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I will pick up where I left off last week. There is much that can be done to prevent or delay diabetes even if you have the risk factors. The World Health Organization (WHO) estimated that 422 million adults were living with diabetes in 2014, compared with 108 million in 1980. The global prevalence of diabetes has almost doubled since 1980, from 4.7% to 8, 5% in the adult population. This reflects an increase in associated risk factors, such as being overweight or obese.
Over the past decade, the prevalence of diabetes has increased faster in low- and middle-income countries than in high-income countries. Diabetes caused 1.5 million deaths in 2012. A higher-than-optimal blood glucose level caused an additional 2.2 million deaths, increasing the risks of cardiovascular and other diseases.
Diabetes of all types can cause complications in many parts of the body and can increase the overall risk of premature death. Possible complications include heart attack, stroke, kidney failure, amputation of a leg, loss of vision and nerve damage. During pregnancy, poorly controlled diabetes increases the risk of stillbirth and other complications. Diabetes and its complications cause substantial economic losses for people with diabetes and their families, and for health systems and national economies through direct medical costs and loss of jobs and wages. .
About 90-95% of diabetes is type 2 diabetes mellitus. Type 1 diabetes cannot be prevented with current knowledge (American Diabetic Association, Standards of Care 2019). There are effective approaches available to prevent type 2 diabetes and prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across entire populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes. This includes exercising regularly, eating healthy, avoiding smoking, and controlling blood pressure and lipids.
Tests for prediabetes and type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI less than or equal to 25 kg / m2 or greater than or equal to 23 kg / m2) and who have one or more factors Additional risk factors for diabetes (eg, family history, high cholesterol, black, high blood pressure). For all people, testing must begin at the age of 45. If the tests are normal, it is reasonable to repeat the tests performed with a minimum of 3 year intervals. In patients with prediabetes and type 2 diabetes, the primary care provider should identify and, if appropriate, treat other risk factors for cardiovascular disease. Risk-based screening for prediabetes and / or type 2 diabetes should be considered after the onset of puberty or after 10 years of age, whichever occurs earlier, in children and adolescents who are overweight / obese and have risk factors additional diabetes.
Diabetes and prediabetes can be assessed based on plasma glucose criteria, either the fasting blood glucose (FBG) value or the 2-hour blood glucose (2-hour PG) during an oral tolerance test. to 75 g glucose (OGTT), or glycosylated hemoglobin (HbA1C). Unless there is a clear clinical diagnosis based on obvious signs of hyperglycemia (eg, excessive thirst, frequent urination), the diagnosis requires two abnormal results from the same sample or on two separate test samples. If patients have test results near the diagnostic threshold margins, the healthcare professional should follow the patient closely and repeat the test in 3-6 months.
“Prediabetes” is the term used for people whose glucose levels do not meet the criteria for diabetes, but are too high to be considered normal (HBA1c 5.7-6.4%, fasting blood glucose 5, 6-6.9 mmol / L, oral glucose tolerance test 7.8-11.0 mmol / L).
Prediabetes should not be viewed as a clinical entity in its own right, but rather as an increased risk of diabetes and cardiovascular disease (CVD). Looking at the numbers, the primary care provider can do a lot to reduce the burden of diabetes on the community, society, and the nation as a whole.
Patients with prediabetes should receive an intensive behavioral lifestyle intervention program to achieve and maintain a 7% loss of baseline body weight and increase moderate intensity physical activity (such as brisk walking) to at least 150 min / week, diet therapy.
Several large randomized controlled trials, including the Diabetes Prevention Program (DPP), have shown that intensive lifestyle intervention can reduce the incidence of type 2 diabetes. In the DPP, the incidence of diabetes was reduced by one 58% for 3 years. Follow-up in the diabetes prevention program outcome study has shown a sustained reduction in the rate of conversion to type 2 diabetes of 34% at 10 years and 27% at 15 years. The 7% DPP weight loss goal was selected because it was feasible to achieve and maintain and would likely decrease the risk of developing diabetes.
Structured behavioral weight loss therapy, which includes a reduced calorie meal plan and physical activity, is of utmost importance for people at high risk of developing type 2 diabetes who are overweight or obese. In this, our cocoa stands out around the world as top quality. The quality standard against which all other cocoa produced is measured meets the requirements. .
The ADA indicates therapy with metformin for the prevention of type 2 diabetes in people with prediabetes, especially those with a BMI greater than or equal to 35 kg / m2, those aged 60 years, and women with prior gestational diabetes mellitus (GDM). Metformin has the strongest evidence base and has been shown to be safe in the long term as a drug therapy for the prevention of diabetes. Prediabetes is associated with an increased cardiovascular risk. The ADA advocates for the detection and treatment of modifiable risk factors for cardiovascular disease (eg, high blood pressure, high cholesterol levels). People with prediabetes often have other cardiovascular risk factors, such as hypertension and dyslipidemia, and are at increased risk for CVD.
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Although the treatment goals for people with prediabetes are the same as for the general population, more vigilance is warranted to identify and treat these and other cardiovascular risk factors early.
Regarding the implications of prediabetes, the regular / daily early consumption of cocoa rich in polyphenols has a great role, since it contains significant amounts of fatty acids (oleic and stearic acid in a much higher percentage), carbohydrates (low caloric content ), proteins, vitamins, minerals, fiber and polyphenols. Cocoa is the richest in polyphenols by weight. Polyphenols are notable antioxidants. These polyphenols have been found to be very beneficial in enhancing the secretion of insulin by the beta cells of the pancreas, improving the absorption of glucose by the cells and improving the sensitivity of the cells to insulin. They have also shown intestinal effects by enhancing signals to beta cells for insulin secretion in sync with the presence of food in the stomach. In addition, polyphenolic cocoa gives a feeling of fullness after ingestion despite its low calorie content, which makes it easier for prediabetics and diabetics to adhere to dietary plans.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
CACAO CLINIC
