Diabetes with serious complications affects approximately 350 million people around the world, and is forecast to double by 2030. In Vietnam, according to the National Hospital of Endocrinology, about 4.5 million diabetes patients in Vietnam (about 5% of the population) have not ever been successfully diagnosed and treated. Regarding this topic, Dr. Jeffery Mechanick, an international expert in the field of diabetic nutrition therapy, a guest speaker at a seminar held by Abbott Nutrition in Singapore end of this August, shared new findings to help manage pre-diabetes and diabetes effectively.
While diabetes has been a critical public health issue in western nations for many years, Asians have largely eluded the disease until now. Can you share some insights as to why diabetes is growing in Asia?
Dr. Jeffery Mechanick: Increases in type 2 diabetes are primarily driven by two key changes in culture a switch to Western-style nutrition and dining habits, coupled with an increasingly sedentary lifestyle. And as a result, one's body composition changes where there may be less muscle and more fat, and as such, there may be more chances of insulin resistance, which constitutes the pre-diabetes stage and increased risk of developing type 2 diabetes.
We hear a lot about diabetes, but not pre-diabetes. Could you explain what pre-diabetes is and why it is important?
Pre-diabetes is not a disease but it's a physiological state which identifies a patient as having increased risk for developing a disease. This was generally unheard of a decade ago, and with the growing info about insulin resistance and the condition of insulin resistance syndrome (or metabolic syndrome), more clinicians are more aware of the condition.
As a result of the recognition, insulin resistance and the role of insulin secretion problems by the pancreas, or what we call a beta-cell defect, was identified as one of the causes of type 2 diabetes. Because of this we can now identify patients who are at increased risk of type 2 diabetes.
What measures can people take during the pre-diabetes stage to protect their health?
Like many other diseases, introducing intervention as a preventive measure during the pre-disease state is more important than treating during the pre-disease state.
To intervene when patients have pre-diabetes can help to prevent the disease and likewise prevent morbidity, adverse effects on quality of life, and the increased amount of complications on other diseases such as heart attacks, strokes, kidney disease and blindness. So that should be the strategy for any society, to shift from a disease treatment paradigm to a disease prevention paradigm.
What can put a person at risk for diabetes? Why is knowing your risk important?
From a clinical standpoint, patients who are at risk are those who have pre-diabetes as a result of biochemical testing.
Additionally, patients who have a family history of type 2 diabetes are also at risk. Others at risk could be due to genetic predisposition or may have other conditions which are known to be associated with insulin resistance, such as polycystic ovary syndrome, which is a common condition associated with menstrual irregularity in reproductive age women.
By understanding the risk, doctors are able to intervene and help patients with lifestyle management, which includes nutritional management, medical nutrition therapy (MNT), physical activity, stress reduction and other benefits to lifestyle such as proper sleep.
What are some of the systemic changes that we need to introduce to keep communities safe from diabetes? What are some of the tools that are available for physicians and patients?
From a system standpoint, municipal and larger-scale governments should institute policies regarding food, and policies that extend into the school system, the workplace and into the general public. Examples would be trying to diminish the amount of junk food at school lunches.
Some of the tools that I would like to see (for doctors) are algorithms (actually a project which we're working on) to develop a culturally sensitive, easy to understand decision tree or algorithm that clinicians can look at and re-stratify patients, and determine what lifestyle interventions the patients can do, even in the prevention stage.
How does MNT play a role in preventing and managing diabetes or pre-diabetes?
Medical Nutrition Therapy includes healthy eating, conforming to a macronutrient and micronutrient composition that has been agreed upon by various professional medical societies such as the AACE and the ADA.
It consists of calorie replacements to be used strategically when needed to facilitate weight loss, and also consisting particularly, in the case of insulin-requiring type 2 or type 1 diabetes, the synchronization of carbohydrates with insulin administration, so-called carbohydrate counting.
Studies have shown that with conventional Medical Nutrition Therapy, glycemic control can be improved.
||Dr. Jeffery Mechanick is Clinical Professor in the Division of Endocrinology, Diabetes and Bone Disease, at the Mount Sinai School of Medicine in New York City, USA. Dr. Mechanick has authored more than 175 scientific publications in endocrinology and nutrition. He has also served as President of the American Board of Physician Nutrition Specialists and lectures nationally and internationally on endocrinology, nutrition and metabolic support.
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