Charmaine Gauci

t is estimated that at least 347 million people worldwide have diabetes.1 In 2004, an estimated 3.4 million people died from consequences of fasting high blood sugar. A similar number of deaths have been estimated for 2010.2 The published data for Malta through the International Diabetes Federation’s Diabetes Atlas estimate that the diabetes prevalence in Malta is 9.8% of the adult population, representing 29,900 people. The atlas forecasts a rise in prevalence to 11.6% of the adult population, representing 36,600 people by 2025.3 

There is strong evidence from randomised, controlled trials that lifestyle interventions incorporating diet and physical activity can prevent Type 2 diabetes in high risk individuals.4 The most dominant predictor for Type 2 diabetes prevention is weight loss. It is estimated that for every kilogram lost, it is associated with a 16% reduction in risk.5 A large trial in the United States has shown that lifestyle interventions including a low-fat diet, significantly reduced body weight, HbA1c and cardiovascular risk factors and these positive changes could be maintained over four years.6

Diabetes and the diet

Technical reviews on the evidence for the nutritional management of patients with diabetes indicate that the most important dietary advice to people with diabetes is to choose a healthy wellbalanced diet; with meals and snacks carefully planned to minimise changes in blood glucose concentrations. This can be achieved via the consumption of normal day-to-day foods. On the other hand, weight management should be the primary nutritional strategy in managing glucose control in Type 2 diabetes for people who are overweight or obese.

A person with diabetes needs to eat a varied, balanced diet based on the four food groups:

1. bread, cereals, wholemeal pasta, rice and potatoes;

2. fruit and vegetables – two portions of fruit and three portions of vegetables are recommended daily;

3. low fat milk, yoghurt and cheese; 4. low fat meat, fish, legumes, eggs and nuts

Diabetes and exercise

Being active is very important for everyone and especially for people who have diabetes. Physical activity has clear benefits on cardiovascular risk reduction and glycaemic control in people with Type 2 diabetes, with a meta-analysis reporting a mean weighted reduction of 0.45%7 to 0.65%8 in HbA1c. It is also recommended to perform moderate physical activity for at least 30 minutes five times a week. This can include going for brisk walks, using the stairs instead of the lift, and walking instead of using the car.

As a health provider you have a crucial role in encouraging your patient to lead a healthy lifestyle. Patients can consult the booklet ‘Id-dijabete u l-Ikel’ from the Health Promotion and Disease Prevention Directorate for further information.

References

1. Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011; 378(9785):31-40. 2. Global health risks. Mortality and burden of disease attributable to selected major risks. Geneva, World Health Organization, 2009. 3. International Diabetes Federation Atlas, 2006. Available from: http://www.idf.org/ diabetesatlas 4. Tuomilehto J, Lindstrom J, Eriksson JG et al. Prevention of Type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 2001; 344 (18):1343–50. 5. Hamman RF, Wing RR, Edelstein SL et al. Effect of weight loss with lifestyle intervention on the risk of diabetes. Diabetes Care 2006; 29 (9):2102–7. 6. Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with Type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010; 170(17):1566–75. 7. Conn VS, Hafdahl AR, Mehr DR et al. Metabolic effects of interventions to increase exercise in adults with Type 2 diabetes. Diabetologia 2007; 50:913-9211. 8. Nagi D, Gallen I. ABCD position statement on physical activity and exercise in diabetes. Pract Diab Int 2010; 27(4):158–63.