Lowering the risk of diabetes – 10, 000 steps at a time

Diabetes is a serious public health concern in Malaysia and is closely related to increased morbidity and mortality as a result of diabetes related complications. Over the past decade, there has been an increasing prevalence of type 2 diabetes (T2DM) among adults aged 30 years and above. In 2011, the 4th Malaysian National Health and Morbidity Survey (NHMS IV) reported the prevalence of T2DM to be 20.8%, affecting 2.8 million individuals (compared with the 3rd National Health and Morbidity Survey (NHMS III), which reported a prevalence of 14.9% in 2006).

Among the major ethnic groups in Malaysia, Indians had the highest prevalence of T2D (24.9% in 2011 and 19.9% in 2006), followed by Malays (16.9% in 2011 and 11.9% in 2006), and Chinese (13.8% in 2011 and 11.4% in 2006).

Furthermore, only 22% of people with T2DM achieved optimal sugar control (measured by a test, HbA1C). The increase in the prevalence of T2DM has contributed significantly to the parallel increase in the prevalence of overweight and obesity. The overall prevalence of abdominal obesity in Malaysia, measured by waist circumference, has been reported to be between 55.6% and 57.4%. Obesity increases the risk of developing T2DM. Indeed, obesity is observed in 75% of Malaysians with T2DM.

In the 2008 DiabCare study, the prevalence of combined microvascular complications (retinopathy, nephropathy, and neuropathy) was 75% and macrovascular complications (angina pectoris, myocardial infarction, angioplasty/coronary artery bypass graft, and stroke) was 29%. Severe late complications (legal blindness, myocardial infarction, angioplasty/coronary artery bypass graft, cerebral stroke, end stage kidney disease, and leg amputation) were present in 25% of patients at the time of the study.

Diabetes mellitus is a major cause of end stage renal disease (ESRD) worldwide. Providing care for dialysis patients is expensive. In 2012, the global cost of dialysis was estimated to be close to USD70 billion per annum. In Malaysia, 32,000 patients undergo maintenance dialysis with an annual growth rate of more than 10%. The Malaysian Dialysis and Transplantation Registry 2013 reported diabetic nephropathy as the predominant cause of ESRD accounting for 61% of new cases. This trend is predicted to put enormous burden on the country’s clinical, public health and economic resources.

Successful diabetes management results from proper integration of healthy eating, physical activity, and, when needed, appropriate medication. Dietary management is considered to be one of the cornerstones of diabetes care. Unfortunately, poor adherence with lifestyle recommendations was highly prevalent among Malaysian patients with T2DM. In Malaysia, only 16.4% individuals with diabetes adhere to the dietary regimen provided by dietitians. This trend increases the difficulty in achieving diabetic targets in our patients. Sedentary lifestyle and physical inactivity is common among Malaysian adults. In a survey, 43.7% of adults did not adopt a physically active lifestyle. It was also reported that 54% of Malaysian adults with diabetes were physically inactive.

Diabetes care outcomes can be improved by regular and sustained follow-up, personalized care through visits by specified team members, regular individual and group diabetes education, scheduled fundus and foot examinations, regular screening of comorbid conditions, and regular sessions with pharmacists and dietitians. Even regular visits to the physical therapist improves conditioning and glucose control. However, activities need to be well coordinated, documented, and followed up for accurate assessment of outcomes.

From a personal perspective, a patient with diabetes must be looking into improving and maintaining their health for the long run. One must control their diabetes successfully, by eating well, increasing activity and keeping themselves updated on new developments for better diabetes treatment.

Below is the must do list for a diabetic:-

• Make an appointment with a trusted healthcare provider
• Always seek medical advice for any questions or concerns you may have.
• Do not let small things go unnoticed. Even little changes can be significant and the sooner you bring it to the attention of your doctor, the better. If you have not been following your recommended diet, or taking your medications as directed, you need to see your doctor for readjustments or clarification

Follow your recommended diet with care

Your doctor or dietitian should have given you a diet to follow. Appropriate diet is key to maintaining wellness. As every diabetic individual has differing needs, so it is likely that your doctor has tailored the diet suggestion to your specific needs. If you haven’t been given a recommended diet, ask for one. A food diary can be helpful if you’re struggling to stay on track. This allows you to plan ahead and prevent bad eating habits. Learn to read labels. Everyone should read nutrition labels on food but for diabetics, this is even more important.

