Article by Malgorzata Garstka
November 14 is World Diabetes Day (WDD). WDD was established by the International Diabetes Federation and the World Health Organization to raise awareness about a serious health risk posed by diabetes. The date of November 14 was chosen because of the birthday of Sir Frederick Banting. He co-discovered insulin and, together with John Macleod, was awarded the Nobel Prize in Physiology or Medicine in 1923. Insulin, which is the primary treatment for type-1 diabetes and used for type-2 and gestational diabetes, has saved many lives.
The theme of 2020 WDD is “The Nurse and Diabetes” to recognize an important role that nurses play in patients’ education and care, early diagnosis of diabetes, prevention of diabetes-associated complications, and to advance their position in diabetes care. Nurses account for more than half of the global health care providers. They do notable work to assist diabetic patients. People living with diabetes encounter several challenges, and nurses need to receive appropriate education and training to help diabetic patients. Worldwide, the number of diabetic patients is increasing. Hence the vital role of nurses in helping diabetic patients to manage the impact of the condition.
Diabetes is a serious global problem. Almost half a billion people live with diabetes, with a significant proportion of remaining undiagnosed. This number is estimated to reach 700 million by 2045. China ranks number one, with the highest number of people with diabetes – an estimate of 116.4 million adults in China live with diabetes. Alarming is a sharp increase in diabetes prevalence in younger people.
What is diabetes?
Diabetes is a group of metabolic diseases characterized by an excess of blood glucose. Glucose is a sugar, a source of energy for the cells in the body. After a meal, glucose levels in the bloodstream rise. In response, insulin is produced by the pancreas. It enables glucose to enter the liver, muscle and fat tissue to maintain healthy levels in the blood. Diabetes is characterized by either the absence of insulin production (type-1 diabetes) or cells’ inability to respond properly to insulin (type-2 diabetes). Gestational diabetes develops during pregnancy and is resolved after delivery. Symptoms of diabetes vary depending on how much your blood sugar is elevated. They include increased thirst and hunger, frequent urination, sudden weight loss, fatigue, blurred vision, slow healing wounds, and frequent infections.
Risk factors for type-1 diabetes are family history, environmental factors (e.g., viral infections), harmful immune system, and geographical location. Finland has one of the highest rate rates of type-1 diabetes. In contrast, China has a relatively low prevalence of type-1 diabetes. Risk factors for type-2 diabetes include age, overweight or obesity, physical inactivity, diabetes family history, high blood pressure, abnormal cholesterol and triglyceride levels, polycystic ovary syndrome, or gestational diabetes. Certain races, including Asian, Black, Hispanic, and American Indian, are more likely to develop type-2 diabetes. The risk factors for gestational diabetes include age, diabetes family history, body mass index (weight/height) and race (Asian, Black, Hispanic, American Indian women are at the higher risk).
The Dangers of Diabetes
Diabetes is associated with various complications that develop gradually. The risk of complications depends on diabetes duration and how well diabetic patients can keep their blood sugar, blood pressure and cholesterol levels within a normal range. Diabetes complications include:
• Cardiovascular problems – a higher risk of heart disease or stroke.
• Nephropathy – damage to the kidney leading to kidney failure or end-stage renal disease. It requires dialysis and, ultimately, a kidney transplant.
• Retinopathy – damage to the eyes that may cause cataracts and glaucoma and lead to blindness.
• Neuropathy – damage to the nerves that may lead to loss of sense of feeling in the affected limbs.
• Higher risk of infections and infection-related-mortality – viral infections: flu or pneumonia, including covid-19; foot, skin and urinary tract bacterial and fungal infections, periodontal infection, sepsis.
• Higher risk of cancer and cancer-related mortality, including breast, endometrial, liver or colorectal cancer.
• Depression – diabetes affects patients’ mental status that can make diabetes management more challenging.
Type-1 diabetes cannot be prevented nor cured. Treatment includes taking insulin, regular monitoring blood sugar levels, keeping a balanced diet, exercising regularly, and maintaining a healthy weight. Type-2 diabetes and gestational diabetes can be prevented and treated. Keep a healthy diet – consume food low in fat and calories and high in fiber. Eat vegetables, fruit, and whole-grain food. Exercise regularly – walk, ride a bike, swim, join a sport club – there are many options in Xi’an. Lose weight. If you are overweight or obese, losing 5-10% of your weight will lower diabetes risk by more than 50%. Do not lose weight during pregnancy. Instead, discuss with your doctor about what is a healthy weight to gain during the pregnancy.
The risk of most diabetes-related complications can be lowered by taking anti-diabetic medication (pills and/or insulin), monitoring blood sugar levels, following a healthy diet, reducing alcohol intake, quitting smoking, exercising systematically, regularly seeing a health care provider (endocrinologist, cardiologist, dentist, optometrist, nurse or other) to monitor for the complications.
Ongoing research aims to develop a cure for type-1 diabetes and the methods for early prediction of diabetes and diabetes-related complications using artificial intelligence (AI). AI technologies have been extensively employed in diabetes prediction, dietary and exercise guidance, insulin injection guidance, monitoring of complications, and self-management.
Which Xi’an hospitals specialize in diabetes?
The Endocrinology Department of the Second Affiliated Hospital of Xi’an Jiaotong University is one of the earliest Endocrinology Specialties established in Shaanxi Province. It was accredited as a Bachelor Degree authorization point by the deputy director unit of Shaanxi Endocrine Disease Quality Control Center in 2006. It is at the leading-level Endocrinology Department in the Northwest of China and earned a strong reputation in the domestic endocrinology circle. Doctors and nurses from the Endocrinology Department of the Second Affiliated Hospital of Xi’an Jiaotong University work tirelessly to treat diabetic patients and help them manage their condition. The Department is located at Daminggong Hospital, Jian Qiang Road, Wei Yang district.
Malgorzata Garstka is a research professor at the Second Affiliated Hospital of Xi’an Jiaotong University. She and her international team study diabetes and are developing methods for the early prediction of gestational diabetes. They collaborate with the doctors and nurses from the Endocrinology Department at the Second Affiliated Hospital of Xi’an Jiaotong University.