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World Diabetes Day - 14 November 2004: «Fight obesity prevent diabetes»

What is World Diabetes Day?

World Diabetes Day is the primary global campaign for raising awareness of diabetes. It aims to inform the public of the causes, symptoms, complications and treatment associated; with the condition. World Diabetes Day serves as an important reminder that the incidence and prevalence of diabetes is increasing all over the world and will continue to do so unless: action is taken immediately.

How did it all begin?

World Diabetes Day was introduced in 1991 in response to concern over the escalating incidence of diabetes around the world. Since then, it has grown in popularity every year and now brings together more than 350 million people worldwide, children and adults with and without diabetes, healthcare professionals, decision makers, and the media.

When does it take place?

World Diabetes Day is celebrated every year on 14 November. The date was chosen as it is the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in October 1921.

The World Diabetes Day logo

In 1996 a permanent logo was designed so as to create a strong, global identity for World Diabetes Day. The logo combines balance and teamwork and is based on the well-known Chinese symbol of Yin and Yang. A careful balance of medication, diet and physical activity is essential to diabetes management, as is cooperation between people with diabetes, their friends and families, healthcare professionals, and healthcare authorities.

How is it organized?

The International Diabetes Federation (IDF), supported by the World Health Organization (WHO), produces a variety of support materials for its member associations who in turn distribute them to people with diabetes and their families, the general public, healthcare professionals, the media, and local and national decision makers. Member associations use these materials, which include posters, leaflets, fact sheets, and audiovisual materials. to complement their own awareness-raising efforts and develop a World Diabetes Day campaign that best meets the needs of their respective communities. IDF material is also sent, on request, to other diabetes associations, hospitals, clinics, healthcare professionals, and iridividuals with an interest in diabetes. World Diabetes Day unites the international diabetes community to produce a powerful global voice for diabetes awareness.

Where does it take place?

All over the world! World Diabetes Day is celebrated by the member associations of the International Diabetes Federation in over 140 countries, as well as by healthcare professionals and individuals with an interest in diabetes.

Is there a special theme every year?

Yes, each year World Diabetes Day is centred on a unifying idea, a theme which is the focus of special attention. Topics covered in the past have included diabetes and human rights, diabetes and lifestyle, and the costs of diabetes. Since 2001 particular attention has been paid to diabetes complications. Recent and future themes include:

2002 Your Eyes and Diabetes: Don't lose sight of the risks
2003 Diabetes could cost you your kidneys:Act now !
2004 Fight Obesity Prevent Diabetes
2005 Diabetes and Foot Care

How is it celebrated?

IDF member associations develop an extensive range of activities which vary from country to country and which aim to inform, educate but also provide enjoyment. Everyone is welcome to join in! Here are some examples of activities that are organized every year:

• Radio and television shows
• Sports events
• Free screening tests for diabetes and its complications
• Marches
• Public information meetings
• Poster and leaflet campaigns
• Diabetes workshops and exhibitions
• Press conferences
• Newspaper and magazine articles
• Events for children and adolescents

The International Diabetes Federation

Founded in 1950 the International Diabetes Federation (IDF) works together with its member associations to enhance the lives of people with diabetes worldwide. IDF currently counts over 180 member associations in more than 140 countries. Its activities aim to raise awareness of diabetes and its related complications, improve the provision of and access to diabetes education, and promote quality standards of treatment and care around the worId. IDF is a non-governmental organization in official relations with theWorld Health Organization (WHO).

World Diabetes Day 2004 is focusing on overweight and obesity, one of the major risk factors for the development of type 2 diabetes. The goal of the campaign is to convey the message that simple and inexpensive life-style changes such as increased physical activity and healthier eating habits can be very effective in countering the serious human and social consequences that would result from a worsening of the diabetes epidemic.

Diabetes is an increasing global health threat.

In 2003, the International Diabetes Federation estimated that there were 194 million people with diabetes around the world.
By 2025 this figure is predicted to rise to 333 million, amounting to 6. 3% of the world's population living with diabetes. Diabetes is now the fourth leading cause of death in most developed countries.

This short booklet aims to raise awareness of the strong link between diabetes and obesity. An alarming rise in overweight and obesity is occurring worldwide and this is likely to drive the prevalence of diabetes even higher than current estimates suggest. Obesity is the main modifiable risk factor for 90% of all cases of diabetes. Levels of overweight are increasing dramatically among children, resulting in more and more childhood cases of type 2 diabetes, a condition that until recently affected primarily adults. The younger age of onset increases the risk of serious complications such as heart disease and blindness.

