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World Health year 2016 is prevention of Diabetes disease Gambia with over 28% of Diabetes is one of the highest   What are the risks of diabetes in children

In 2008, an estimated 347 million people in the world had diabetes and the prevalence is growing particularly in low- and middle-income countries.

In 2012, the disease was the direct cause of some 1.5 million deaths, with more than 80% of those occurring in low- and middle-income countries. WHO projects that diabetes will be the 7th leading cause of death by 2030.

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin, a hormone that regulates blood sugar, gives us the energy that we need to live. If it cannot get into the cells to be burned as energy, sugar builds up to harmful levels in the blood.

 There are 2 main forms of the diabetes. People with type 1 diabetes typically make none of their own insulin and therefore require insulin injections to survive. People with type 2 diabetes, the form that comprises some 90% of cases, usually produce their own insulin, but not enough or they are unable to use it properly. People with type 2 diabetes are typically overweight and sedentary, 2 conditions that raise a person’s insulin needs.

Over time, high blood sugar can seriously compromise every major organ system in the body, causing heart attacks, strokes, nerve damage, kidney failure, blindness, impotence and infections that can lead to amputations.

World Health Day 2016: Key messages

WHO is focusing the next World Health Day, on 7 April 2016, on diabetes because:

1. The diabetes epidemic is rapidly increasing in many countries, with the documented increase most dramatic in low- and middle-income countries.

2. A large proportion of diabetes cases are preventable. Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. Maintaining normal body weight, engaging in regular physical activity, and eating a healthy diet can reduce the risk of diabetes.

3. Diabetes is treatable. Diabetes can be controlled and managed to prevent complications. Increasing access to diagnosis, self-management education and affordable treatment are vital components of the response.

4. Efforts to prevent and treat diabetes will be important to achieve the global Sustainable Development Goal 3 target of reducing premature mortality from noncommunicable diseases (NCDs) by one-third by 2030. Many sectors of society have a role to play, including governments, employers, educators, manufacturers, civil society, private sector, the media and individuals themselves.

Goal of World Health Day 2016: Scale up prevention, strengthen care, and enhance surveillance

The main goals of the World Health Day 2016 campaign will be to:

1.      Increase awareness about the rise in diabetes, and its staggering burden and consequences, in particular in low-and middle-income countries;

2.      Trigger a set of specific, effective and affordable actions to tackle diabetes. These will include steps to prevent diabetes and diagnose, treat and care for people with diabetes; and

Launch the first Global report on diabetes, which will describe the burden and consequences of diabetes and advocate for stronger health systems to ensure improved surveillance, enhanced prevention, and more effective management of diabetes.

Diabetes

Key facts

·  In 2014 the global prevalence of diabetes * was estimated to be 9% among adults aged 18+ years (1).

·  In 2012, an estimated 1.5 million deaths were directly caused by diabetes (2).

·   More than 80% of diabetes deaths occur in low- and middle-income countries (2).

·  WHO projects that diabetes will be the 7th leading cause of death in 2030 (3).

·  Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes (4).

What is diabetes?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar (5). Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.

In 2014, 9% of adults 18 years and older had diabetes. In 2012 diabetes was the direct cause of 1.5 million deaths. More than 80% of diabetes deaths occur in low- and middle-income countries.

Type 1 diabetes

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type 2 diabetes

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world (5), and is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.

Gestational diabetes

Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They are also at increased risk of type 2 diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than reported symptoms.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

What are common consequences of diabetes?

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

· Diabetes increases the risk of heart disease and stroke. In a multinational study, 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke) (6).

·  Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.

·  Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. One percent of global blindness can be attributed to diabetes (7).

·         Diabetes is among the leading causes of kidney failure (4).

·   The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes (8).

How can the burden of diabetes be reduced?

Prevention

Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

· achieve and maintain healthy body weight;

· be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;

· eat a healthy diet of between 3 and 5 servings of fruit and vegetables a day and reduce sugar and saturated fats intake;

· avoid tobacco use – smoking increases the risk of cardiovascular diseases.

Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive blood testing.

Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Interventions that are both cost saving and feasible in developing countries include:

·  moderate blood glucose control. People with type 1 diabetes require insulin; people with type 2 diabetes can be treated with oral medication, but may also require insulin;

· blood pressure control;

·    foot care.

Other cost saving interventions include:

screening and treatment for retinopathy (which causes blindness);

blood lipid control (to regulate cholesterol levels);

screening for early signs of diabetes-related kidney disease.

These measures should be supported by a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use.

WHO response

WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low and middle-income countries. To this end, WHO:

provides scientific guidelines for diabetes prevention;

develops norms and standards for diabetes diagnosis and care;

builds awareness on the global epidemic of diabetes; celebration of World Diabetes Day (14 November);

conducts surveillance of diabetes and its risk factors.

The WHO Global strategy on diet, physical activity and health complements WHO’s diabetes work by focusing on population-wide approaches to promote healthy diet and regular physical activity, thereby reducing the growing global problem of overweight and obesity.

Defined as fasting blood glucose >= 7 mmol/l or on medication for raised blood glucose or with a history of diagnosis of diabetes.

What are the risks of diabetes in children?

Online Q&A

Q: What are the risks of diabetes in children?

A: The frequency of diabetes is rising around the world, and studies are showing children are at increasing risk of developing the disease. About 350 million people worldwide have the illness, a number likely to more than double in the next 20 years. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves - causing chronic problems and early death.

Type 1 diabetes

Type 1 diabetes (sometimes called insulin-dependent, juvenile or childhood-onset diabetes) occurs when the pancreas does not produce enough insulin, a hormone that regulates blood sugar. The cause is not known, but it is thought to be the result of a combination of genetic and environmental factors.

Many countries are documenting higher numbers of newly diagnosed cases of type 1 diabetes, particularly in younger children. Interestingly, some disease patterns among children resemble infectious disease epidemics. Currently, there is no known way to prevent type 1 diabetes.

Type 2 diabetes

Type 2 diabetes (sometimes called non-insulin-dependent or adult-onset diabetes) happens when the body cannot effectively use the insulin it produces. Often preventable, it can result from excess body weight and physical inactivity, and sometimes, a genetic predisposition.

Recently, type 2 diabetes has increasingly been reported in children and adolescents, so much so that in some parts of the world type 2 diabetes has become the main type of diabetes in children. The global rise of childhood obesity and physical inactivity is widely believed to play a crucial role. Healthy eating and lifestyle habits are a strong defence against the disease.

For further information try on WHO web site Diabetes disease, Gambia Diabetes association, Email to azadehhassan@yahoo.co.uk, Text to Dr Azadeh 002207774469/3774469 from 3-6 pm

Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director of Medicare Health Services