Diabetes

January 1, 2021
Diabetes

WHO defines diabetes as “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”.

Diabetes is categorized into three types :

  • Type 1 Diabetes occurs where there is little to no production of insulin. About 10% of the diabetic population has type 1 diabetes.
  • Type 2 Diabetes where there is a decreased production of insulin. It is the most common form of diabetes and occurs in about 90% of the population.
  • Gestational Diabetes occurs during the 23 to 28th week of pregnancy. It is marked by hyperglycemia or increased blood sugar levels which usually disappears away once the baby is delivered. Such females and their offspring develop type 2 diabetes at a later stage in life1.

Improper lifestyle with lack of awareness about diabetes and its complications, delayed diagnosis, increasing urbanization, risk factors such as sedentary lifestyle and improper diet, account for the escalating rates of type 2 diabetes worldwide.

Global numbers of diabetes prevalence have continuously risen from 151 million in 2000, when the IDF Diabetes Atlas first was launched, to 285 million in 2009 and 382 million in 2013. In the year 2017, the number of people with diabetes was 424.9 million which is estimated to increase to 628.6 million by the year 2045. In this context, 50% of individuals with diabetes are undiagnosed, especially in developing countries2.

Type 2 diabetes is preventable through early diagnosis and lifestyle interventions. Insulin resistance and prediabetes are recognized as preconditions that could be managed through medical nutrition therapy early in the life cycle of an individual to prevent the onset of type 2 diabetes.

For early screening of diabetes or prediabetes, the Madras Diabetes Foundation has developed an Indian Diabetes Risk Score tool(IDRS) for identifying undiagnosed subjects with diabetes in India. This tool is useful in making screening programs more cost-effective and can also be used in several national programs not only for the prevention of diabetes but also in cardiometabolic diseases such as stroke. The IDRS tool is also applicable in identifying the prevalence of diabetes-related complications such as coronary artery disease, peripheral vascular disease, and neuropathy among type 2 diabetes individuals.

The tool uses four parameters: age, abdominal obesity, family history of diabetes, and physical activity to diagnose type 2 diabetes mellitus and also to distinguish diabetics from nondiabetics.

Based on a questionnaire a maximum score of 100 is allowed for the above-mentioned categories. The results of the tool are as follows.

Individuals with an IDRS of less than 30 are categorized as low risk whereas a score of 30-50 is considered a medium risk and a score of more than 60 is at high risk for developing diabetes.

Similarly, individuals with a waist circumference greater than 90 cm, a sedentary lifestyle, and a family history of diabetes are at high risk of diabetes.

Besides this, if the IDRS score is limited to 50 and above for persons with blood sugar testing then diabetes and prediabetes could be identified in more than 90% of Indians3.

PARAMETERSCORE
AGE
≧ 35 years0
35-49 years20
≧50 years30
WAIST CIRCUMFERENCE
Waist<80cm(female),<90cm(male)0
Waist ≧80-89cm(female),≧90-99cm(male)10
Waist≧90cm(female),≧100cm(male)20
PHYSICAL ACTIVITY
Regular exercise or strenuous physical activity at home/work0
Regular moderate exercise or moderate physical activity at home/work10
Regular mild exercise or mild physical activity at home/work20
No exercise and/or sedentary activities at home/work30
FAMILY HISTORY OF DIABETES
No diabetes in parents0
One parent is diabetic10
Both parents are diabetic20
TOTAL SCORE

Minimum score- 0 Maximum score-100 Positive score ≧ 60/100

TEST TO DIAGNOSE DIABETES According to the American Diabetes Association, the following tests are used to

