Advanced Nutrition and Dietetics in Diabetes

Louise Goff, Pamela Dyson, Louise Goff, Pamela Dyson

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781119121718
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Published on behalf of The British Dietetic Association, Advanced Nutrition and Dietetics in Diabetes is an exploration of the evidence and practice of nutrition in diabetes, offering a global view of the lifestyle interventions for the prevention and management of diabetes, including management of complications and special population groups. With internationally recognised authors, this book applies the rigour of evidence-based medicine to important enduring topics in diabetes, such as:

• public health efforts at diabetes prevention
• formulating nutritional guidelines for diabetes
• carbohydrates and the glycaemic index
• the management of diabetes in older people

The authors draw on their research and practical experience to offer sound guidance on best practice, ensuring that interventions are both scientifically secure and effective.

ABOUT THE SERIES

Dietary recommendations need to be based on solid evidence, but where can you find this information? The British Dietetic Association and the publishers of the Manual of Dietetic Practice present an essential and authoritative reference series on the evidence base relating to advanced aspects of nutrition and diet in selected clinical specialties. Each book provides a comprehensive and critical review of key literature in its subject. Each covers established areas of understanding, current controversies and areas of future development and investigation, and is oriented around six key themes:

• Disease processes, including metabolism, physiology, and genetics
• Disease consequences, including morbidity, mortality, nutritional epidemiology and patient perspectives
• Nutritional consequences of diseases
• Nutritional assessment, drawing on anthropometric, biochemical, clinical, dietary, economic and social approaches
• Clinical investigation and management
• Nutritional and dietary management
• Trustworthy, international in scope, and accessible, Advanced Nutrition and Dietetics is a vital resource for a range of practitioners, researchers and educators in nutrition and dietetics, including dietitians, nutritionists, doctors and specialist nurses.

SECTION 1
Background

Chapter 1.1
Prevalence, public health aspects and prevention of diabetes

Pamela Dyson

University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK

1.1.1 Prevalence

Globally, diabetes is one of the most common non-communicable diseases (NCD), affecting an estimated 371 million people (8.3% of the adult population) worldwide in 2012 [1]. Type 2 diabetes accounts for 85–90% of global diabetes, and conservative estimates by the International Diabetes Federation (IDF) predict that diabetes will increase to 776 million by 2035 (9% of the population), and that over 80% of those with diabetes will live in low and middle-income countries (LMIC) [2]. The predicted increase in diabetes is largely due to type 2 diabetes and is strongly associated with lifestyle factors, including obesity, physical inactivity and unhealthy diet. The rising incidence of diabetes is not confined to one part of the world and the IDF reports a wide geographic spread. Table 1.1.1 shows the rising pandemic, split by world region. It illustrates that the diabetes epidemic, although well established in high-income countries, will be much more prominent as an increasing problem in LMIC. For example, it is predicted that the number of people with diabetes will double in Africa and the Middle East and North Africa between 2010 and 2030.

Table 1.1.1 Regional estimates for diabetes (20–79 age group), 2010 and 2030

	2013			2035
Region	Population (20–79 y) (millions)	No. of people with DM (millions)	Diabetes prevalence (%)	Population (20–79 y) (millions)	No. of people with DM (millions)	Diabetes prevalence (%)
NAC	325	36.7	9.6	405	50.4	9.9
MENA	375	34.6	10.9	584	67.9	11.3
SEA	883	72.1	8.7	1217	123.0	9.4
EUR	659	56.3	6.8	669	68.9	7.1
SACA	301	24.1	8.2	394	38.5	8.2
WP	1613	138.2	8.1	1818	201.8	8.4
AFR	408	19.8	5.7	776	41.5	5.3
Total	4564	381.7	8.3	5863	592.9	8.8

Key: NAC North America and Caribbean, MENA Middle East and North Africa, SEA South East Asia, EUR Europe, SACA South and Central America, WP Western Pacific, AFR Africa

Source: Diabetes Atlas 6th edition.

Approximately 80–90% of those with diagnosed diabetes have type 2 diabetes and 10–20% have type 1 diabetes. Different countries exhibit different rates of diabetes with a range from <5% in parts of Africa to >30% amongst adults in Narau. In the United Kingdom (UK), prevalence rates were estimated at 4.26% (2.8 million adults) in 2010 based upon data from the Qualities and Outcomes Framework [3] although this may be an underestimate as a more recent study reported that the prevalence amongst adults in the UK was 3.1 million (7.4%) in 2011 [4].

The global statistics for the prevalence of diabetes refer only to those who have received a diagnosis but population-based studies have reported a high prevalence of undiagnosed diabetes. Globally, approximately 175 million people may be unaware of their diabetes [2] and in the UK, for example, it has been estimated that 850 000 people are living with undiagnosed diabetes [5]. There are large differences between countries for the prevalence of undiagnosed diabetes, with rates of 90% reported in some African countries and much lower rates in high-income countries. As with diagnosed diabetes, over 80% of people with undiagnosed diabetes live in LMIC.

1.1.2 Pre-diabetes

Pre-diabetes or impaired glucose tolerance (IGT) is characterized by elevated blood glucose levels, and is considered a risk factor for the development of type 2 diabetes and for cardiovascular disease. Approximately 316 million people in the world were estimated to have IGT in 2013, and 70% of these live in LMIC. By 2035, the numbers with IGT are projected to increase to 471 million, meaning that over one billion people, or approximately 20% of the adult population, will be living with diabetes or pre-diabetes by 2035 [2].

1.1.3 Public health aspects

Diabetes, in common with other NCDs, is regarded as a clinical disease and is traditionally managed by application of the acute medical model to the individual with diabetes. As type 2 diabetes prevalence has increased, it has become a public health concern requiring a broad, multidisciplinary approach that targets individuals, families, communities and societies. Diabetes requires more than the traditional approach of medical management of each individual, and effective treatment and prevention will entail a population-based public health approach.

Public health includes the concepts of surveillance for assessment and monitoring, prevention strategies and policy implications. Surveillance can provide data about the prevalence of diabetes and associated risk factors, including health behaviour and obesity. These data can be used to define and ultimately reduce the burden of diabetes by targeting services and prevention strategies at relevant populations. Many countries do not maintain national diabetes registers and do not have systems to assess risk factors, and uncertainties about prevalence in the general population and in high-risk groups prevent instigation of effective public heath strategies to prevent and manage diabetes.

Public policies for prevention and management of diabetes can be introduced at local, state and national levels. Management of diabetes can be improved by policies at a national level e.g. the UK retinal screening programme and at a local level e.g. school policies for the management of children with type 1 diabetes. Health care policies are an important factor for the management of diabetes, and integration of health care (whether provided by the state or through private insurance) with public policy is essential.

Economic impact of diabetes

Diabetes affects quality of life, general health and well-being an...