Posted on 24 April 2014
Dr Alkesh Magan, a specialist endocrinologist at Mediclinic Sandton explains who should be screened for diabetes and what the trends are.
Who should be tested for diabetes?
‘There is a so-called silent phase in type 2 diabetes,’ says Dr Alkesh Magan, a specialist endocrinologist practising at Mediclinic Sandton. ‘So when screening patients we risk stratify them: are they over 40, overweight, or have a strong family history of diabetes? The earlier the diagnosis, even in asymptomatic patients, the better the long term outlook. If you are obese or have high cholesterol, high blood pressure or vascular conditions, you must be tested for diabetes.’
Shouldn’t we prophylatically screen the entire population for diabetes?
According to Dr Magan this is not feasible. ‘Multiple genes [that play a role in diabetes] are being defined daily. And diabetes is polygenic – which means that a person’s lifestyle is an important determining factor in whether they will develop diabetes. That’s part of the puzzling reality behind the disease. We understand the genetic make-up but what role the gene has to play in the manifestation of the gene is as yet unknown.’
But we do know early diagnosis and intervention are effective in managing the disease…
‘This is true for diseases associated with diabetes as well, whether they affect the brain, heart, kidney or the back of the eye. Since we started intensively controlling glucose – much easier to do since the advent of synthetic insulin – managing diabetes became easier… but not foolproof,’ says Dr Magan. ‘Insulin was discovered in 1921 [and the first commercial insulin was made by Eli Lilly in 1923] and we doctors thought we had the disease wrapped. But that’s far from the truth. It’s not just about lowering sugar anymore. It’s about the inflammatory milieu that diabetes creates in the body. You can have patients who meet every single target you set for them but still develop complications from the disease. Controlling glucose is just one facet. Blood pressure, smoking habits, weight, and others are all confounding factors.’
What are the trends in terms of diabetes and the developing world?
‘Type 1 diabetes is on a downward trend worldwide, specifically in developing counties – and we are not sure why. We think that HIV has something to do with it, as type 1 diabetes is an autoimmune disease and requires an intact immune system to function,’ said Dr Magan.
In developing countries the incidence of type 2 diabetes is substantially higher than in the developed world. Projected figures for diabetes predict that Africa will soon have the highest worldwide incidence. This can probably be ascribed to the rapid urbanisation of traditionally rural communities. With wealth – as people are able to access high calorie processed foods and lead sedentary lives – comes disease.
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