Diabetes requires early diagnosis, says US doctor

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Dr. Jeffery Mechanick speaks at a seminar on diabetes in Ho Chi Minh City in April 2013

Early detection is important in combating diabetes, whose incidence is increasing rapidly in Vietnam, said Dr Jeffery Mechanick, a clinical professor of diabetes in the US and the president of the American Board of Physician Nutrition Specialists at the seminar "Update on medical nutrition therapy for management of diabetes" held by Abbott in Ho Chi Minh City & Ha Noi in April 2013.

Thanh Nien: It is said that the diabetes rate is increasing in Vietnam. What do you think?  

Jeffery Mechanick: If you look at the prevalence rate increases in Southeast Asia, it is projected that from 2000 to 2030 they are going to increase by about 160 percent. But, if you look at individual countries that comprise Southeast Asia, there may be differences. So you may see more rises in some countries, and less rises in another countries.

Those statistics are generally gathered by individual governments. I would imagine that the prevalence rate is increasing.

In fact, one of the other things that would be of interest is not only to know whether the prevalence rate is increasing for the entire population, but which part of the population may be affected more than others -- for instance, diabetes is increasing more in the north than the south.

A report from the Central Hospital of Endocrinology this month said nearly 6 percent of the Vietnamese population has diabetes, double the rate 10 years ago, an alarming rise...  

Right, so that is in line with the 160-percent increase projected from 2000 to 2030. That is a remarkable increase. Once you see there is an increase that is so severe, not only is it alarming but also there is now the responsibility of figuring out why it is happening and what you can do to prevent it.

What are the likely reasons for such an increase in the diabetes rate in Vietnam?

What you are really asking is what the drivers for diabetes are. In the US, the main driver is obesity. If you look, you will see the prevalence rate of diabetes is going up. But the prevalence rate of obesity is also very high.

If you look around in Vietnam, you don't really see many people who are obese, and you don't see a high prevalence rate of overweight and obesity like in America.

Therefore, there must be other drivers.

One might be the way in which eating patterns are changing. Eating patterns are ways to describe the types of food that we eat, the composition of the food that we eat, and the molecules in the food the good molecules and the bad molecules. As a result of that eating, you start to create the state of insulin resistance, or pre-diabetes which is a condition that places patients at higher risks for diabetes.

Another possibility would be other factors of lifestyle, for instance, physical activity. In the past, most Vietnamese were probably out on the farm, in the field, growing crops and doing agriculture work doing more manual labor and hard physical activities. They did not have cars and scooters. So they were walking, they were carrying things, and they were exerting a lot of effort.

Now, everybody is on scooters, motorbikes, and cars. They are at desks and in front of computers, playing a game, watching TV, and seeing a movie. We spend a lot more time sitting down, being physically inactive. That's a very important driver.

There may be other drivers that we are unaware of. Besides stress or not enough sleep, there could be factors related to our own individual genetics inherited factors.

That is going to be a topic that needs to be researched. It needs to be researched here in Vietnam to understand why more people are getting diabetes.

What do you think the government should do?

My advice to the Vietnamese government would be the same as the advice I give to all organizations mandated with healthcare policy. That advice, which is also consistent with recommendations by professional societies, is that early detection is important: to set up screening programs so that people who are at higher risk of developing diabetes to screen not only for diabetes but screen for pre-diabetes, and establish a standard of care to intervene.

This project is about not only screening, but when you do want to intervene and you need to intervene in a culturally sensitive way.

Thank you Dr Mechanick!

According to International Diabetes Federation (IDF), 371 million worldwide currently are diagnosed with diabetes and unless rapid action is taken, one person in ten will have diabetes by 2030.

Medical nutrition therapy includes healthy eating and conforming to a macronutrient and micronutrient composition that has been agreed upon by various professional medical societies such as the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA).

It consists of calorie replacements to be used strategically when needed to facilitate weight loss, and also, particularly in the case of insulin-requiring type 2 or type 1 diabetes, the synchronization of carbohydrates with insulin administration, or so-called carbohydrate counting.

Studies have shown that with conventional medical nutrition therapy, glycemic control can be improved. There is also some data to indicate that a result of that improvement is risk reduction for cardiovascular events and complications.

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