Drink at least 6 to 8 cups of fluid daily

You are what you drink. There’s no doubt about it – consumption of sugar-sweetened beverages has skyrocketed in recent decades. There is increasing evidence that overconsumption of these drinks is associated with weight gain, insulin resistance, and diabetes. But what can you drink instead? While water is your absolute best first choice, you can also consume tea, coffee, unflavored soda/mineral waters, diet drinks, artificially sweetened drink powders, low calorie drinks. Drinks to avoid or minimize completely include: sports drinks, sweetened soda drinks, flavored water and milk, tonic water and fruit juice.

Know what is healthy to eat as a diabetic

The American Diabetes Association recommends the following food categories for a diabetic:

• Whole grains, beans, noodles, and starchy vegetables (including unrefined potatoes): 6 or more total servings per day. (Breads and cereals should be limited and low in sodium, avoiding white flour.)
• Fruit: 2-4 servings per day
• Vegetables: 3-5 servings per day
• Meat, fish, and cheese: 2-3 servings per day
• Milk and yogurt: 2-3 servings per day
• Fats, sweets, and alcohol: Small amounts
• Condiments should be low in sodium and free of sugar. Check the labels of foods that have been cured, pickled, corned, marinated, smoked and canned.

Allow “treats” in your diet

While sugary confectionery and sugary baked items are discouraged, this doesn’t mean the end of enjoying sweet treats. There are plenty of good diabetic cookbooks both in stores and online that you can use to recreate sugar-free treats that still taste fantastic. Many health food stores stock diabetic-suitable sweets and treats too, so start hunting around for substitutes that will still “hit the spot” and keep your sweet tooth satisfied.

A healthy small snack includes as much as a medium piece of fresh fruit, a small serving of yogurt, a few wholegrain crackers, small handful of nuts or celery/carrot sticks are great substitute.

Exercise regularly

Wondering why physical activity is so important? Regular activity is a key part of managing diabetes along with proper meal planning, taking medications as prescribed, and stress management. When you are active, your cells become more sensitive to insulin so it can work more efficiently. Your cells also remove glucose from the blood using a mechanism totally separate from insulin during exercise. So, exercising consistently can lower blood glucose and improve your sugar levels. When you improve your sugar levels you may be able to take fewer diabetes pills or less insulin.

Regular physical activity has many other benefits:

• Potentially lowers blood pressure
• Burns calories to help lose or maintain weight
• Increases your energy for daily activities
• Helps you sleep better
• Relieves stress and improves quality of life
• Strengthens your muscles and bones
• Keeps your joints flexible
• Improves your balance to prevent falls

A 20-30 minute of moderate intensity exercise on most days of the week is usually sufficient. Different exercise works for different people, so experiment to find the exercise that you like most (after consulting your doctor). Achieving 10,000 steps a day is another alternative who look for a more targeted approach.

Take your medications as directed

For many diabetes patients, taking their medications on schedule is a challenge. Some forget regularly, and others miss a dose here or there. The vast majority of diabetics control their blood sugar with medication or insulin. 12% of adults with diabetes take both insulin and oral medications, 53% take oral medications only, 19% take insulin only and 15% do not take either.

What happens if people don’t adhere to their medication schedules? The potential for severe consequences is tremendous. In a 2004 study that appeared in Diabetes Care, researchers found that people with T2DM who missed doses of their medications had a greater risk of being hospitalized. The risk of hospitalization was more than twice as high among T2DM who did not adhere to their oral diabetes medications the year before. Patients who have trouble remembering to take their medication should establish a system of some type of reminder to improve compliance to their medications.