by Elena Meli
Diet and physical exercise slow down the development of the disease even in those who are very familiar. Where you live also counts: it’s easier to get sick in the city
It has long been a candidate to be the worst health emergency of the near future, but according to new estimates, the avalanche will be even more overwhelming than expected. At the end of June, The Lancet published the latest report by the Institute for Health Metrics and Evaluation of the University of Washington on the current and future spread of diabetes and the numbers are merciless: today half a billion people in the world cannot keep their blood glucose under control, within the next 30 years the figure will touch one billion three hundred million with double-digit increases especially in the countries of North Africa, the Middle East and Latin America and in low-income nations. A load that no Health System will be able to deal with, as the authors underline.
The risks for those with diabetes
Only 4 percent will be type 1 diabetes, an immune-mediated disease that typically appears at a young age; all the others will be people with type 2 diabetes, which was once considered a disease of the elderly but today it always develops earlier due to factors such as overweight and obesity, sedentary lifestyle, incorrect diet. Is eating better and moving more the solution? essential to do so, but this pathology, which greatly increases the risk of lethal cardiovascular events such as heart attacks and strokes, is the result of a set of genetic, behavioral and environmental factors that are not easy to deal with, explained the coordinator of the study, Liane Ong. Many barriers and social and financial inequalities affect the risk of diabetes, they must be taken into account for true prevention. Which in any case is possible, starting from the behavior of each of us.
Prevention
When was the last time we measured our blood sugar? Diabetes prevention can start from being aware of your blood glucose level by measuring it once a year. Without it, it is difficult to know if you have pre-diabetes, a condition which according to the data presented at the last congress of the Italian Society of Diabetology (SID) affects at least 4.5 million Italians (other estimates speak of 1 in 3 adults) and which in 11% of cases leads to diabetes within 3 years, in 25% within 5.
Values
In pre-diabetes, fasting blood sugar is between 100 and 125 mg/dl and/or there is impaired glucose tolerance, i.e. a blood sugar between 140-199 mg/dl two hours after a glucose load curve (a high dose of sugar is taken and how it is disposed of by the body in the following hours is monitored). For glycemia it can return to normal by changing lifestyle, increasing movement and improving diet with adequate weight control, says Raffaella Buzzetti, president-elect of Sid. Some remain for years in pre-diabetic conditions, which in itself increases the risk of cardiovascular events. It is not a question of watertight compartments, but of a continuum: one does not become pre-diabetic or diabetic from morning to night but over time, adds Graziano Di Cianni, president of the Association of Diabetologists (AMD). For example, if a diet rich in sugars and fats is followed, the body produces more insulin to manage the excess blood sugar but over the years the mechanism goes haywire, the glycemic balance gets worse and then it can jump completely, sometimes as a result of triggering factors such as concomitant treatments, infections or other situations that precipitate glycemic metabolism. And the diagnosis of type 2 diabetes arrives.
Movement
Increasing physical activity, the other cornerstone of prevention in addition to a healthy diet, is also one of the best strategies because it can even counteract the negative effects of a high genetic risk of diabetes: this was demonstrated by a study by the University of Sydney conducted on about 60,000 people who wore a smart-watch to record movement for 7 years. It is known that those with a family history of diabetes and a genetic profile at risk have a two and a half times higher probability of getting the disease: however, the study shows that the risk decreases by 74% with one hour a day of moderate or intense physical exercise, i.e. with an activity such as walking, gardening or with more vigorous sports such as running, cycling or dancing. In short, even an unfavorable fate can be changed, but playing more sports and trying to eat better is the simple part of preventing pre-diabetes and diabetes. Because there are many factors that can favor it, as underlined by the latest Italian Diabetes Barometer Report presented in July: from 2019 to 2022 the prevalence of diabetes in Italy rose by 14%, but the increase can only be attributed to the aging of the population for 50%. For the rest, earlier diagnoses, the effects of the Covid-19 pandemic and socio-economic and cultural factors weigh heavily and also account for profound differences in the geographical distribution of diabetes, which, for example, affects 4.7% of the population in the North-East and as much as 8.5% in Calabria.
Social determinants
The social determinants of the disease must be considered for effective prevention: in cities, for example, diabetes is more widespread and there are also differences between different neighborhoods, observes Francesco Dotta, head of the Diabetes Unit of the Le Scotte University Hospital in Siena. A survey by the Health City Institute has shown that in Rome diabetes is more common in the suburbs, where the average age is lower. In just five subway stops, going from the center to more distant districts, the prevalence increases by 140% and life expectancy decreases by 2 years: in central districts even if the older population, wealth, culture and access to services reduce the impact of the disease. The Health City Institute is part of the international project Cities Changing Diabetes, which seeks to reverse the course of urban centers where the disease is rampant: in the world two thirds of people with diabetes live in cities and this is not happening only because the inhabitants of the planet are increasingly concentrated in the metropolis, but also because urban contexts can favor diabetes if they are not designed to favor the movement of inhabitants, if there are too many opportunities to eat poorly, if one does not try to reduce inequalities and less access to health services disadvantaged social classes. It is no coincidence that, as underlined by the latest Sid data, 15% of type 2 diabetes cases depend on prolonged exposure to smog associated with being overweight, and in less educated people the risk of getting sick is 60% higher.
New treatments
There is much to be done for real prevention; however today it is possible to treat oneself better, as Dotta concludes: Compared to a few years ago we have many more tools to manage diabetes: there are over one hundred different combinations of drugs to choose based on the patient’s characteristics. If, for example, the cardiovascular risk is high, active ingredients with a protective effect on the heart and vessels can be used, for an effective and truly customized therapy.
The rise of diabetes among children
We need to start thinking about diabetes prevention from an early age. Because as Graziano Di Cianni, president of the Association of Diabetologists, points out, thirty years ago we only saw cases of type 1 diabetes in adolescents, today we also diagnose type 2 diabetes in 12-13 year olds.
The increase in diagnoses of diabetes under the age of 18 is occurring for both types of disease and was recently confirmed by two studies conducted in Italy and in the USA, which also emphasized the negative effect of the Covid-19 pandemic. As explained by Valentino Cherubini, Italian research coordinator and president-elect of the Italian Society of Pediatric Endocrinology and Diabetology, we evaluated the incidence of type 1 diabetes from 1989 to 2019 in two Italian regions and then compared it with the new diagnoses made during the pandemic, between 2020 and 2021. Well, in 2021 there was an increase of 7.2% compared to the number of expected diagnoses, which in ratio to the entire national territory translates into one hundred more cases per year.
Something similar also happened with type 2 diabetes, according to US data presented at the recent congress of the American Diabetes Association: in the last 10 years, new diagnoses of type 2 diabetes in children or youth have grown by 9% every two years and in the US, adolescents who receive the diagnosis are more than double compared to before Covid-19. The worsening of lifestyles in the years of the pandemic have had an impact, but probably also the virus itself, because various data seem to suggest that having contracted Covid-19 increases the probability of later developing diabetes. How to do prevention in the youngest? As Cherubini suggests, it is mostly a question of following good rules that apply to everyone, even for the little ones diagnosed with the disease: Creating a daily routine with regular times for meals and physical exercise, cooking together with the children to take the opportunity to educate them on the nutritional value of foods and the right combinations for controlling sugar levels, encouraging children and young people to do at least half an hour a day of physical activity, perhaps together: in this way diabetes is prevented, but above all, one learns to manage it if the diagnosis has already been made.
July 23, 2023 (change July 23, 2023 | 07:31)
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