Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body.

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1 International Diabetes Federation Diabetes Background Information Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body. Insulin is a hormone made by the pancreas that helps sugar (glucose) to leave the blood and enter the cells of the body to be used as fuel. When a person has diabetes, either their pancreas does not produce the insulin they need (type 1 diabetes) or their body does not make enough or cannot make effective use of the insulin they produce (type 2 diabetes). Diabetes Prevalence According to the World Health Organization (WHO) and the International Diabetes Federation (IDF), diabetes is reaching epidemic proportions and is a leading cause of death worldwide. Particularly the prevalence of type 2 diabetes is rising at an alarming rate throughout the world. This is believed to be due to increases in longevity, obesity and sedentary lifestyles. Dramatic examples of the intensification of diabetes prevalence can be found in India and China. India appears to host the largest diabetic population in the world with an estimated 45 million people, which amounts to 8% in the adult population; and in China, where 2.7% of the adult population is affected by type 2 diabetes, the number of people with this condition is likely to exceed 50 million within the next 25 years. Generally, in most parts of the world 50 to 80 percent of those with type 2 diabetes do not know that they have the condition. (Ref. Diabetes Atlas, International Diabetes Federation, 2000) Symptoms The onset of type 1 diabetes is usually sudden and dramatic, and can include symptoms such as abnormal thirst, hunger, increased need to urinate, weight loss, dry/itchy skin, exhaustion/lack of energy, problems seeing clearly and sickness. The symptoms of type 1 diabetes, in a less marked form, may also affect people with type 2 diabetes, which is a more progressive disease. Some people with type 2 diabetes however have no early symptoms and are only diagnosed several years after the onset of the condition, when various diabetic complications are already present. Complications of Diabetes Without proper insulin production and action, sugar remains in the blood, leading to chronic hyperglycaemia (raised blood sugar). This can result in short and long-term

2 complications, many of which, if not prevented and left untreated, can be fatal. All have the potential to reduce the quality of life of people with diabetes and their families. The short-term effects of diabetes include: Ketoacidosis: A metabolic disorder that results from high levels of blood glucose and ketones. If levels of insulin are too low for a long period of time, the body begins to break down its stores of fat for energy. This causes the body to release ketones into the blood. Ketoacidosis can make people feel confused, sick, extremely thirsty, tired or short of breath. It may result in coma and death. Recurrent infections: When blood glucose is high defences against infection do not work properly. Weight loss: the body starts to burn protein and fat instead of glucose. If uncontrolled, diabetes can cause serious long-term complications. The most common are: Diabetic nephropathy (kidney disease), which may result in total kidney failure and in the need for dialysis or kidney transplant. Diabetic eye disease (retinopathy and macular oedema, damage to the retina of the eye which can both lead to vision loss). The incidence of blindness is 25 times higher in people with diabetes than in the general population. Diabetic neuropathy (nerve disease which can ultimately lead to ulceration and amputation of the feet and lower leg). Cardiovascular disease, which affects the heart and blood vessels and may cause fatal complications such as coronary heart disease (leading to a heart attack) and stroke (a common cause of disability and death in people with diabetes). Management The effective management of diabetes includes careful long-term monitoring and effective early management of diabetic complications. The risk of long-term diabetic complications can be greatly reduced by: Good control of blood glucose levels Good control of blood pressure Good control of blood fats including cholesterol and triglycerides Not smoking Exercise Diabetes Prevention The importance of diabetes prevention cannot be underestimated. Unless significant efforts are made to stem the rise in diabetes, healthcare services across the world will soon be crippled by the costs of treating the diseases and its complications. Recent studies have shown that lifestyle advice can be extremely effective at reducing diabetes risk in these groups.

3 Treatment Options Diabetes is a progressive condition that requires different treatments at different stages. Treatments should be aimed at keeping blood glucose at near-normal levels. Treatment of type 1 diabetes typically includes a carefully calculated diet, exercise, home blood glucose testing multiple times daily and multiple daily insulin injections. Treatment of type 2 diabetes typically includes diet control, exercise, glucose testing, oral medication and, at a later stage, insulin. Obesity Background Information Obesity is an excess amount of body fat sufficient enough to harm health. Although obesity can affect anyone, the main risk factors are high-fat, high-energy dense diet and physical inactivity. Obesity is usually assessed by a single measure, the Body Mass Index (BMI). The way in which BMI is calculated equals the weight in kilograms divided by height in metres squared (BMI=weight (Kg) / height (m)²). Individuals with a BMI between 25 and 29.9 (Kg/m²) are considered overweight, while those with a BMI of 30 and above are considered obese. Being overweight or obese seriously increases an individual s risk of developing other health problems such as type 2 diabetes, coronary heart disease, and some forms of cancer. The prevalence of obesity is rising to epidemic proportions worldwide. In some countries, an astonishing half the population is overweight. Even more worrying is the fact that childhood obesity is on the increase in many developed countries. Obesity is the most prevalent nutritional disorder among children and adolescents in the majority of developed countries. Growing trends in many countries portray an obesogenic society where the consumption of high-fat, high energy dense food is preferred to healthy fresh fruit and vegetables, and where the level of physical activity has dramatically been reduced or substituted by the constant usage of motor vehicles. Obesity and Diabetes: the Risks In both men and women, the more overweight an individual is, the greater the risk of developing type 2 diabetes. The means by which excessive body fat causes type 2 diabetes is not clearly defined, but it appears that excess fat increases insulin resistance, raising blood glucose levels and the likelihood of developing diabetes. People with a greater amount of abdominal fat have a higher risk of developing the condition.

