Written by Dr Muthuswamy Balasubramanyam | Dean of Research Studies and Senior Scientist, Madras Diabetes Research Foundation, Chennai, India
In 2017, the International Diabetes Federation (IDF)1 reported that 425 million adults have diabetes worldwide, and India alone has 73 million adults with diabetes. The prevalence of diabetes is already a significant cause for concern today and projections suggest it will escalate year by year. What can we do to stop this? Focus on family: family is the key for the detection, prevention, and management of diabetes. For example, the theme for World Diabetes Day 2018 and 2019 is ‘The Family and Diabetes’, with an underlying message that diabetes concerns every family.
Background of World Diabetes Day2
The 14th November is globally observed as World Diabetes Day, aimed at raising diabetes awareness and calling for urgent action to tackle the diabetes epidemic. The date was chosen because it marks the birthday of Frederick Banting, who, along with Charles Best, is recognised for the discovery of insulin. World Diabetes Day was created in 1991 by the IDF and the World Health Organization (WHO) in response to growing concerns about the escalating health threat that diabetes posed. World Diabetes Day became an official United Nations (UN) Day in 2007 with the passage of a UN resolution. This landmark resolution also recognised diabetes as “…a chronic, debilitating, and costly disease associated with major complications that pose severe risks for families, countries, and the entire world.”3 Until 2006, there was no global symbol for diabetes. A blue circle logo is now the universal symbol for diabetes and was adopted in 2007 following passage of the UN World Diabetes Day resolution. The blue circle signifies the unity of the global diabetes community in response to the diabetes pandemic. In recent years, blue lights have been added to monuments and buildings as a part of World Diabetes Day activities all over the world.
Focus on Family
Since 1991, each year World Diabetes Day has been centred on a theme related to diabetes. The theme for World Diabetes Day 2018 and 2019 is ‘The Family and Diabetes’. A 2-year timeframe has been chosen to best facilitate the two aims through vigorous public campaigns: a) To raise awareness of the impact that diabetes has on the family and support network of those affected, and b) To promote the role of the family in the management, care, prevention, and education of diabetes.
Diabetes imposes life-long demands on people with the disease, requiring them to make multiple decisions related to managing their condition. People with diabetes need to monitor their blood glucose, take medication, exercise regularly, and adjust their eating habits. Without diabetes education and family support, people with diabetes are less prepared to take informed decisions, make behavioural changes, and address the psychosocial issues presented by diabetes, and, ultimately, may be ill-equipped to manage their diabetes effectively. Poor management will result in reduced health outcomes and an increased likelihood of developing diabetic complications. Type 2 diabetes mellitus is largely preventable through regular physical activity, a healthy and balanced diet, and the promotion of healthy living environments. Thus, families have a key role to play in addressing the modifiable risk factors for Type 2 diabetes mellitus and must be provided with the education, resources, and environments to live a healthy lifestyle.
Diabetes Prevention: Focus on the Mother
While the focus worldwide is to prevent diabetes, one way to do this is to take care of women during pregnancy. Transient diabetes occurs in certain women during pregnancy, known as gestational diabetes mellitus (GDM). The prevalence of GDM is increasing worldwide, especially in developing countries. In India, the prevalence of GDM is as high as 20%.4 It is crucial to detect women with GDM because the condition is associated with diverse range of adverse maternal and neonatal outcomes, i.e., a health burden not only to the mother but also to the offspring at a later stage of life. In addition, having a history of GDM puts the mother at risk of the development of Type 2 diabetes mellitus or recurrent GDM. Therefore, taking care of the mother during pregnancy and continuing appropriate medical care in the postnatal period may prevent diabetes in the mother and also prevent diabetes development in the offspring at a later stage. Diabetes is a family issue, indeed.
Diabetes-alerting dogs (DAD) can rescue diabetic patients and offer day and night service. It may be hard to believe but the evidence available in the current scientific literature5 attests that DADs have a high-calibre sniffing efficiency for warning owners of episodes of hypoglycaemia (low glucose in the blood) or hyperglycaemia (high glucose in the blood), during the day and night, with high sensitivity and specificity. The dog was the first animal to be domesticated by humans and is now universally regarded as ‘man’s best friend’. In the world we live in today, dogs are part of our families. The olfactory system of the dog has the capacity to detect even negligible amounts of volatile organic compounds (VOC) and this can be exploited to detect changes in the breath or sweat of the diabetic patients according to the extent of potentially dangerous variations of blood glucose concentrations. The most frequent dog alert behaviours are vocalisations, licking, staring intently at their owner’s face, nuzzling, or jumping. Awareness of glucose variations is more important for diabetic patients during the night, when they can experience low glucose levels and become helpless. At a time when World Diabetes Day is focussed on family support, let’s have a buy one – get one free approach: buy a pet dog and train it to become a diabetes-alerting family member.
Health Assurance by Family
Parents have a huge influence on the long-term health status of their children. For instance, research6 has shown that when mothers are granted greater control over resources, they allocate more to food, children’s health and nutrition, and education. Parents, or a parent, are often the gatekeepers of household nutrition and lifestyle habits and, therefore, have the potential to drive diabetes prevention from the household and beyond. Thus, by choosing healthy food choices and parental care, parents can prevent their child from becoming obese and thereby preventing diabetes. Therefore, diabetes prevention is in your parents’ hands and family is, therefore, important in diabetes prevention as well as management.
Treat the Diabetic Patient but Train the Family Too!
Recent reports2 have implied that one in two people currently living with Type 2 diabetes mellitus are undiagnosed. Most families are affected by diabetes and so awareness of the signs, symptoms, and risk factors for all types of diabetes is vital to help detect the condition early. Diabetes can be expensive for the individual and their family. In many countries, the cost of insulin injections and daily monitoring alone can consume half of a family’s average disposable income7, and regular and affordable access to essential diabetes medicines is out of reach for too many. Improving access to affordable diabetes medicines and care is, therefore, urgent to avoid increased costs for the individual and their family, which can impact health outcomes. While family support in diabetes care has been shown to have a substantial effect on improving health outcomes for people with diabetes, less than one in four family members have access to diabetes education programmes.2 Patient and family-centred care is an approach to the planning, delivery, and evaluation of healthcare that is grounded by mutually beneficial partnerships among healthcare providers, patients, and families. So, the message is clear: treat the diabetic patient but train the family too to achieve ideal health benefits.
- International Diabetes Federation, IDF Diabetes Atlas 2017, 8th Edition, Brussels, Belgium.
- International Diabetes Federation. WDD 2018-19. Available at: https://www.worlddiabetesday.org/about-wdd/wdd-2018-19.html. Last accessed: 19 November 2018.
- United Nations. Resolution A/RES/61/225. Available at: http://undocs.org/A/RES/61/225. Last accessed: 20 November 2018.
- Seshiah V et al. Prevalence of gestational diabetes mellitusin South India (Tamil Nadu)–A community based study. J Assoc Physicians India.2008;56:329-33.
- Lippi G et al. Hypoglycemia alert dogs: A novel, cost-effective approach for diabetes monitoring? Altern Ther Health Med.2016;22(6):14-18.
- Pratley P. Associations between quantitative measures of women’s empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world. Soc Sci Med.2016;169:119-31.
- Diabetes Research and Wellness Foundation. Affordable medicines and care needed “urgently” to help prevent families facing poverty over diabetes. Available at: www.drwf.org.uk/news-and-events/news/affordable-medicines-and-care-needed-“urgently”-help-prevent-families-facing. Last accessed: 21 November 2018.