Diabetes mellitus is a disease which is characterized by
increased glucose levels in blood due to defect in insulin production,
insulin action or both.1 Diabetes
can be broadly classified as type 1 diabetes or Insulin Dependent Diabetes
Mellitus (IDDM), Type 2 diabetes or Non-Insulin Dependent Diabetes Mellitus
(NIDDM), gestational diabetes which may be developed during pregnancy in
females and other form of diabetes that result from specific genetic
conditions.1 IDDM is
caused when the immune system of the body kills the pancreatic β cells which
produces insulin and destroys them.1 NIDDM occurs due to
reduced ability of cells to utilize insulin.1 90% to 95% of all cases
diagnosed are of NIDDM.1
History
and Back ground information
Diabetes is a major health problem that has reached epidemic and
is growing at an alarming rate around the world.2 Approximately 347 million people
are living with diabetes.2 Low
and middle income countries accounts for more
than 80% of death due to diabetes.2 WHO
predicts that diabetes will become the 7th leading cause of death by the year
2030.2 Canada is the
third highest country with diabetes as compared to other countries in the
world.3
Figure
1. Prevalence† of diabetes among individuals aged 20 to 79
years, Europe, North America and Oceania, 2010
†
Standardized to the global population.
Source:
Public Health Agency of Canada (2011); adapted from Shaw JE, Sicree RA, Zimmet
PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diab
Res Clin Pract 2010;87:4-14.
In 2008/09, almost 2.4 million Canadians (6.8%)
were diabetics3 and
nearly 450,000 were living with undiagnosed diabetes.4 The
prevalence of diabetes has increased over a period of 11 years from 1998/99 to
2008/09 and if it continues to increase then the diabetics people will rise to
3.7 million bay 2018/19 representing 56% of the population.3
Figure 2. Age-standardized† prevalence and number
of cases of diagnosed diabetes among individuals aged one year and older,
Canada, 1998/99 to 2008/09
† Age-standardized to the 1991 Canadian population.
Source: Public Health Agency of Canada (July 2011); using 1998/99 to 2008/09 data from the Canadian Chronic Disease Surveillance System (Public Health Agency of Canada).
Risk Factors for Diabetes
Risk Factors for Diabetes
The rapid increase in urbanization with
the adoption of unhealthy food habits, obesity, sedentary lifestyle, lack
of physical exercise are major contributing factor for diabetes.4Additionally,
aging, family history of diabetes or belonging to certain ethnic group such as
aboriginal also results in diabetes.5Medical conditions such as
hypertension, metabolic syndrome, depression or schizophrenia are also
associated with developing diabetes.4All these factors impact the
economic, social, emotional and physical well being of
an individual thereby resulting in a public health problem.5 Females with gestational
diabetes are at risk of developing type 2 diabetes.4The causes for
type 1 diabetes are not known but it is hypothesized that genetic factors and
exposure to virus is responsible for causing it.4
Figure 3. Risk
factors for type 2 diabetes
· Frequent urination (polyuria)6
· Increased thirst (polydipsia)6
· Increased hunger (polyphagia)6
· Weight loss (type 1 diabetes)6
·
Tingling,pain or numbness in hands/feet(type2 diabetes)6
· Blurring of vision 6
Figure 4. Symptoms of diabetes
Source:Preventous(2014)
using exercise and diabetes available from:http://www.preventous.com/exercise-n-diabetes/2010/11/23/
Untreated
diabetes can result in life threatening complications such as heart,
kidney and eye diseases, nerve damage, depression and cause death.5 The risk of an individual dying with
diabetes is double than non-diabetics.2
Figure 5. Prevalence rate ratios† of
complications among hospitalized individuals‡ aged 20 years and
older, by diabetes status, Canada, 2008/09
† Rate ratios based on rates
age-standardized to the 1991 Canadian population.
‡ A person with diabetes hospitalized with more than one complication was
counted once in each category, except for cases of acute myocardial infarction,
where regardless of multiple counts in the acute myocardial infarction
category, the individual was counted only once under the broader ischemic heart
disease category.
Source: Public Health Agency of Canada (August 2011); using 2008/09 data from
the Canadian Chronic Disease Surveillance System (Public Health Agency of
Canada).