4 Diabetes is the most preventable consequence of the obesity epidemic. IOTF figures suggest that up to 1.7 billion of the world s population are already at a heightened risk of weight-related non-communicable diseases such as type 2 diabetes. In fact, the risk in type 2 diabetes appears to be mainly related to the increasing prevalence of overweight and obese individuals worldwide. Prevention The importance of eating a low-fat, low-energy dense diet and participating in physical activity should be greatly promoted in order to reduce the risks of becoming overweight or obese. If these habits are introduced in children, there is a greater chance that they will continue into adulthood. Public health programmes should stress the importance of a healthy environment, promoting improved diet and activity throughout communities. National programmes should be especially aimed at improving education and awareness of obesity and its consequences in schools and in youth recreational centres. Treatment Options Research has shown that even a small amount of weight loss can decrease or slow down the risk of developing type 2 diabetes. Group therapy is advised to improve the psychological approach to weight loss, and to maintain an appropriate weight. Drugs to assist weight loss play a role in individuals for whom lifestyle changes alone may be insufficient to produce the required weight loss. In recent years a number of studies have been carried out, confirming the view that a healthy bodyweight can also contribute to prevent the development of type 2 diabetes. The findings from four studies are as following: Finnish Diabetes Prevention Study This important study from Finland confirms and extends initial research by demonstrating that sustained changes in lifestyle can substantially reduce the development of type 2 diabetes in middle-aged adults at high risk for diabetes. The lifestyle intervention included better diet, increased physical activity, and modest weight loss. The programme aimed to achieve a weight reduction of 5% or more, an intake of total and saturated fat of less than 30% and moderate exercise for at least 30 minutes a day. This large study involved more than 500 overweight, middle-aged men and women who were at high risk of diabetes because they had higher-than-normal blood glucose levels that were not yet high enough to be diagnosed as diabetes. After four years, the lifestyle intervention group had more than a 50% reduction in diabetes incidence although the average weight loss was low, about 7 pounds (approximately 3 kg) or less than 5% of body weight. DPP The Diabetes Prevention Program Research Group carried out this study, involving more than 3000 people over approximately 3 years. The study was designed as a lifestyle intervention programme to prevent or delay the development of diabetes. The goal was a

5 weight loss of at least 7% and 150 minutes of physical activity per week, similar in intensity to brisk walking. Participants mean age was 51 years, with an average BMI of % of the participants were recruited from ethnic minority groups because these are disproportionately affected by type 2 diabetes. Methods used to achieve lifestyle changes included individual lifestyle coaches, supervised physical activity sessions and an extensive network of training, feedback, and clinical support. Important features of the programme also encouraged the self-monitoring of fat and calories intake and weight on a daily basis to achieve a lasting change in diet and exercise behaviours. The study found that the participants who increased their physical activity and lost 5-7% of their body weight (10-15 pounds) reduced their progressing to diabetes by 58% during the course of the study. DA QING IGT AND DIABETES STUDY The purpose of this study was to determine whether diet and exercise interventions in people with impaired glucose tolerance (IGT) could delay the development of type 2 diabetes. More than 100,000 men and women from 33 healthcare clinics in the city of Da Qing, China, were screened for IGT and type 2 diabetes. Of these individuals, 577 were classified as having IGT. Subjects were randomized into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Follow-up evaluation examinations were conducted at 2-year intervals over a 6- year period to identify subjects who developed diabetes. The result was that the cumulative incidence of diabetes at 6 years was 67.7% in the control group compared with 43.8% in the diet group, 41.1% in the exercise group, and 46.0% in the diet-plusexercise group. The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight (BMI < or > or = 25 kg/m2). In an analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31%, 46%, and 42% reductions in risk of developing diabetes, respectively. This study underscored the fact that diet and/or exercise interventions can lead to a significant decrease in the incidence of diabetes among those with IGT. STOP-NIDDM The STOP-NIDDM trial consisted of about 1400 participants with impaired glucose tolerance that received a daily dosis of either acarbose or a placebo. After a mean period of 3.3 years the study revealed that while in the acarbose group diabetes incidence sunk to 31%, in the placebo group the reduction of incidence of diabetes was 41%. This also confirms the findings from other studies that even without medication a change in lifestyle including weight reduction and increased physical activity can lower the risk by more than 50%. Impaired Glucose Tolerance (IGT) IGT is an intermediate state between normal blood glucose control and type 2 diabetes. It is a combination of impaired secretion of insulin (i.e. the phase of insulin secretion that occurs prior to and immediately after eating) and reduced sensitivity of the body s cells to insulin (insulin resistance).

6 In people with IGT, fasting blood glucose levels are usually normal or moderately raised, however the rise in blood glucose that occurs after consuming 75g glucose is greater than normal, although not as great as in people with type 2 diabetes. IGT carries a high risk of progressing to type 2 diabetes, and The American Diabetes Association has on this matter suggested referring to IGT as pre-diabetes. Extra Information: The International Diabetes Federation (IDF) is the only global advocate for people with diabetes and their healthcare providers. It is an umbrella organization of 183 member associations worldwide, representing millions of people with diabetes, their families, healthcare providers and specialists. IDF operates through a wide range of activities and tools, including education for people with diabetes, public awareness campaigns and the promotion of the free exchange of diabetes knowledge. For more information please contact International Diabetes Federation (IDF) Executive Office Avenue Emile de Mot, 19 B-1000 Brussels, Belgium Tel: Fax: The International Association for the Study of Obesity (IASO) represents the global obesity research community and aims to improve global health by promoting the understanding of obesity and weight-related diseases through scientific research and dialogue, whilst encouraging the development of effective policies for their prevention and management. The International Obesity Task Force, a part of IASO, works in collaboration with a global network of experts and linked NGOs to seek action on obesity. For more information please contact: International Association for the Study of Obesity (IASO) International Obesity Task Force (IOTF) 231, North Gower Street London NW1 2NS United Kingdom Tel: Fax:

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