Control risks of diabetes with healthy lifestyles

By Carol Aloysius

Diabetes continues to remain a leading cause for morbidity and mortality globally and across Sri Lanka. Many factors have contributed to this non communicable disease which has increased sharply in the past two decades. Among the leading contributory causes are the unhealthy lifestyles that modern society with its technological trappings have forced us to adopt. Lack of exercise, diets saturated with high cholesterol, food dripping with sugar and processed foods in place of fresh high fibre meals accompanied with lots of fruits and vegetables have made us obese and put us at risk of diabetes from a very early stage. Many would-be mothers today, are also being diagnosed with diabetes during pregnancy which puts them at risk of developing diabetes at an early age, besides having an adverse impact on their unborn children.

Normal vision	Vision with diabetic retinopathy

Health authorities are also concerned about the large number of undiagnosed cases of diabetics who remain untreated for the disease and become aware they have the disease only when it has advanced to a stage when they develop other health complications due to diabetes.

While diabetes is not curable once a person develops it, it can be controlled with regular prescribed medication and life style changes, says a leading authority on the subject.

Professor of Reproductive Medicine, Dept. of Obstetrics and Gynaecology, Faculty of Medicine, Colombo University and Hony.Consultant Physician and Endocrinologist, De Soysa Hospital for Women, Dr Chandrika Wijeyaratne discusses some of the golden rules to follow in minimising modifiable risks to developing diabetes and the importance of controlling it so that one can lead a normal life even when one becomes a victim of this disease.

Following are excerpts from an interview with the Sunday Observer.

Q. Diabetes is still the leading non communicable disease in Sri Lanka. Compared to a decade ago, has it shown a marked increase? If so why?

A. It certainly is on the rise but remains second to high blood pressure. The exponential rise is due to rapid societal transition that has made our lifestyle more unhealthy.

Q. I understand a cross-sectional study was conducted by the Diabetes Research Unit of the Colombo University with some 5,000 samples collected of persons over 18 years during 2005 and 2006. Your comments?

A. This study confirmed that diabetes occurs from a young age in adults over 20 years its prevalence was 1 in 10, an extremely high figure.

Q. One of the findings of this study I believe was the very large number of persons who had diabetes but were undiagnosed. It was something like 15% diagnosed cases as against 36% undiagnosed cases. How and what led to this?

A. No the study revealed that approximately 1/3rd of the diabetics were unaware; this is a distinct improvement to the earlier estimate that a half of diabetics were unaware of their condition. Nevertheless, our concern as a group of professionals advocating for Diabetes Prevention in the SLMA, is that even those who know of their diabetes do not take adequate care to prevent complications.

The public response to take on the responsibility to minimise the impact of diabetes is just as important to ensure secondary prevention.

Q. Commenting on the study again, I read that there was a high number of pre-diabetics. Who are pre-diabetics? To what age group do they fall?

A. Pre diabetics are those with FBS between 100 and 125 mg/dl (Impared Fasting Glucose) and/ or with second hour value of the 75g OGTT between 140-200 mg/dl. They are at a higher risk of developing diabetes in the next few years. The age distribution of pre-diabetics is often between adolescence and 40 years.

Q. What are the adverse effects that can impact on a pre-diabetic?

A. Most importantly this group also has high blood pressure and high lipids (colloquially cholesterol) with central obesity that contribute to premature heart attacks and strokes etc. Therefore, identifying them and preventing disease is very important.

Q. How can one detect if one is a pre-diabetic? Symptoms?

A. Blood glucose testing FBS or OGTT.

Q. Can you prevent getting diabetes if you find out you are at pre-diabetic stage? If so how?

A. There are available measures to prevent this occurring through lifestyle and a few medications such as metformin.

Q. Does diabetes affect men and women alike? At what age is it more likely to get diabetes?

A. There is no gender difference. In fact women are now found to be at greater risk simply because of less physical activity and consumption of greater quantity of starch.

Q. What are the main risk factors that contribute to the disease? Life styles?, Smoking? drinking, drug consumption? Wrong diets?

A. All of the above and I might say alcohol must be viewed as added calories. Additionally mental stress is something we talk about but cannot quantify and therefore often dismiss.

Q. Diabetes was once perceived as a disease of the West. But according to recent statistics from WHO, over 80 percent of people in Asian countries now have diabetes. Why is this?

