The number of diabetics in the Philippines is increasing, and it is increasing at an alarming rate. The Diabetes Atlas Fourth Edition (2009), published by the International Diabetes Federation (IDF), puts the prevalence rate for diabetes in the Philippines at 6.7 per cent of the population which translates to 3.4 million out of 51 million adult population aged 20 – 79 years old.
In 2003, the national prevalence rate for diabetes was four percent, and that’s a big jump in the last five years, because that translates to over one million people who developed diabetes in a short period.
Meanwhile, the prevalence rate for impaired glucose tolerance (IGT) is a higher 9.6 per cent which translates to 4.8 million people more at risk of developing diabetes. IGT is an intermediate condition in the transition between normality and diabetes. It occurs when the blood sugar level of a person is higher than normal but below the level of a person with diabetes.
In the next 20 years, it is estimated that more than half of the adult population worldwide will have diabetes.
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
Type 1 diabetes (formerly called juvenile diabetes or insulin-dependent diabetes) is usually first diagnosed in children, teenagers, or young adults. It is an autoimmune disease characterized by the destruction of the insulin-producing cells in the pancreas. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.
Type 2 diabetes (formerly called adult-onset diabetes or noninsulin-dependent diabetes) is the most common form of diabetes. People can develop Type 2 diabetes at any age—even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.
The rising prevalence of Type 2 diabetes is associated with rapid cultural and social changes, ageing populations, increasing urbanization, dietary changes, reduced physical activity and other unhealthy lifestyle and behavioral patterns. Type 2 diabetes is also often, but not always, associated with obesity, which itself can cause insulin resistance and lead to elevated blood glucose levels.
Major Complications of Diabetes
Chronic elevation of blood glucose, even when no symptoms are present to alert the individual to the presence of diabetes, will eventually lead to tissue damage, with consequent, and often serious, disease.
IDF explained that while evidence of tissue damage can be found in many organ systems, it is the kidneys, eyes, peripheral nerves and vascular tree, which manifest the most significant, and sometimes fatal, diabetes complications.
Uncontrolled diabetes in children can result in stunted growth and adversely affect neurological development. Children are more sensitive to a lack of insulin than adults and are at a higher risk of a rapid and dramatic development of diabetic coma.
The IDF also said that the mechanism by which diabetes leads to complications is complex, and not yet fully understood, but involves the direct toxic effects of high glucose levels, along with the impact of elevated blood pressure, abnormal lipid levels and abnormalities of small blood vessels.
The following major chronic complications of diabetes:
Cardiovascular disease (CVD). It is the major cause of death in diabetes, accounting in most populations for 50 percent or more of all diabetes fatalities, and much disability. The kinds of CVD that accompany diabetes include angina, myocardial infarction (heart attack), stroke, peripheral artery disease, and congestive heart failure.
Nephropathy. Diabetes is an increasingly important cause of renal (kidney) failure, and indeed has now become the single most common cause of end stage renal disease, that will require either dialysis or kidney transplantation.
Neuropathy. When blood glucose and blood pressure are not controlled, diabetes can harm the nerves. Problems with digestion and urination, impotence, and many other functions can result, but the most commonly affected area is the feet and legs. Nerve damage in these areas is called peripheral neuropathy and could manifest in many ways including loss of feeling in the feet and toes. Loss of feeling is a particular risk because it can allow foot injuries to escape notice and treatment, leading to major infections and amputation.
Amputation. Through effects on peripheral nerves and arteries, diabetes can lead to foot ulceration, infection and the need for amputation. People with diabetes carry a risk of amputation that may be more than 25 times greater than that seen in those without diabetes.
Retinopathy. Diabetes can harm sight and cause blindness in several ways. The most common cause of blindness in diabetes is macular oedema, caused by fluid build-up behind the retina of the eye. A more common complication is background and proliferative retinopathy, which can cause blindness as a result of repeated haemorrhages at the back of the eye. Diabetes also increases the risk of cataracts and glaucoma.
In addition to the human suffering that diabetes-related complications cause, to those with diabetes but also to their carers, their economic costs are huge. Costs include those for healthcare, loss of earnings, and economic costs to the wider society in loss of productivity and associated lost opportunities for economic development.
Diabetes is a “double burden” for people in the lower income brackets. It is estimated that a Type 2 diabetic needs at least PhP 106 per day for maintenance drugs, assuming he/she buys the cheapest generic drugs. The patient also needs to spend about P1,000 more every two to three months for regular blood tests. And then there is the dialysis of at least twice a week, although the ideal is every other day, which ranges from PhP 2,000 to PhP 5,000 per session.
As the diabetic gets more complications, he/she will need more medicines. The daily minimum wage is not enough. And if only one member of the family is earning, that is easily a loss of at least P100 a day, he added.
No wonder, many families telling doctors that they would discontinue treatment or dialysis because they do not want to drain their resources anymore and that their patient would die anyway.
Type 2 diabetes usually develops among the middle-aged group, between 40 to 50 years old. Now, even high school students have Type 2 diabetes which was very rare before. Little physical activity among the youth, coupled with taking high-calorie diet from fastfood restaurants are to be blamed. Even among the poor, there is also malnutrition-related diabetes because of food they take that destroys the pancreas.