A. Fasting plasma glucose (FPG or fasting blood glucose, FBG):

  • This test measures the level of glucose in the blood after an 8 to 12 hour fast.
  • Normal ranges for fasting blood glucose levels are 70 to 99 mg/dL and a level above 126 mg/dL observed after more than one test is categorized as diabetes. B. Hemoglobin A1c:
  • Also called A1c or glycated hemoglobin is hemoglobin with glucose attached. The A1c test evaluates the average amount of glucose in the blood over the last 2 to 3 months by measuring the percentage of glycated hemoglobin in the blood.
  • In individuals without diabetes: the HbA1c level is less than 5.7% (39 mmol/mol)
  • For individuals suffering from Diabetes: the HbA1c level is 6.5% (48 mmol/mol) or higher.
  • Individuals with HbA1c levels between 5.7% to 6.5% are categorized as suffering from Prediabetes. C. 2-hour oral glucose tolerance test:
  • This test involves drawing a fasting blood test sample, followed by having an individual drink a 75-gram glucose solution and drawing another sample two hours after consuming the glucose solution3. The blood glucose level 2 hours after consumption of glucose solution is an indication of the individual’s health condition as categorized below.
2-hour blood glucose levelIndication
Less than 140mg/dLNormal glucose tolerance
Between 140 and 199 mg/dLPrediabetes (impaired glucose tolerance)
Greater than or equal to 200 mg/dLDiabetes

Uncontrolled diabetes leads to an increased risk of complications such as

  • Heart diseases
  • Stroke
  • Kidney diseases
  • Nerve damage
  • Eye complications
  • High blood pressure
  • Foot complications
  • Infections

Increasing physical activity and maintaining a healthy weight plays a crucial role in the management of diabetes4,5.

Strong evidence supports the effectiveness of Medical Nutrition Therapy interventions when conducted for 3-6 months improved HbA1c in type 2 diabetes up to 2.0% and 1.9% in type1 diabetes respectively6.

In a study effect of low-carbohydrate- compared with low-fat diet intervention on metabolic control in people with type2 diabetes it was found that individuals on a low carbohydrate diet had improved hba1c levels, lowered triglycerides, raise HDL cholesterol, lowered blood pressure, and a greater reduction in diabetes medication7.

A study conducted by Ojho et al states that individuals on a low glycemic index diet (GI) have better glycemic control than a higher glycemic index diet in patients with type 2 diabetes8.

Apart from this study conducted by Wang et al concluded that individuals on a low carbohydrate diet can improve blood glucose levels better than a low-fat diet in type 2 diabetes9.

A meta-analysis conducted in 2013 of studies ranging from 4-24 weeks in duration reported that plans that are high in protein constituting 25-32% of the total energy compared to 15-20% resulted in 2kg more weight loss and 0.5% reduction in Hba1c levels10.

REFERENCES:

  1. What is diabetes

  2. Global statistics on diabetes, comment by Eberhard Standl, Forschergruppe Diabetes eV at Munich Helmholtz Centre, Germany For the EAPC Diabetes and CVD Educational Programme 01 Apr 2019

  3. Mohan V, Sandeep S, Deepa M, Gokulakrishnan K, Datta, M, Deepa R. A diabetes risk score helps identify metabolic syndrome andncardiovascular risk in Indians—the ChennaiUrban Rural Epidemiology Study (CURES-38). Diabetes,Obesity & Metabolism. 2007; 9(3):337–343.

  4. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 Diabetes Care 2004; 27: 1047-53

  5. Diabetes - Lab tests online

  6. Complications | ADA

  7. Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO expert consultation, Geneva, 28 January - 1 February 2002

  8. Franz MJ, MacLeod J, Evert A, et al. (PDF) Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process J Acad Nutr Diet 2017;117:1659–1679 10.

  9. Lacey K, Pritchett E. Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes managementJ Am Diet Assoc 2003;103:1061–1072

  10. van Zuuren EJ, Fedorowicz Z, Kuijpers T, Pijl H.Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments Am J Clin Nutr 2018;108:300–331

  11. Ojo O., Ojo O.O., Adebowale F., Wang X.-H. The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2018;10:373

  12. Wang L.-L., Wang Q., Hong Y., Ojo O., Jiang Q., Hou Y.-Y., Huang Y.-H., Wang X.-H. The Effect of Low-Carbohydrate Diet on Glycemic Control in Patients with Type 2 Diabetes Mellitus. Nutrients. 2018;10:661.

  13. Dong J-Y, Zhang Z-L, Wang P-Y, Qin L-Q.Effects of high-protein diets on body weight, glycaemic control, blood lipids and blood pressure in type 2 diabetes: meta-analysis of randomised controlled trials | British Journal of Nutrition Br J Nutr 2013;110:781–789

  • Diabetes
  • Medical Nutrition Therapy
  • Lifestyle Interventions
  • Unhealthy Diet
  • Physical Inactivity