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Diabetes a developing-world
epidemic

After heart disease, diabetes is the most rapidly

developing disease on our planet. 382 million adults are
living with diabetes and it is estimated that the number
will increase by another 200 million by the year 2035.
Unfortunately, like heart disease, diabetes is
increasing fastest in the developing world; in Africa, Asia
and South America.
The main causes are rapid urbanisation, economic
growth and changes in dietary habits, largely because
we are eating more calories and our overall quality of
diet has declined.

60% of South Africans are

overweight or obese

The consumption and quality of dietary fats and

carbohydrates have been critical in causing the
phenomenal rise in obesity, which is the commonest
reason for the increase in diabetes. At the same time,
diets rich in whole grains, fruits, legumes (e.g. peas,
beans, lentils) and nuts have reduced. Take for example
South Africa. A recent, shocking study has revealed that
seven out of ten women are overweight, and so are four
out of ten men. 60% of the SA population is overweight
or obese. This is almost double the global rate according
to a study published in the Lancet (2011), a leading
medical journal.

Understanding Type 1 and Type II

diabetes

Type 1 (previously known as juvenile onset) is

principally a result of the lack of insulin in the body.
Various causes for the destruction of the organ that
produces insulin (the pancreas) have been postulated
and several breakthrough research studies are near
completion. These herald possible vaccines and other
exciting treatment developments.
However the escalation in diabetes is not Type 1 but
what is now termed adult onset (Type II) diabetes. This is
a result of an obesogenic diet, weight gain and lack of
exercise.
Insulin is the key that unlocks the cells in the body,
permitting glucose (the energy molecule) to enter and
provide the energy required for all living cells. If insulin is
lacking (Type 1) or insulin resistance occurs (Type II) the

By Professor Kiran Bhagat,

Heart Foundation of Botswana

cells, tissues, organs and ultimately the body suffer. The

irony is that large amounts of sugar are circulating in the
blood but cannot enter the cellular structures because
of insulin resistance. So death of tissues occurs amidst
plenty!

The management of Type 1

diabetes is always insulin based.
Tablets do not work

The management of Type II however is principally

a radical change in diet, weight loss and exercise. Its
important to change the food you eat, leaning more
heavily on whole grains, fruits, vegetables, legumes and
nuts. A reduction in alcohol, refined grains (processed
starch), red or processed meat and sugar-sweetened
drinks has been shown to remarkably reduce the
complications of diabetes and improve blood glucose
in some situations. Lifestyle changes need to be
co-managed with the use of oral medication and
occasionally with insulin injections.

How to address the diabetes

problem?

This serious epidemic requires global public

health policies that create healthy food environments
and promote corporate social responsibility. Potential
strategies include nutrition and agricultural policies that
favour the production and distribution of healthy food.
The accessibility and affordability of fruits, vegetables,
whole grains, legumes and nuts need to be increased.
Higher taxes on sugar-sweetened drinks and other
unhealthy products may also reduce consumption of
these toxic foods and improve overall diet quality. Finally,
the standardisation of packaging nutrition
labels and nutrition facts in conjunction
with public health campaigns and sound
agricultural and food policies could
reshape this escalating epidemic. We
must not remain idle!

The Heart Foundation of Botswana is

committed to Educating, Enabling,
Engaging and Empowering Botswana
on lifestyle management in the
prevention of lifestyle diseases.

page 11 H&D magazine