Weight loss is the key to control diabetes |
Dr Minati Adhikary
Diabetes is growing as an epidemic throughout the world, and the epidemic are seldom controlled unless their causes are addressed. Obesity is strongly and causally linked to diabetes mellitus. Recent data suggests that the prevention of diabetes is feasible if weight management is addressed adequately in individuals at high risk. Weight management also has the potential to make a significant impact in those with established diabetes.
The most common definition of obesity is a body mass index (BMI) greater than 30kg/m2. [BMI=weight in kg/(height in meter)2].
The overall prevalence of self reported diabetes in the United States has reached 7.3 per cent, 15 per cent in people over 60 years of age, driven by epidemic obesity. There is no room for complacency in Bangladesh.
In Bangladesh the prevalence of diabetes in age group above 30 years is estimated to be more than 2 per cent. Moreover obesity related diabetes in childhood, already common worldwide, has now reached Bangladesh.
How could we prevent diabetes?
In a prospective study of 84941 female nurses in UK followed for 16 years, a combination of five modifiable risk factors related to dietary behaviour, physical activity, weight, and cigarette smoking was identified that was associated with a remarkable 91 per cent reduction in the risk of developing diabetes. Even with a family history of diabetes the risk reduction was 88 per cent. Therefore, it is expected that, most diabetes could be preventable, largely irrespective of genetic background.
The mechanism of prevention of diabetes probably entails changes in both dietary behaviour and physical activity, for which weight loss is a surrogate indicator. Whatever the mechanism the message is that much could be done to prevent diabetes in individuals at high risk. If theory is to be put into practice in Bangladesh, however, where few general practitioners see a role for primary care in prevention of diabetes, a substantially increased awareness of risk factors such as obesity and impaired glucose tolerance is needed. A bigger obstacle still is that lifestyle and body weight are far from being voluntary control, and so prevention of diabetes requires sustained cultural change.
The success of diabetes prevention studies begs a controversial question: should we pit greater emphasis on weight loss for patients with new diabetes? The traditional dogma is that people with diabetes cannot loose weight and so this is futile. However the regular support of a dietitian, practical help with physical activity, and behavioural change at home and at work the central tenets of successful weight management is absent from diabetes care. Weight loss at least 5-10 per cent would be a logical goal, alongside standard glycaemic (normal level of glucose found in glucose) and cardiovascular targets, for many overweight people with diabetes. This would slow progression, reduce insulin requirements, allow withdrawal of treatment for some, and, most importantly, reduce mortality. Experience shows, however, that this is often beyond the reach of older patients; it may be more realistic for younger newly diagnosed patients, given appropriate support, and perhaps judicious use of anti-obesity drugs.
While the goal of a cure for diabetes remains some way off for most patients, prevention of diabetes and slowing of the natural history of the disease are clearly feasible. We should act on this important new evidence.
Dr Minati Adhikary is an Assistant Professor of department of Community Medicine, Comilla Medical College