November 2010, Theme: Diabetes Education and Prevention
2010 marks the second year of the five-year focus on ‘Diabetes education and prevention”, the theme selected by the International Diabetes Federation and the World Health Organization for World Diabetes Day 2009-2013.
The campaign slogan is: “Let’s take control of diabetes. Now”
Whilst most frontline pharmacists in general practice have to deal with diabetic patients on a daily basis, World Diabetes Day is an opportunity to reflect on the current situations in which we operate and to perhaps consider activities which in the coming year will provide the patients with improved service. In more specific terms those benefits arising from better education. This may most commonly feature the best combination of medication, monitoring and dietary management to maintain blood sugar levels within acceptable limits and to remain aware of developing complications such as retinopathy but may be usefully extended beyond this. A recent British study suggested that increased understanding by all those involved, particularly the patient, improved the overall prognosis. In the study, outcome measures not only included usual monitoring data such as Haemoglobin A1c, blood pressure and lipid levels, weight etc., routine issues such as smoking status and physical activity but also the patient’s views on the illness, their perceived quality of life and the emotional impact of diabetes on them.
Although diabetes is very much a universal and growing problem (recent data from the International Diabetes Federation Diabetes Atlas show that over 285 million people worldwide now live with diabetes and, within 20 years, IDF predicts the figure will jump to 435 million) there is considerable variation between and within countries. This means that in our interactions with healthcare colleagues, relatives/carers and with patients with diabetes our activities and priorities are focused on local issues and initiatives.
Whilst you may be developing your own specific activities or be linking with colleagues in your locality, country or region you might find some relevant information in the following extracts, from last year’s message on the same topic which can be found on www.commonwealthpharmacy.org “About the CPA” – Awareness Health Days or on one of the specific websites listed below.
The International Diabetes Federation Task Force on Clinical Guidelines has issued updated documents including on oral health, diabetes in pregnancy and on self-monitoring in type 2 patients.
A UK study in which patients newly diagnosed with type 2 diabetes were followed over 4 years regarding their views about self monitoring. It found that self monitoring decreased over time, and those who did continue monitoring did so less frequently. Some patients expressed uncertainty about the meaning of the test results and how to act on them, while others found self monitoring to be reassuring. How to act on high readings was a consistent problem. Most patients also voiced concerns about the value health professionals placed on their readings. Doctors generally appeared to show little interest in patients’ test results after the initial phase, leading some patients to see self monitoring as not very important or even pointless.
The use of specifically accredited Diabetes educators is spreading. An example of the approach in Canada can be seen on www.cdecb.ca
The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive control of blood glucose levels is extremely effective in preventing complications affecting the eyes, kidneys, and nerves. Long-term results from the follow-on study show that intensive therapy dramatically reduces the risk of heart disease, which is the leading cause of death in people with diabetes. Results also showed that a finite period of good glucose control provides benefits years down the road, with enduring protection from complications of the eyes and kidneys, and from cardiovascular disease. Thus, physicians are advised to start intensive therapy as early as possible following diagnosis.
Recent advances in genetics such as the identification of the responsible genes for several forms of Maturity Onset Diabetes of the Young have established precedents linking specific drug therapies to defined subtypes of diabetes patients.
An Australian study has shown that obstructive sleep apnoea is linked with diabetes: estimates suggesting that up to 40% of people with OSA have diabetes.
A European study showed that Hyperglycemia during critical illness may be used as a warning of future diabetes. Researchers found a significant association between acute illness complicated with hyperglycaemia and the future development of type II diabetes or glucose intolerance.
- Every 30 seconds, a leg is lost to diabetes somewhere in the world. Thats more than 1 Million amputations a year!
- It is estimated that up to 85% of amputations could be avoided.
- Every 10 seconds, someone dies from diabetes related causes and 2 new cases are diagnosed.
- Diabetes is the leading cause of blindness and visual impairment in adults worldwide
- People with type 2 diabetes have the same risk of heart attack as people without diabetes who have already had one.
- Obesity is a key factor in Type 2 diabetes.
- For many people Type 2 diabetes can be managed or prevented by a healthy diet and regular exercise.
- Diabetes is one of the major causes of premature death worldwide. Every 10 seconds a person dies from diabetes-related causes.The death rates are predicted to rise by 25% over the next decade.
- Diabetes is increasing faster in the world’s developing economies than in developed countries. Seven out of ten countries with the highest number of people living with diabetes are in the developing world. With an estimated 35 million people with diabetes, India has the world’s largest diabetes population.
- Each year another 6 million people develop diabetes. In many countries in Asia, the Middle East, Oceania and the Caribbean, diabetes affects 12-20% of the adult population.
- If present trends persist, by 2025 the majority of people with diabetes in the developing countries will be in the 45-64 age group.
- Type 2 diabetes is responsible for 90-95% of diabetes cases. 80% of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment.
Planned professional activities for this year are listed in the World Diabetes Day website and include events in:
Trinidad and Tobago
www.ispad.org (related specifically to paediatric and adolescent diabetics)
www.pdep.org (specific to the Pacific region)
www.worlddiabetesfoundation.org (specific for a manual prepared for use in sub-Saharan Africa
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