As with every year, since 1991, the International Diabetes Federation (IDF) and the World Health Organization (WHO) observe World Diabetes Day on November 14. The day marks the birth of Frederick Banting, co-discoverer of insulin in 1921. The significance of this day is more important than ever, as globally the number of diabetic patients continues to grow rapidly.
Over the past 30 years, diabetes has emerged as a true pandemic. According to the WHO, the number of people with diabetes has risen from 108 million in 1980 to a staggering 422 million in 2014 and is estimated to reach over 640 million by 2040. Its rise is a real threat for many middle and lower-middle income countries, where health systems are the most fragile.
Diabetes, put simply, is a problem with the regulation of sugar in the body. Glucose (or sugar as we call it), is an essential element of life, fuelling our cells and keeping the brain active. We get sugar from many natural sources including the carbohydrates, like rice and roti, which often make up our basic diet. The regulation of glucose in the blood stream is managed by the pancreas, which secretes different hormones (insulin and glucagon) to keep the levels in check.
Exercise promotes efficient use of insulin by the cells
The modern age, however, has seen an explosion in the varieties and amounts of sugar consumed by people. This, combined with increasingly sedentary lifestyles, is believed to be the major cause of the rise of type 2 diabetes that accounts for between 90-95% of all cases worldwide (the other types being type 1, an autoimmune disorder, and gestational diabetes, which affects pregnant women). The constant flood of sugar into our bodies leads to a state of insulin resistance. This process continues until the body can no longer regulate sugar levels adequately and diabetes sets in.
Left uncontrolled, type 2 diabetes can lead to increased risk of heart disease, stroke, kidney failure, blindness and loss of sensation to the extremities. In 2012 alone, 1.5 million deaths were directly attributed to this disease. Once believed to be a rich world problem, the prevalence of type 2 diabetes is rapidly growing in the lower income nations that include Bangladesh (WHO, 2015). Latest estimates put the number of diabetics in Bangladesh at around 7.1 million or approximately 8% of the adult population. Alarmingly, in line with the global trend, over 50% of those affected are unaware that they have the disease.
So what can be done? The good news is that according to the WHO, over 80% of type 2 diabetes is preventable. Maintaining a healthy weight, through good diet and regular exercise, is essential. It is advised that one should consume 2 fruits, and 5 or more multi-colored vegetables every day. Physical activity is also vital and every bit counts. We should aim for either 30 minutes of moderate exercise, like walking, jogging, and light aerobics, 5 times a week or more intensive exercise on fewer days. This can be challenging, especially in Bangladesh, but people need to aim to move more each day. Be creative – whether it be taking the stairs at work, or some light movements in the house.
Exercise promotes efficient use of insulin by the cells, therefore reducing the load on the pancreas. Aside from the cellular benefits, you will also feel better, perform better and your heart will thank you. Cut out all forms of tobacco – with one decision you will reduce the risk of diabetes, heart diseases, and many cancers. For those with diabetes, do not despair, good management of the condition can lead to a full life lived. All these measures, with the right medications, can keep blood sugar levels under control. If you do have diabetes, make sure to get regular check-ups to keep your condition well managed and screen for early signs of complications like eye problems or sensory changes in your feet and fingers.
The rise of diabetes and other chronic diseases highlight the impact that the environment plays on our health and how we are all becoming susceptible due to lifestyle choices. This is not clearly understood and we need to spread that message if we have any hopes of changing the future. A survey recently conducted by Telenor Health and Nielsen Bangladesh found that 66% of responders believed that they could not get diabetes. Interestingly the survey results also highlighted that understanding about the importance of physical activity was high among responders, but a lack of knowledge and time prevented them from participating in regular exercise. This is something we can work to change.
There is a growing coalition of public and private institutions across Bangladesh working toward this end. Private organizations like Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) and the Diabetes Association of Bangladesh (DAB) have been working for decades to raise awareness, provide screening and improve access to care for those with diabetes. Government bodies like the Bangladesh National Institute of Population Research and Training (NIPORT) have conducted nationwide population based studies focusing on awareness and treatment of diabetes and the Health Ministry is engaged in nationwide campaigns and working to expand essential services.
Bangladesh is a remarkable country that has shown the world that a lot can be achieved, especially in terms of health, with very little resources. In this regard there is much to be hopeful for. To really address the challenge of type 2 diabetes and other chronic diseases, we all need to work together. From Government, the private sector, NGOs to civil societies, we all have a role to play. On this World Diabetes Day, it is important for us to remember that small steps can lead to big changes. Through a collaborative effort, the people of Bangladesh can move the needle on diabetes too.