Type 11 diabetes cases expected to rise by 200mn globally over next two decades

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Diabetes is the catastrophe of the 21st century, remarked Sir Michael Hirst, the visiting President of the International Diabetes Federation (IDF) headquartered in Brussels, Belgium.

This debilitating disease is a challenge to the world, to Sri Lanka and to every other country, he underscored. “No longer are those afflicted old people, even many teenagers are now diabetic”.

With a surge in Type 11 diabetes, the number is expected to rise by 200 million globally over the next 20 years, Sir Michael said in an interview with The Sunday Island on the sidelines of the recent launch of Heberprot-P, an innovative injectable drug in the treatment and cure of advanced diabetic foot ulcers, at the Ramada Hotel in Colombo.

The majority four-fifth of these cases over the next two decades will be in the developing world, impacting people of working age. Diabetes is not just a health issue, but an economic development issue as well, he stressed.

“We cannot have young workers incapacitated by this killer disease”, the IDF chief noted. “It’s time to make a collective effort through educational and awareness initiatives to arrest this disturbing spiral”.

Sir Michael William Hirst is a former Scottish Conservative and Unionist Party politician. He is a chartered accountant, who served as a public relations consultant and company director.

With representation in 171 countries, the IDF’s advocacy is driven by the ambition to improve the lives of people with diabetes and those at risk. As the world’s health NGO, it works at the global or local level to make self-management education available to all people suffering from diabetes.

The following are excerpts of Sir Michael’s interview:

Q: Isn’t undiagnosed diabetes a cause for serious concern in the current context?

Yes, because if you have half of the people with diabetes not diagnosed and not treated, they are more susceptible to complications. This condition can also lead to neuropathy, which affects the nerves of the feet impairing sensation. This means that if they cut or injure themselves in the feet, they will not feel it.

In diabetic patients, wounds take a longer duration to heal. In case of a severe laceration, the injury could turn gangrenous resulting in amputation of the leg to prevent it from spreading to other parts of the body.

Diabetic foot ulcers are another major cause for amputations. The complications are many. It could lead to strokes, heart attacks, end stage renal failure and blindness. Diabetes is a silent killer –- it’s a very nasty disease. Many people may be unaware that they are diabetic as they remain undiagnosed, and untreated as a result.

People with diabetic foot ulcers should take utmost care. They should wear special footwear and keep their feet clean. I am in Sri Lanka for the launch of Heberprot-P, an injectable drug to cure these foot ulcers, which is a significant achievement by Cuba. I have come here as part of our mission to improve the lives of people with diabetes.

Even in the UK and many other countries in the world, there are not many products to heal foot ulcers and the end result is amputation. With this drug, Cuba has reduced its amputation rate by 70%. This means that patients can keep a limb rather than lose it. Heberprot-P is a major breakthrough by the biotech industry in Cuba.

Q: Does diabetes have a genetic factor?

Yes, but it is not inevitable. If there is a history of diabetes in the family, the offspring will go on to develop it. It is, therefore, well advised to speak to the doctor and get the requisite tests done.

Lifestyles have to be modified. People who are overweight with significantly high cholesterol levels, body pressure and other chronic disease are more prone to diabetes. More than half of the cases can be prevented with a dramatic change in lifestyle and diet. A balanced diet is important.

More physical exercises also help in a big way. Escalators compound the problem because most people opt for them in a building complex rather than using a flight of stairs.

Q: There is a conception that eating fruit could also aggravate diabetes. What are your views?

Fruit and vegetable are an excellent part of the diet. Natural sugars are not a problem. What becomes a problem is when sugar is added. Fizzy drinks, carbonated sodas, confectionery and sugar-based products should be avoided. Moderation is the answer. Of course, eating a little chocolate now and then cannot do much harm.

A Cola contains 90 spoonfuls of sugar. An excessive energy intake leads to obesity and at a particular stage the body becomes insulin resistance, which precedes the development of type 2 diabetes. Undetected diabetes could also lead to heart attacks and strokes. That’s why it is described as a silent killed.

Sri Lanka has a fine health service, but the government does not provide insulin to patients, though people have free access to healthcare facilities.

Q: How critical is the prevalence of diabetes in the UK?

It is very serious as in every country. Numbers vary as anywhere else in the world. In the UK, patients have total access to vital medicines. There is modern technology, but numbers are still rising. We work on awareness programs and people undiagnosed are now being treated.

The complications of type 1 and type 2 diabetes are both the same. Insulin producing beta cells in the pancreas are destroyed. As the body can then no longer produce insulin, it has to be injected to balance the blood sugar level.

Nothing can be done to reverse type 1 diabetes, but type 2 can be postponed or put off altogether with lifestyle changes, diet, physical exercises and optimizing health.

Q: Metformin is a drug common prescribed for people with diabetes. There is a fear that long-term use of the drug could have an adverse impact on the kidneys?

Metformin is effective in controlling blood glucose levels of patients with type 2 diabetes. I am not in a position to answer the second part of the question as I am not a diabetologist.

Q: Is this your first visit to Sri Lanka?

No, I was here in 2004 to receive the Frank Gunasekera Award for my work in the sphere of diabetes. I see significant advances in Sri Lanka since then. I was encouraged to see the terrific job done by Prof. Jennifer Perera in this field.