A. Changes in lifestyle, easy access to unhealthy food, consumption of unhealthy food and drink far exceeding our requirements and socio-cultural trends towards sedentary occupations (such as the IT revolution) has made us relatively small made Asians develop large waistlines that considerably increases our risk

Q. How does a woman get diabetes during pregnancy? What is the impact on the mother’s health? Will she get diabetes at an early stage due to developing it at the pregnancy stage?

A. Pregnancy is a diabetogenic state due to the placenta elaborating excess hormones that act against insulin. Therefore pregnancy can unmask a previously unknown pre-diabtic woman. In the short term, she is at greater risk of developing pregnancy complication of high blood pressure, infections, excess water around the baby.

Additionally if she has high vblood sugar at conception (i.e. she was unaware of her diabetes prior to conception) she is at greater risk of miscarriage and the birth of a baby with congenital malformation.

We found almost a half of mothers who had become normal at two months after the birth of their baby, having developed pre-diabetes or diabetes within five years after their index pregnancy.

Q. What signs indicate she has developed diabetes at this stage?

A. Very often there are no signs. Only a blood test will reveal the problem. Therefore Sri Lanka is prioritizing universal screening of pregnant women, through the excellent supervision by the focal point for women’s health in this country - the Family Health Bureau of the Ministry of Health linked with a SLMA program called Nirogi Maatha funded by the World Diabetes Foundation

Q. If the baby she delivers is more than nine lbs, could she be at risk of developing diabetes later?

A. This is indeed true. However, for Sri Lanka a birth weight exceeding 3.5 kg (about 7.7 pounds) the mother has a greater likelihood to develop diabetes in later life.

Q. What is the treatment?

A. This can be prevented by losing weight after the birth of your baby through breast feeding and healthy lifestyle. Being aware of the problem and checking your blood sugar annually is our recommendation.

Q. Does the medication she is given to continue even after she is no longer considered at risk of the disease?

A. Most mothers do not need the insulin or metformin they were given during pregnancy after the birth of their baby. However they should undergo an OGTT test six to eight weeks later when the doctor can make a decision regarding the follow up

Q. What are the ‘golden rules’ to follow in order to prevent getting diabetes?

A. Diabetes can be prevented. This needs a healthy life cycle approach from pre-conception to childhood and adolescence and in young adult life including during childbearing and child rearing. Healthy diet and lifestyle are the jey to rpevention

Q. At what age should one start following them?

A. From the womb .

Q. Once diagnosed, should a diabetic continue with her drugs for life, of can she /he stop when her diabetes is under control?

A. There is no complete cure for diabetes. However we can control it – with a combination of drugs and lifestyle that must go hand in hand.

Very often people with diabetes do not feel unwell. So, when they find a drug prescribed by their doctor has brought down the blood sugar – they stop the medication without continuing follow up by their attending doctor. Quite often they get “misled” by claims of cure for diabetes by non medical professionals. So we see them again a few years down the line with complications of diabetes having set in. By this time we cannot reverse the damage that has occurred.

Q. What is the role of diet in preventing diabetes?

A. Diet plays a major role in preventing excess fat getting deposited particularly around the waist. This occurs mainly in the liver.

Fat deposition in the liver has a major impact on the chemical processes in the body, particularly carbohydrate and fat metabolsim

Q. Exercise?

A. Physical activity brings about a chain of chemical reactions that reverse the trend for developing diabetes and excess body fat. It increases your muscle mass, minimizes your aches and pains due to inactivity and improves your mental well being

Q. Your advice to patients?

A. Do not consider yourself a patient - you are afflicted by diabetes that can be easily overcome through your own efforts. There is nothing to feel shy or frightened by the fact you have been diagnosed with diabetes. Proper control with self management is your most valued investment for a healthy future

Q. Your message to the public?

A. Eat, think and live healthy - these are the keys to a happy and fulfilled life.

Higher breastfeeding rates likely with early skin-to-skin contact

Skin-to-skin contact between mother and infant in the delivery room is associated with an increased likelihood for exclusive breastfeeding, according to an abstract presented at a Conference and Exhibition in Orlando. When combined with a mother's intent to breastfeed, the likelihood was even greater.

