC Digital, El Pais, La Opinión Digital, The Independent, Gazzeta.Ru

https://www.jpost.com/science/science-around-the-world/article-827319