Do you have diabetes? This is no idle question. The disease is common and dangerous. Roughly half of those who have it don't know it. What's more, the number of people with diabetes has skyrocketed in recent decades, leaving at least one person out of 20 affected in most countries. In the United States, there were 12 to 16 million people with diabetes in 1997, compared to 2 or 3 million in 1960. In Jamaica, 18 percent of all adults are now affected. In Mexico City, the number exceeds 14 percent.
These high rates make diabetes more than a sporadic villain striking occasional victims. Even if you don't have it now, you could get it in the future, and you probably already have a friend or relative with diabetes. So clearly, this is no obscure peril but a major public health problem that in one way or another affects us all.
If you have diabetes, you probably have some of these telltale symptoms: sporadic tingling or numbness in the hands or feet, frequent urination, unusual hunger, small brown scaly patches on your skin, and recurrent skin or vaginal infections. More severe signs include blurred vision, sudden weight loss, and unexplained weakness, fatigue, or lethargy.
Many people with some of the less alarming symptoms ignore them. The signs may have come on slowly, and so may have seemed like a natural part of the aging process. It's also possible that the affected person simply failed to recognize the symptoms or was in denial.
Whatever the reason, ignoring signs that suggest diabetes is risky business. Diabetes is no minor troublemaker but a really bad actor whose cumulative damage often sets the stage for amputations, blindness, kidney failure, heart disease, stroke, and death. Indeed, diabetes currently kills about two-thirds as many U.S. women as breast cancer and has become the Western Hemisphere's sixth leading cause of death.
Anyone who suspects diabetes should have these suspicions checked out by a health worker trained to diagnose the disease and qualified to recommend effective treatment. Many ways exist to cope with diabetes and to minimize its harm. The key is early diagnosis and sound treatment.
Just as some people have done, nations of the Americas also have occasionally slipped into denial over the large-scale impact of diabetes. But now the problem has grown too serious and costly to ignore: an estimated 30 million people in this Region have the disease-more than a quarter of the world's total number of cases. This knowledge is spurring many governments to act.
What Diabetes Is
Diabetes arises from lack of insulin-a chemical produced by the pancreas-or from the body's failure to respond to insulin. Insulin removes sugar from the blood and helps transfer it to the tissues. So failure to make or properly use insulin creates excess sugar in the blood. In turn, the excess sugar does cumulative harm, mostly by damaging blood vessels, that can lead to blindness, stroke, or other disasters.
Although there is really one problem-high blood sugar levels-there are two kinds of diabetes-Type I and Type II. Type I, which often develops in childhood and usually before age 20, occurs because the pancreas is making little or no insulin. Unless the victim receives frequent insulin injections, the disease typically runs a severe and fatal course. In contrast, Type II diabetes develops later, typically after age 40, mostly in overweight sedentary people whose tissues no longer respond well to insulin. Type II, which accounts for roughly 90 percent of all diabetes cases in the Americas, can prove just as crippling and fatal as Type I and can also progress to a point where the patient needs to inject insulin. However, most people with Type II diabetes can manage their disease by following professional guidance on weight loss, diet, and exercise. Medicines that stimulate insulin production and assist the body's efforts to use insulin can also help.
The Diabetes Profile Changes
In the distant past, developing countries typically saw few diabetes cases. That's because many Type I cases never got diagnosed or were diagnosed too late. Type II diabetes was also scarce-since most people lived in rural areas, rarely overate, did lots of physical work, and died relatively young. So health officials in developing countries tended to ignore diabetes in favor of more obvious and pressing needs.
What changed all this was social progress. As the countries of the Americas have advanced toward urbanized modernity, increasing numbers of the population have come to experience the consequences of being less active, overfed, older, and overweight. Since these circumstances promote Type II diabetes, a rising tide of Type II is now sweeping through most Latin American and Caribbean countries, abetted by genetic or other factors that seem to make persons of African descent or east Indian origin, and certain indigenous populations, especially prone to the disease.
Indeed, scattered data from a number of Latin American and Caribbean countries suggest urban or even national diabetes rates equaling or exceeding the fast-rising rates of developed countries such as the United States and Canada. Obviously, the problem has come of age.
