Diabetes a growing concern in AsPac

Experts at the International Diabetes Federation Western Pacific Region (IDF WPR) congress recently held in Bangkok expressed concern about the continuing growth of diabetes – referred to as the "silent killer" – in the Asia-Pacific region.

The IDF estimates that there are about 190 million people worldwide with diabetes, and the number is expected to increase by as much as 330 million by 2025.

More than 60 percent of those afflicted will be in the Asia-Pacific, with majority of the cases being type 2 diabetes, a chronic, progressive illness that occurs when the body does not respond properly to insulin.

When the body is unable to effectively use insulin (insulin resistance), the pancreas compensates by producing more insulin to keep the blood glucose levels under control, until the pancreas eventually become exhausted and can no longer function properly leading to type 2 diabetes.

According to Dr. Mary Anne Lim-Abrahan, president of the Philippine Lipid Society and immediate past section head of endocrinology of the University of the Philippines-Philippine General Hospital’s Department of Medicine, the prevalence of diabetes across all age groups in the Philippines is estimated at 4.2 percent (approximately 3.5 million) of the 84 million population.

"And there is a similar number of people who are undiagnosed. So if the prevalence in the Philippines is 4.2 percent, there’s another 4.2 percent that said.

"Diabetes is a serious, debilitating disease. If it is not managed, the consequences can have an impact on the whole family and not just the person with the disease," said Dr. Paul Zimmet, director of the International Diabetes Institute in Melbourne, Australia.

Another cause for concern is the complications associated with diabetes such as heart disease, stroke, kidney failure, increase in cataract formation and even blindness, says Lim-Abrahan.

"In fact, most of the patient’s money is spent on taking care of the complications of diabetes. If you look at the patient’s medical expenses, about 75 percent of the medication costs go to managing the complications. The more complications a person has, the more the expense," she added.

An even more frightening consequence of diabetes is leg amputation. People with diabetes are 25 times more likely to lose a leg than people without the condition.

Worldwide, up to 70 percent of all leg amputations happen to people with diabetes, according to Dr. Karel Bakker, a specialist in internal medicine, diabetology and endocrinology at the Spaarne Hospital in the Netherlands, and chairman of the IDF Consultative Section and the International Working Group on the Diabetic Foot.

"The good news, however, is that, if monitored accurately, anyone with diabetes can have the chance to help control his own destiny by making necessary lifestyle changes," Zimmet said.

The new guidelines contained in the fourth edition of IDF WPR’s Type 2 Diabetes Practical Targets and Treatment were made relevant to Asians’ dietary and other lifestyle practices, he added.

Just as the risk of a stroke is monitored by regularly checking a patient’s blood pressure, global guidelines necessitate that the risk of diabetes complications be monitored using a test called glycated haemoglobin or HbA1c, acknowledged as the "gold standard" in the assessment of long-term glycaemic control.

Daily blood glucose readings are not considered as reliable as HbA1c because daily glucose can easily fluctuate depending on an individual’s diet or exercise patterns.

"The HbA1c test is not used to diagnose diabetes; it is used to assess the level of glycaemic control as this correlates with the complications of diabetes. For example, if your HbA1c is near the target level of 6.5 or lower, then your chance at complications is lower," Lim-Abrahan said.

"If a patient’s HbA1c level is high, then the doctor will know that what’s being done is not benefiting the patient. So there is a need to review the patient’s dietary compliance, the type of medications and even the patient’s compliance to medication," she added.