In “Early Skin-to-Skin Contact in the Delivery Room Leads to an Increase in Exclusive Breastfeeding during the Newborn Hospital Stay,” researchers reviewed electronic medical records of single, late preterm or term healthy births at a New York hospital. Study authors looked for information on whether or not the mother and infant had skin-to-skin contact in the

delivery room, as well as maternal age, intention to breastfeed, gestational age, mode of delivery, admission temperature and glucose testing on admission to the newborn nursery. They also noted the number of formula feedings, birth weight, discharge weight and duration of hospital stay.

In total, 150 newborn hospital records were reviewed, of which 53 percent of the infants had skin-to-skin contact with their mothers in the delivery room.

Seventy-two percent of the mothers intended to breastfeed exclusively, although only 28 percent actually did. The intention to breastfeed and skin-to-skin contact were significantly related to exclusive breastfeeding, independent of maternal age, mode of delivery, parity and gestational age. When corrected for gestational age and delivery mode, exclusive breastfeeding was significantly associated with skin-to-skin contact.

“Breastfeeding is one of the easiest things we can do for babies to make sure they're growing up healthy,” said study author Darshna Bhatt.

“While skin-to-skin contact is associated positively with exclusive breastfeeding, the statistically significant factor is intention.” This “synergistic effect” between intent and skin-to-skin contact increases the odds that a mother will breastfeed, she said.

“We have to create a more interdisciplinary approach to increasing awareness and intention,” Dr. Bhatt said. “When mothers declare their intention to breastfeed, there really shouldn't be a reason why they don't have skin-to-skin contact with her new infant in the delivery room.”

- MNT

Green fingers or light DIY ‘cut risk of stroke for over-60s’

A spot of gardening or some light DIY are as good as rigorous exercise for fending off heart attacks and strokes in the over 60s, a study has found. Researchers in Sweden found that older people who performed a high level of “non-exercise physical activity” (NEPA), including everyday tasks like cutting the hedge, home repairs and even car maintenance, were 27 percent less likely to suffer a major cardiovascular problem.

Such low-level activity was beneficial whether or not people also took part in organised exercise.

The study involved more than 4,200 people aged over 60. Participants were monitored for more than 12 years and asked how often they performed 24 different NEPA tasks.

Those who performed the highest level of light day-to-day activity were not only less likely to suffer from heart problems, they also had “more preferable waist circumference”. Overall the group was 30 percent less likely to die during the study period than the least active group. “Our findings are particularly important for older adults, because individuals in this age group tend, compared to other age groups, to spend a relatively greater proportion of their active day performing [routine activities] as they often find it difficult to achieve recommended exercise intensity levels,” write the authors from Sweden’s Karolinska University and the Swedish School of Sport and Health Sciences. Christopher Allen, senior cardiac nurse at the British Heart Foundation said: “Being physically active is important in maintaining good heart health. But, as this study demonstrates, you don’t need a gym membership to do that. “As long as they make you feel warmer, breathe harder and make your heart beat faster, activities such as DIY and gardening count towards the 150 minutes of moderate intensity activity recommended for a healthy lifestyle.”

- The Independent

Young maternal age and quick pregnancies linked to high infant mortality in South Asia

Having children early and in rapid succession are major factors fuelling high infant mortality rates in the South Asian countries of

Bangladesh, India, Nepal and Pakistan where one in 14 births to young mothers ends with the death of the child within the first year, say researchers. Writing in the current online issue of the International Journal of Gynaecology and Obstetrics, Anita Raj, professor of medicine and director of the Center on Gender Equity and Health at UC San Diego, and colleagues said younger maternal age (under 18 years old) and short intervals between pregnancies (under 24 months) accounted for roughly one-quarter of the infant mortality rate among young mothers in India and Pakistan, a percentage that represents almost 200,000 infant deaths in 2012 for those two nations alone.

In Bangladesh, only the short inter-pregnancy interval was linked to infant mortality while in Nepal, only young motherhood was associated with infant death.

Infant mortality is a significant public health issue in South Asia.

According to United Nations data, the infant mortality rate worldwide is 49.4 deaths per 1,000 live births. In Pakistan, it is 70.90; India, 52.91; Bangladesh, 48.98 and Nepal, 38.71. By comparison, the infant mortality rate in the United States is 6.81 and just 1.92 in Singapore lowest in the world.

- MNT