The result is an increased burden on health budgets and society as a whole. In many cases diabetes can be prevented, and various studies have shown that this can be done through simple lifestyle changes (healthier diets and increased physical activity) and education. It is possible to take action to slow the increasing epidemics of obesity and diabetes. This requires an integrated, international approach involving national health authorities, civil society, and the private sector.

What is diabetes?

Diabetes is a chronic condition that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin produced. Failure of insulin production, insulin action or both leads to raised glucose levels in the blood (hyperglycaemia).

There are two main types of diabetes:

Type 1: people with type I diabetes produce very little or no insulin and require injections of insulin to survive. It is the most common type in children and young adults.

Type 2: people with type 2 diabetes cannot use insulin effectively. They can manage their condition with lifestyle measures alone, but oral drugs are often required, and less frequently insulin.

The two major types of diabetes recognized are type 1 and type 2. A third type of diabetes develops during some cases of pregnancy but usually disappears afterwards.

Type 2 diabetes accounts for over 90% of diabetes cases worldwide.

Symptoms of diabetes

Commons symptoms of type I diabetes include:

• Excessive thirst
• Constant hunger
• Frequent urination
• Sudden weight loss
• Extreme tiredness
• Blurred vision

Almost 50% of people with type 2 diabetes are not aware that they have the condition.

People with type 2 diabetes may have the same symptoms but they may be less apparent. Many have no symptoms and are only diagnosed after several years with the condition.

Diabetes complications

Diabetes is a chronic, life-long condition that requires careful controLWithout proper management it can lead to hyperglycemia, which is associated with long-term damage to the body, and the failure of various organs and tissues.

Short and longterm complications of diabetes include:

•  Cardiovascular diseases (CVD) - Diseases of the circulatory system including those conditions affecting the heart and circulatory system. The most common manifestations of CVD include angina, heart attack, heart failure and stroke. CVD is the main cause of death among people with diabetes, and is the number one cause of death in industrialized countries.

Kidney disease (diabetic nephropathy) - Results from increasing amounts of protein in the urine and progresses slowly, eventually resulting in kidney failure. This usually occurs many years after the initial diagnosis of diabetes and can be delayed with tight blood pressure and blood glucose control. Diabetes has now become the most common cause of kidney failure, requiring dialysis or kidney transplantation, in most developed countries.

Numbness and loss of sensation in the feet is the most common sign of this, resulting from damage to the nerves of the legs. Neuropathy can sometimes lead to severe pain, but more often goes unnoticed. Even in the absence of symptoms, diabetic neuropathy results in a higher risk of foot ulceration and amputation.

Nerve disease (diabetic neuropathy) - Damage to the nerve fibres caused by The more risk factors an individual has, the greater their likelihood of developing type 2 diabetes.

Eye disease (retinopathy) - Damage to the blood vessels servicing the retina of the eye. Diabetes is the most common cause of blindness in people of working age in the developed world.

Risk factors for diabetes

Type 1

Both genetic and environmental influences appear to be important in the development of type I diabetes. Potential environmental triggers include viruses,toxins in the food chain and dietary components,though to date the involvement of these factors has not been proven in the majority of cases.

Type 2

• Overweight and obesity
• Physical inactivity
• High-fat and low-fibre diet
• Ethnicity
• Family history
• Age
• Low birth weight

The prevalence of type 2 diabetes increases rapidly with age, and people over the age of 45 are at higher risk of developing the condition. When age is accompanied by other risk factors for type 2 diabetes, the chances of developing the condition increases further.

What is Obesity?

Obesity results when the size or number of fat cells in a person's body increases. When a person gains weight, these fat cells first increase in size and later in number. Overweight and obesity can cause diabetes, and contribute to high blood pressure, high cholesterol, infertility, birth complications and arthritis. Obesity is largely preventable through changes in lifestyle, especially diet.

Obesity is most commonly assessed by a single measure, the Body Mass Index (BMI), which uses a mathematical formula based on a person's height and weight.

Waist circumference is also increasingly recognized as a simple means of identifying obesity. This measurement in combination with BMI has shown to be the best predictor of obesity and its associated health risks.

Risk factors for obesity

Obesity can affect anyone there are no defined absolute risk factors. However, certain groups of people are more likely to become obese. Risk factors include:

• High-fat, high-energy diets
• Sedentary lifestyle/physical inactivity
• Family history
• Ethnicity
• Age
• Stopping smoking

Diabetes and Obesity

The risk of developing diabetes increases progressively in both men and women with the amount of excess weight. The alarming increase in the worldwide prevalence of type 2 diabetes, particularly in developing countries, in minority groups, and in children, appears to be mainly related to overweight and obesity.