Current statistics
Figure 6. Prevalence of diagnosed diabetes among individuals aged one year and
older, by age group, Canada, 1998/99 to 2008/09
Source: Public Health Agency of Canada (July 2011);
using 1998/99 to 2008/09 data from the Canadian Chronic Disease Surveillance
System (Public Health Agency of Canada).
Descriptive Epidemiology
The Canadian population is aging due to baby boom
generation and is one of the major factor for contributing increase in the
cases of diabetes among Canadians.3 The ability of the body to produce
insulin reduces with the advancement in age thereby increasing the risk of
developing NIDDM.3 Recently,
diabetes incidence has increased from 127,608 in 1998/99 to 315,521 in 2008/09
between age group 60 to 64 years.3Additionally, due to advancement
in treatment and early diagnosis there is increased longevity and prevalence of
diabetics.3
The prevalence of diabetes has increased to 6.5%
in 2008/09 and particularly the prevalence has increased in males as compared
to females and amongst aboriginal as compared to non-aboriginal Canadians.3 It is estimated that the prevalence of
diabetes is fives more than the non-aboriginal population and they are at the
high risk population with diabetes.9
Figure 7. Prevalence of
diagnosed diabetes among individuals aged one year and older, by age group and
sex, Canada, 2008/09
Source: Public Health Agency of
Canada (July 2011); using 2008/09 data from the Canadian Chronic Disease
Surveillance System (Public Health Agency of Canada).
The prevalence of diabetes varies according to the province in
Canada such as Newfoundland and Labrador (11.1%), Nova Scotia (8.6%), New
Brunswick (8.6%) and Ontario (6.5%) has higher rates as compared to Alberta
(4.7%), British Columbia (5.0%) and the Northwest Territories (3.3%) 3.The diabetes rates were
at the national average in Prince Edward, Quebec, Manitoba, Saskatchewan and
Yukon 3.
Figure 8. Age-standardized† prevalence of diagnosed diabetes among
individuals aged one year and older, by province/territory, Canada, 2008/09
†
Age-standardized to the 1991 Canadian population.
Source:
Public Health Agency of Canada (Septermber 2011); using 2008/09 data from the
Canadian Chronic Disease Surveillance System (Public Health Agency of Canada).
Mobilization
of resources and personal
1) Canadian Diabetes Association is a community based organisation
which is helping the people to fight against diabetes by providing educational
resources about prevention, early diagnosis and management of diabetes. 7The
organisation also conducts several campaigns to create awareness about diabetes
and also improves access of services to support people.7 The
website is a good source of online information about diabetes and its
management.7
2) National Collaborating Centre for Aboriginal Health is an
organisation which is promoting aboriginal vision health to promote the yearly
eye examination amongst the aboriginal people with diabetes so as to reduce the
loss of vision in aboriginal as compared to non-aboriginal people.8
3) Canadian Diabetes Strategy
(CDS) supports several programs with federal grants such as Canadian Diabetes
Association:transforming Materials for people with diabetes, Healthy Feet and
You, Hypertension Canada "Getting to the heart of the Matter" to
educate and reduce diabetes among Canadians.12Moreover, CDS in
collaboration with Aboriginal
Diabetes Initiative strategy focuses in improving the health of the aboriginal
people by increasing access to nutritional food, promoting physical activity,
early detection by screening the people, increasing awareness about prevention
by knowledge transfer.9
4) Canadian Diabetes Care guide
also provides extensive information about managing diabetes amongst the
population.10
Treatment
of Diabetes
The
day to day management is imperative to keep the blood glucose level in control.11
Non medicinal treatment of diabetes could be accomplished by doing regular
exercise such as brisk walking for at least 30 minutes, weight control, stress
management and monitoring the blood glucose level using glucometer.11
Medicinal treatment includes administering insulin therapy by using insulin pumps
in IDDM and using medications prescribed by the physician which helps in
reducing the blood glucose levels in blood in NIDDM.11Sometimes a combination
of medication along with insulin is used.11
Figure 9. Management of diabetes
Source:Sdpathaniashealthyliving using diabetes
hypoglycemia Available from: http://sdpathaniashealthyliving.blogspot.ca/2013/03/hypoglycemia-in-diabetics.html
