WHEN it comes to diabetes it is the East and not the West where this disease is more widespread with the latest statistics showing that 8.8% of the Thai population have this ailment, Dr Thep Himathongkam, chairman and CEO of Theptarin Diabetes Center and Hospital said on Friday.
The highest total right now is in the Middle East while millions of people in both China and India also have this disease.
“This is due to genetics because the gene which helps people survive in times of food scarcity – a good gene – turns into a bad one when food supply is adequate and this leads to diabetes.
“In Asia it’s the same story – China, India and Thailand too because malnutrition ended not too long ago.”
However Dr Thep added that while people may be genetically prone to get this illness, environmental factors play a role in switching this gene on with the most important issues being food and exercise.
“Today people exercise very little while they consume high fat and high carbohydrate food, greater amounts of sweet things and sugary drinks which leads to becoming fat and this in turn spurs this gene which triggers insulin resistance.
“Insulin resistance is one of the causes of type two diabetes with another key reason being beta cells which produce insulin slowly dying.”
In 2002 a diabetic prevent program (DPP) study was conducted among a group of people who are in a state called impaired glucose tolerance, that is they are quite close to getting this disease but have not done so yet.
This group was divided into two with one being told to exercise by walking for half an hour five days a week and eat low-fat food with a target to lose 5% of their weight.
A follow up four years later showed that there were 58% fewer people who developed diabetes in the group that changed their behavior.
Dr Thep pointed out that this led to the term lifestyle change becoming important. However in preventing the onset of diabetes one has to scrutinize several factors with one important one being family history, whether parents and near relatives have this disease.
“The second is whether they are fat – what is their body mass index (BMI)?
“Third is whether they have high blood pressure because those with this condition tend to also develop diabetes as both illnesses emerge from the same gene.
“Fourth is to check triglyceride because if this is high and HDL cholesterol low, it is a sign of insulin resistance.
“With women we also check whether they got diabetes when they were pregnant, this is called GDM or gestational diabetes mellitus. Also whether they ever gave birth to a child weighing over 4 kilograms.”
These are the risks which could lead to the onset of diabetes, Dr Thep said, but people in this category can determine whether this disease is looming by challenging themselves with a test.
This test involves drinking a sugary drink, with the standardized amount being 75 grams of glucose, but doing a blood test both before and two hours afterwards.
If the result is over 200 then they have diabetes but if it is in the range of 140 to 200 then they are at impaired glucose tolerance (IGT) level.
Another way is to do a blood fasting test and if the result is over 100 but below 126 then people are at the impaired fasting glucose (IFG) level.
“However blood fasting is not very good, it’s best to drink glucose and then challenge.
“What happens is blood sugar rises after meal but people prefer blood fasting test so they don’t find out their true condition.
“If we can control post-meal sugar level to be in the range of 160 to 170 and not more than 180 then that is considered okay.”
Yet another indicator is hemoglobin A1c blood test with the result of normal people being in the range of 4 to 5 but if it is over 6.5 then you have diabetes. Dr Thep recommends that this test be done every two to three months to see how well diabetes is being controlled.
Those who are at the IGT or IFG level and have not yet got diabetes can prolong the period they are free of this disease by changing their lifestyle.
“Because once you get it you have to be strict with your food and the reason for this is to prevent complications.”
TOP: An image of a cartoon showing how people fear diabetes. Photo: Mark Doliner, CC-BY-2.0
INSET: Dr Thep says a glucose challenge test is better than blood fasting test.
By Nina Suebsukcharoen