As every year, World Diabetes Day is celebrated on November 14. This year the main theme focuses on diabetes and the family. For this, we have the collaboration of our recognized expert in Endocrinology and Nutrition, Dr. José Antonio Piniés Raposo who talks about how diabetes affects the family.
What is diabetes?
Diabetes is a chronic disease, characterized by a high concentration of glucose in the blood. If it is not controlled, it produces long-term complications that lead to a decrease in the quality and quantity of life of those who suffer from it.
Diabetes affects some 425 million people worldwide, half of whom are undiagnosed. This epidemic of the 21st century is due to changes in lifestyle habits characterized by an excess in our diet of foods and beverages rich in sugars and saturated fats and a sedentary lifestyle.
In Spain in 2010, 14% of our population over 18 years of age suffered from diabetes, with 40% of people with diabetes being undiagnosed. In this study it was observed that about another 14% of people had prediabetes, that is, a very high risk of developing the disease.
It is important to note that people with prediabetes (high risk of developing diabetes) can reduce their risk of developing diabetes by 60% with lifestyle changes and exercise.
Types of diabetes
Regarding the disease, there are different types of diabetes mellitus (DM), the 2 most important are DM1 and DM2. DM1 accounts for 10% of cases and affects young people, characterized by an autoimmune destruction of the insulin-producing beta cells of the pancreas. DM2 represents 90% and occurs in adulthood; its cause is twofold: on the one hand, resistance to insulin in its mission of introducing glucose into the cells and, on the other, the inability of the pancreas to secrete sufficient insulin to overcome the resistance to its action. It should be pointed out that this resistance is produced fundamentally by an increase in body fat.
Given the importance of early diagnosis, people over 40 years of age should have an annual glucose test, which could be done earlier if they have obesity, hypertension, high cholesterol, a family history of diabetes or have had diabetes during pregnancy. The preventive medical examination to detect this disease is important because we can diagnose it early, before complications arise, and in those cases in which prediabetes is detected, we can act immediately.
How can this disease affect the family?
Diabetes can be a major financial cost to the individual and the family. In many countries, the cost of insulin injection and blood glucose testing can be half of a family’s disposable income, and regular and affordable access to essential diabetes medications is out of reach for many. Improving access to affordable diabetes medicines and care is therefore essential to avoid major costs to the individual and family.
Fewer than 1 in 4 family members have access to diabetes education programs. Family support in diabetes care has been shown to have a substantial effect on improving health outcomes for people with diabetes. Therefore, it is important that all people with diabetes and their families have access to ongoing diabetes self-management education and support to reduce the emotional impact of the disease that can result in a negative quality of life.
What advice can be given to the family of a diabetic patient?
Type 2 DM, which accounts for 90% of cases, could be prevented by changing lifestyle habits, promoting a healthy and balanced diet, regular physical exercise and avoiding toxic habits. In this sense, the family has a fundamental role in the education of modifiable risk factors for type 2 DM (diet and exercise), resources and means to promote healthy lifestyles.
One in two people with diabetes is undiagnosed. Early diagnosis and treatment are key to preventing diabetes complications and achieving a good quality of life. Knowledge of the signs, symptoms and risk factors for all types of diabetes are vital for early detection of the disease.
The role of the family is essential in the management, care, prevention and education of people with diabetes. The experience, support and protection of family members will be vital for the good development of these people’s lives.
What advances have been made in recent years?
In recent years, new basal (slow) and rapid insulins have been developed with more physiological mechanisms of action that allow better control of diabetes and in many cases less hypoglycemia (decrease in the level of glucose in the blood). In the field of anti-hypoglycemic drugs, we have new families of drugs that, in addition to lowering blood glucose levels, help patients lose weight and produce fewer hypoglycemias.
In addition, some of these drugs reduce cardiovascular and renal risk in patients with type 2 DM and a high cardiovascular risk.
New technologies, such as sensors with continuous or flash glucose monitoring that display glucose levels for 24 hours, allow strict monitoring of glycemic levels that favors disease control, thus helping to reduce complications and reduce the time that patients with DM1 or DM2 spend in hypoglycemia or hyperglycemia. The sensors have been implemented with alarms that alert the patient in case of hypoglycemia or hyperglycemia.
Continuous insulin infusion pumps are devices that allow better glycemic control for those who cannot achieve it with multidose insulin. Closed-loop systems (a kind of artificial pancreas) are already a reality. A sensor on the skin is used to continuously measure the subcutaneous glucose level. This information is transferred to a terminal carried by the person in which a microchip with a mathematical algorithm orders a continuous insulin infusion pump the amount of this hormone to be dispensed according to the glucose level at any given moment. Although these systems will not be in general use, they will be of great help to some patients and will represent a paradigm shift in the treatment of diabetes in the not too distant future.
In any case, education of people with diabetes and their families aimed at achieving healthy lifestyle habits, self-measurement and self-control of blood glucose and its associated risk factors, are essential to control the disease and avoid its complications.
The management of this epidemic is a multidisciplinary task and requires the intervention of physicians, nurse educators, dieticians, podiatrists, psychologists and health authorities.