The Americas Respond
In response, national concern has been rising. Mexico's health ministry made diabetes prevention and control its number-one chronic disease target in 1995; Chile and Bolivia have undertaken major diabetes surveys; and in one way or another most of the Hemisphere's other countries have shown a growing willingness to take major action.
They have also shown a desire to work together. In August 1996, at a meeting sponsored by the Pan American Health Organization (PAHO) and the International Diabetes Federation (IDF) in San Juan, Puerto Rico, representatives of 29 countries adopted the Declaration of the Americas on Diabetes. This statement pointed up the problem's severity, noted that all nations could improve and strengthen their approach to the diabetes challenge, and presented a strategic plan of action to guide the work of governments.
The Declaration was kept broadly worded, partly because the diabetes problems of the countries vary greatly and the aim was to allow each country to design its own response in a way that would reflect available resources and technical capacity. On the other hand, the Declaration broke new ground: for the first time, virtually all health ministries of the Americas recognized diabetes as a priority regional public health concern.
In September 1996, PAHO's Directing Council, its highest governing body, acknowledged the Declaration and emphasized that the Hemispheric scope of the diabetes problem requires a collective response. Since then, PAHO has been helping individual countries set priorities tailored to their specific needs, and a secretariat separate from PAHO and the IDF, with its own program manager, newsletter, and Web page, has been established. Also, major planning workshops for South America and the Caribbean have been held, a working group on diabetes education has been created, minimum essential goals for developing national programs have been established, and a baseline assessment of where each country is has been completed. According to Dr. Franklin White, coordinator of PAHO's noncommunicable diseases program, "Watching the process unfold is pretty exciting. We are seeing a lot of action."
The highest diabetes rates in the Americas are found in the Caribbean, where rapid cultural changes in diet and lifestyle have led diabetes and other chronic conditions to replace nutritional deficiencies and infectious diseases as major causes of death. Here, as elsewhere in the world, diet is the cornerstone to successful diabetes management. Treatment must be individualized, taking into account the person's age, duration of diabetes, lifestyle, food preferences, and finances.
One fact emerging from the baseline assessment is that 45 percent of the countries have now developed national diabetes strategies, and many more are well on their way. These are not empty exercises. In each case it means that government health officials have tried to examine diabetes as a public health problem, and as Dr. White points out, a country with a national strategy is much more likely to have the people and budget in place and specific goals in mind.
This increased willingness to tackle diabetes is founded upon a conviction that there is a light at the end of the tunnel. As Dr. White explains, while "the problem is big and getting bigger, the evidence that you can do something about it has also improved enormously."
Knowledge Is Power
For starters, we know that monitoring and controlling blood sugar levels better reduces complications. This applies across the board-to those with Type I injecting insulin as well as those with Type II who are mostly managing the disease through diet and exercise. We know the effect is strong, ideally cutting the rate of complications from diabetes roughly in half. And we know that virtually anything that improves monitoring and control improves the picture.
We also know that those who have diabetes tend to do poorly if they fail to understand their condition, or see it as strictly a medical problem, thereby placing exclusive responsibility for its management in the hands of a health worker or physician. On the other hand, according to Dr. White, "the more the effort is shifted toward education of the individual and self-management, the more successful the outcome seems to be. So we can see that metabolic [blood sugar] control is critical to prevention of complications, and that the most critical factor there is patient education."
More broadly, we have learned that proper exercise and weight control will help prevent emergence of diabetes in people with high blood sugar levels short of diabetes who could easily progress to it. And we already know exercise and weight control can prevent or reduce major health problems like heart disease, stroke, and kidney failure that affect millions of people without diabetes. So lowering the risk of diabetes also lowers other risks; and the broad goal is not just to help manage diabetes but promote healthier lifestyles overall that will have long-ranging effects for modern living.
Seen this way, the budding national and Hemispheric efforts to cope with diabetes have vast importance. Not only are many of us, our friends, and our family members affected by diabetes. Not only are many others at risk. But the stealthy cause of most cases is a lifestyle that seems innocuous until the diagnosis of diabetes is pronounced. There is thus a clear message for people and communities everywhere. And so, to the extent the new national and international measures directed against diabetes prove effective, they seem likely to benefit us all.
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2006-07-13 04:44:29
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answer #1
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answered by mohnish 2
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