Obesity and type 2 diabetes, however, do not always go together. Not all of those who are overweight or obese will develop diabetes and not all of those with type 2 diabetes are obese. The likelihood of developing diabetes when overweight or obese depends on the interaction of a number of factors:

• How much overweight or obese a person is
• The level of abdominal fat
• The genetic predisposition to developing insulin resistance
• A person's insulin producing capacity

80% of people with type 2 diabetes are either overweight or obese.

Prevalence of obesity worldwide

Remarkable increases in obesity have occurred in both higher and lower income countries, particularly during the 1990's. Overweight and obesity now often affect an alarming 50-65 % of a nation's population, not only in the USA, Europe, and Australia, but also in countries as varied as Mexico, Egypt, and the black population of South Africa. The highest concentration of obesity is now found in some of the Pacific Islands, and in parts of the Middle East.

The rising levels of obesity worldwide are likely to drive the prevalence of diabetes even higher than present estimates, as these do not take into account changes in the obesity epidemic.

Urbanization will see more than half the world's population concentrated in cities by 2005, rising to more than 60% by 2020. The urban environment presents a barrier to physical activity, and creates a greater dependence on industrial food processes, dominated by foods high in fat, sugar and salt.

Reducing the risks

There are some indications that the like-lihood of a particular individual becoming obese may be reduced if the following modifiable risk factors are given attention:

• Adequate maternal nutrition during pregnancy
• Introducing a variety of tastes to infants after breast feeding
• Developing a taste for fruit and vegetable consumption early in life
• Encouraging physical activity during childhood
• Maintaining diets low in energy density

It has been shown that simple lifestyle interventions can reduce the risk of developing type 2 diabetes by as much as 60%. These include:

• Increased physical activity
• A healthy diet
• Weight loss

It is estimated that at least half of al] cases of diabetes would be eliminated if weight gain in adults could be prevented.

Treatment for Diabetes and Obesity

Weight management and physical activity are the true foundation of the treatment of type 2 diabetes. Most people with type 2 diabetes can lose 5-10% of their body weight if treatment is offered by a professional team consisting of a physician and dieticians or nurses. Increasing daily physical activity plays an important role in the maintenance of this weight loss.

Diet

Diet is a fundamental part of the treatment of diabetes. However, there is more to the management of diabetes than good nutrition.

Physical activity

Increased physical activity does not significantly affect the rate of early weight loss but it plays an important role in weight maintenance. Just 30mins of moderate physical activity (eg. walking) a day is enough to ensure good health. Types of diet suitable for weight loss and weight maintenance include:

• low-energy density diets
• low-fat diets
• low-carbohydrate diets

Medication

Weight loss drugs have a role in individuals in whom lifestyle changes are either not enough to produce the required weight control or are impossible to achieve because of physical incapacity. Drugs used for weight loss in the overweight and obese, with or without diabetes, may be classified into three categories:

• Drugs that shift nutrient metabolism
• Drugs that reduce food intake
• Drugs that increase energy expenditure

Other treatments

Stomach or Bariatric surgery is a very effective means to produce a longerlasting weight loss, and may be an option in severely obese individuals who find their weight very difficult to control with other weight management measures. Such operations, however, include a small but significant risk and therefore should only be considered
in very serious cases.

The Way Forward

The twin epidemics of diabetes and obesity already represent the biggest public health challenge of the 21 st century. It is no longer possible to rely only on management and prevention strategies that focus on the individual. Responses are required at the population level as well.

Since major changes in both physical inactivity and food explain the development of the obesity and diabetes crisis, rational measures to address both issues are needed. The epidemic of obesity and diabetes has developed in spite of decades of national and local efforts to emphasize the value of `balanced diets' and to stress the importance of moderate daily exercise. Health education should, therefore, also be designed to support other measures. These include:

• Providing children with a wide variety of physical activities.
• Appropriate urban environments that encourage healthy lifestyle habits for all.
• Teaching healthy eating habits and providing nutritious foods in schools.
• Monitoring the weight of children
• Food labelling.
• Smaller portion sizes.
• Lower prices for healthy foods.

It is important to establish strong national systems and partnerships that enable governments, civil society, and the private sector to evaluate and implement effective new policies. Given the epidemic of obesity and the increased incidence of diabetes that is likely to follow, systems to ensure annual monitoring of diabetes prevalence in populations should be established. It is already late, but a global effort can be made to transform diets, encourage less dependence on motorised transport, and promote efforts to restore physical activity into our daily lives.

The Time to Act is now !
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