The Epidemic of Diabetes
THE FACTS: An estimated 9 million Canadians have type 2 diabetes or pre diabetes (90%) or type 1 diabetes (approximately (10%). In Ontario, 1.1 million people contribute to this number representing approximately 8.3 % of the population. Those numbers are expected to reach 1.9 million in Ontario by 2020. Diabetes is the sixth leading cause of death in Ontario and a leading cause of blindness, kidney failure, leg amputation, heart disease and stroke as a result of the complications of diabetes. Simply being over age 40 puts you at an increased risk for the development of type 2 diabetes. Add to that being overweight, having poor eating habits with a sedentary lifestyle and you’ve just upped the ante and increased your risk for developing type 2 diabetes. In fact, we are seeing more and more children and young adults with this type of diabetes formerly only seen in older adults. This is also the first time in recorded history where our children may not have a longer life expectancy than their parents!
Contributed by: Annette Barnie RN, CDE, CPT
Manager/Coordinator, Diabetes Research
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital
And, did you know that people of South Asian, Asian, Aboriginal, Hispanic, or African descent are at particularly high risk for developing type 2 diabetes? Diabetes can indeed “run in families,” meaning that heredity often makes someone more likely to develop diabetes. Researchers believe that certain genes affecting insulin function can contribute to the development of type 2 diabetes and are present in high risk populations. While more men than women have diabetes, diabetes prevalence is greater in women in high risk populations. Of note the South Asian population is at a particularly high risk for developing type 2 diabetes. It is estimated that over 50% of type 2 diabetes could be prevented or delayed with healthier eating and increased physical activity!
A LOOK AT WHAT HAPPENS IN DIABETES:
If you do not have diabetes, your body gets energy by making glucose (sugar) from the foods you eat. Think here about all the foods you eat. All food including rice, potatoes, milk, bread, most vegetables etc. contain sugar not just the usual foods one would think of immediately like the usual suspects of dessert and fruit. The glucose can only get into the cells to be used if insulin is there. Insulin is a hormone produced by the pancreas that is present if you do not have diabetes. It acts like a key to open the cell door and let glucose in. It is a delicate balance of energy in versus energy out. If the scale between what goes in your mouth compared to how much energy you use in your everyday life through all activities (including a regular exercise routine) stays in balance, then you will maintain a steady weight.
If however that balance starts to tip in the direction of too much food in for what is needed for the energy used, then it is likely the person will start to gain weight. This unfortunately is what we are seeing in the general population with over 60% of Canadians being overweight or obese. This doesn’t necessarily mean that you will get type 2 diabetes; however it puts you at a much higher risk for its development especially if there is a family history of type 2 diabetes. Being overweight or obese makes it difficult for insulin to do its job because it makes your cells resistant to the insulin that your body makes. This means that some of the glucose will stay in your blood stream where it doesn’t belong. At this point, if you were tested, your doctor might tell you that you have “pre-diabetes” or “a touch of diabetes”.
What happens next is that eventually your pancreas cannot produce enough insulin at all. Almost all of the glucose will stay in your blood stream possibly starting to damage some of the organs in your body. Many people for example come into the hospital having had a heart attack and are diagnosed at the same time with diabetes not ever previously knowing that it was present. Instead they may have been feeling tired (no energy getting into the cells), going to the washroom more (the body is trying other ways to get rid of the excess glucose), dry mouth (because of going to the washroom more) or blurred vision (the fluid in the eye is attracting the excess glucose). Some people may not have noticed any of these symptoms because they have come on so gradually.
WHAT CAN BE DONE?
Your doctor may instruct you to try a period of “natural” treatment. That means a healthy diet, low in fat and with lots of fruits and vegetables along with regular exercise. Even a small amount of weight loss (e.g. 10 lbs) may be enough to reverse the process for a period. Unfortunately, however, type 2 diabetes is a progressive disease so your doctor may need to prescribe 1 or 2 anti-diabetes medications or even insulin to try and control your blood sugar in order to decrease any symptoms you may be having and to try to prevent the complications of diabetes.
ANOTHER OPTION?
All prescription medications (including things like aspirin and Tylenol for example) available today have gone through clinical research studies. Because of this research, we now have new, more effective treatments for hundreds of diseases including diabetes.
If you have diabetes and heart disease:
At Mount Sinai Hospital in Toronto under the supervision of Drs. Zinman and Retnakaran, we are currently recruiting for several diabetes studies. We have 3 studies for which we are recruiting people with type 2 diabetes who currently have heart disease. In two of these studies, the medications being assessed have already been approved by Health Canada and are being used to treat diabetes. In the third of these diabetes and heart studies, the medication is on its way to being approved. In all three studies, we are assessing whether the medication being studied has no unfavourable effects and possibly beneficial effects on the long term outcome of participants’ current heart disease.
If you have had diabetes less than 7 years:
Drs. Zinman and Retnakaran are also involved in one other study for which we are currently recruiting that is in a class of studies not yet discussed. That being; a new indication for an already approved drug. In this case, we are testing the ability of the medication liraglutide to possibly reverse type 2 diabetes! Armed with the information we have learned so far about liraglutide it is hoped that we may be able to regenerate beta cells in those people who have had type 2 diabetes less than 7 years. This is a very exciting prospect indeed and would be akin to the discovery of insulin itself!
You might ask yourself why someone would participate in a research study. The following are some of the reasons for participation that we have heard from our current and past research participants here at Mount Sinai Hospital in Toronto.
- They are not just doing if for themselves to see if there is a better treatment. They are often more interested in doing it for the next generation in their families. With the relative high heritability of type 2 diabetes in particular, they want their loved ones to possibly have a better life.
- They want to be on the “cutting edge” of care and gain access to potentially new treatments. By participating you may have a chance to receive a new therapy that is not available to the general public.
- Since research is more often done by specialists in the field, they want to have access to that care along with their current health care providers
- Participation gives them the opportunity to get a better understanding of their diabetes.
- Many participants feel they get very personalized care by participating in a research study.
- It gives you the opportunity to participate in breakthrough research that may aid the future understanding and care for others with your disorder and the knowledge that you are helping to advance medical science.
- You may be monitored more closely than normal follow up visits with your own doctor.
If you know of anyone who may be interested in participating in any of these studies and they live in the Toronto area, please have them call 416-586-8775 and they will be put in touch with the appropriate study personnel to find out more about participating in these very important studies.
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