Novo Nordisk Editorial

Managing diabetes is about more than just medicine

Managing diabetes and the risk of diabetes is about more than just handing out prescriptions. Rapid urbanisation is leading to lifestyle changes that are putting more and more South Africans at risk of developing this chronic, lifelong condition. Dr Timmy Kedijang of Novo Nordisk SA examines the real causes behind the statistics, and the impact that diabetes is having on both individuals and society. Medical experts estimate that approximately 6.5% of adults aged between 20 and 79 in South Africa have diabetes, and there is an age-adjusted prevalence of as high as 13% in urban areas. This equates to easily three million people. As startling as this figure is, even more startling is the fact that about half of these individuals have not been diagnosed, and only half of those diagnosed are receiving some form of treatment. Most sobering of all, perhaps, is that the number of people living with diabetes is set to outstrip those living with HIV/Aids in 20 years time. Current statistics indicate that 360 million people worldwide are living with diabetes, and this figure is likely to increase to 560 million by 2030. And as local trends reflect global trends, the number of affected individuals in South Africa is also expected to double by that time. This growing epidemic is linked to rapid urbanisation, increasingly inactive lifestyles, unhealthy eating habits and rising levels of obesity, all of which increase the risk of developing diabetes. Simply put, once people move into urban areas, they become less physically active and tend to eat a diet that is higher in fats, processed foods and refined sugars than people in the rural areas do. This, in turn, leads to a higher level of obesity which, together with a lack of exercise, increases the risk of developing diabetes significantly.

Novo Nordisk Editorial Page 1 of 3

So, as Newsweek journalist Gary Taub puts it (2012, May 7), the rapidly-rising levels of obesity and diabetes are more likely to be about the type of food people eat when they move to urban areas than merely about the amount of food they eat. In fact, it is the perfect storm of a more sedentary lifestyle and a diet high in hydrogenated fats and refined sugars and grains that is most likely to be behind the obesity epidemic, as well as the alarming increase in the incidence of diabetes. This is because of the effect these foods have on the hormone insulin, which regulates fat accumulation in the body. Further, in a vicious cycle of cause and effect, the more body fat one develops, the less capable the body is of regulating insulin usage, and this increases the probability of developing insulin resistance. Lifestyle choices are therefore vital to minimising the risk of developing diabetes, and to managing the condition if and when diagnosed. So, while modern treatment protocols offer people living with diabetes the chance of living long, normal and active lives, managing the illness is about more than just medication, it is about an holistic approach to disease management. And the remedy is to begin by returning to a more wholefood diet, such as that eaten by people living in rural areas. The problem with this is that refined foods often provide the cheapest calories, and many recently-urbanised South Africans cannot afford a diet which contains more low-fat protein, natural gains and fresh fruit and vegetables. So when we look at the incidence of diabetes from a socio-economic perspective, the picture changes, and the ramifications are huge. This is especially true as pre-diabetic symptoms and early-stage diabetes can be treated with proper diet and exercise alone. Even somewhat more advanced cases can be treated with diet, exercise and medication, cutting down on the need for more costly and intrusive therapies based on insulin and other injections. Healthcare policy therefore needs to take into account the need to educate the population particularly the urban population - about the risks associated with fatty and refined foods, and about the very real effect that poor diet has on low-income households. If this aspect of diabetes prevention and management is not addressed, the impact of the condition will be felt not only in the rising numbers of affected individuals, but in an ever-

Novo Nordisk Editorial Page 2 of 3

increasing burden on already-overstretched healthcare resources. Not only that, but a greater number of sick-leave days will have a direct impact on productivity and the economy. It is for these reasons that progressive medical professionals and policy makers are beginning to understand that managing the risk and incidence of chronic conditions such as diabetes is far more than a healthcare issue. In short, it is about more than just medicine; it is about healthcare education, food policy and poverty reduction too. Advances in medical science offer people living with diabetes the chance to lead normal and fulfilling lives, but medicine alone is not enough. At policy level, we need to be taking a much closer look at the impact that socio-economic issues have on the risk and management of diabetes.

For further information on diabetes, testing and treatment options for people living with diabetes, visit www.novonodisk.co.za or www.novonordisk.com Word count: 856 References:

1. Kedijang, T. Dr (2012, May 8). Telephonic interview. 2. JEMDSA (2012, Volume 17, number 1:S4). Available at: www.jemdsa.co.za 3. Taube, G. (2012, May 7). Why the Campaign to Stop America's Obesity Crisis Keeps
Failing. The Daily Beast (Newsweek online). Retrieved from: http://www.thedailybeast.com/newsweek/2012/05/06/why-the-campaign-tostop-america-s-obesity-crisis-keeps-failing.html

Novo Nordisk Editorial Page 3 of 3