Cities Are The Front Line In The Global Diabetes Epidemic

Cities Are the Front Line in the Global Diabetes Epidemic

Today, 437 million people worldwide have type 1 or type 2 diabetes. New estimates published this month show that three-quarters of a billion people could have the disease by 2045 — and cities are the front line of this challenge. As the growth fast becomes unmanageable for health systems, shortening the lives of millions of urban citizens and constraining economic growth, Novo Nordisk is working with a coalition of major cities to bend the curve on type 2 diabetes. We’re calling for local political and health leaders of all cities to ask what it will take to change the trajectory of the disease in their area and to put into practice the new models that we are forging.
A rapidly urbanizing world is changing not just where we live but also how we live. As my predecessor at Novo Nordisk wrote, the way cities are designed, built, and run creates health benefits for citizens — but critically it also creates risks. Towns and cities, where half of the world’s population now lives, are home to two-thirds of people with diabetes. That’s why when we initiated the Cities Changing Diabetes program in 2014, we set out to put a spotlight on urban diabetes. This effort has grown into a global partnership of nine major cities, home to over 75 million people, and over 100 expert partners united in the fight against urban diabetes.
Without concerted action, health systems around the world will reach a point in coming decades when they won’t be able to effectively treat patients sustainably. We conservatively estimate that the related costs of diabetes — including medication, su Continue reading

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Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring

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Continuous Glucose Monitoring Technology
Given the problems of exercise-associated disturbances in glycemia described earlier and the risk for hypoglycemia unawareness, frequent monitoring of glucose is essential for active individuals with type 1 diabetes. Most exercise-related guidelines recommend self-monitoring of blood glucose (SMBG) with capillary blood at least twice before exercise and every 30 min during the exercise as well as hours into recovery.2 This recommendation for frequent SMBG is difficult to adhere to for some, because it requires a pause in activity, a limitation that would be ameliorated with CGM. Moreover, a fear of exercise associated hypoglycemia is a major barrier to exercise participation in adults5 and in youth,6 and CGM might help increase self-efficacy during sport. Finally, CGM has the potential to assist active persons with diabetes by recording exercise-associated changes in blood glucose levels, and this information may be useful in developing appropriate insulin and carbohydrate modifications during times of increased activity. A brief overview of CGM technology is provided in the next section.
Continuous glucose monitoring devices have been available since the late 1990s and were developed for the measurement of interstitial glucose levels in subcutaneous tissue as a reflection of circulating glucose concentrations. The main components of CGM include a transcutaneous sensor inserted into the abdomen or arm, a transmitter, and a receiver that is typically worn on a belt or carried in a pocket. With this technology, the implanted sen Continue reading

3 Lessons Running 5Ks Has Taught Me About Living With Diabetes

In 2013, three years after I was diagnosed with type 2 diabetes, I was awarded a Fulbright grant that allowed me to live in the United Arab Emirates for that academic year. In addition to teaching and conducting research, my goal was to explore the country and break from my comfort zone.
By the time I signed up for the Dubai Women’s Run, I had already completed a variety of firsts. I rode a camel for the first time, drank camel’s milk, sandboarded in the desert, and visited the top of the world’s tallest skyscraper, the Burj Khalifa. I thought that a 5K race would fit well on this list.
When I finished my first 5K, I immediately developed a love for running. But surprisingly, this new interest wasn’t the result of a natural talent for racing. In fact, the only positive result from my first 5K was that I completed it within my goal time of 45 minutes. Aside from that, it was a classic example of what not to do in a 5K race: I hadn’t trained properly, I got caught up in the crowd’s excitement and lost my pace, I paid more attention to other runners than to myself, I exerted all my energy by the second kilometer, and, when I crossed the finish line, I fell to the ground in agony. I felt whipped, and every muscle in my body wept in unison with me.
Even as I lay in the grass in anguish, I knew that I had to do it again. I perceived the race as a living metaphor because I saw so many life lessons in that first race, especially as a person living with type 2 diabetes. I promised myself that I would train better, have the perfect music playlist, remember my earphones, p Continue reading

Canada Still Has A Chance To Reverse Its Diabetes Epidemic

Earlier this year I retired after a dozen years as president of Innovative Medicines Canada. Shortly after I took an assignment with the Canadian Diabetes Association and the opportunity to work on what is one of Canada's largest and most perplexing challenges: our diabetes epidemic.
For years public health authorities have been sounding the alarm. But the tone has become more urgent in recent years -- with terms like "burning platform" and "crisis" increasingly used.
Since 2000, the prevalence of diabetes has more than doubled. In the next 10 years, both prevalence and direct health-care costs for diabetes are projected to grow by more than 40 per cent.
In 2016, an estimated 29 per cent of Canada's population have either diabetes or prediabetes. The prevalence of diabetes in Canada is now slightly higher than in the United States. In fact, Canada has the second highest prevalence rates in recent study of 34 Organization for Economic Cooperation and Development (OECD) countries.
This is having a profound impact on the health of millions of Canadians, and costs our health-care system billions of dollars per year. In medical and human terms, the numbers are staggering:
Diabetes reduces the average lifespan by five to 15 years. It is estimated that one of 10 deaths in Canadian adults was attributable to diabetes in 2008-2009.
People with diabetes are over three times more likely to be hospitalized with cardiovascular disease, 12 times more likely to be hospitalized with end-stage renal disease and over 20 times more likely to be hospitalized for a non-traumatic lower limb ampu Continue reading

In India, diabetes is fast becoming a disease of the poor

Two years ago, 49-year-old Ramachandran, a resident of Kolkata, underwent a regular medical check-up and was told that he was pre-diabetic. Even though he changed his diet to control his blood sugar levels, after a year he found that he was losing weight unusually and that his vision was blurring.
“I was also feeling a burning sensation while passing urine,” he said. “I found minor cuts and bruises in my private parts.”
In September last year, Ramachandran was diagnosed with type 2 diabetes. Ramachandran is an engineer from a middle-income background. It is among people like Ramachandran that diabetes is on the rise.
Diabetes has long been a disease of affluence but small regional studies in recent years have indicated that, in India, it has been slowly spreading among lower income groups. However, an ongoing national survey of diabetes called the Indian Council of Medical Research – India Diabetes or simply ICMR-INDIAB study finds that many more people from middle-income and poor communities are becoming diabetic.
The ICMR-INDIAB study is the largest national representative of diabetes and includes data from more than 57,000 people across 15 states, both in rural and urban areas. The study represents 363·7 million people or 51% of India’s adult population. Similar previous studies have been only regional with small sample sizes, low response rates and with varied diagnostic criteria. For this study, the researchers considered each person’s bodyweight, height, waist circumference and blood pressure and used glucose tolerance tests to diagnose diabetes and pre Continue reading