This year the theme of World Diabetes Day 2017 is Women and diabetes - our right to a healthy future.
The accelerating prevalence of Diabetes Mellitus (DM), has taken pandemic proportions. Most indicators suggest that current prevalence rates in South Africa (SA) are underestimating the burden of disease. A major limitation is that South Africa does not have a national diabetes registry. Despite the paucity of epidemiological data, the prevalence of DM is reported to be higher in the reproductive age group in SA than that of Africa and of the world. With the projected increase in DM, no economy in the world will be able to afford to treat all people with DM in the near future. The mortality rate from diabetes now exceeds that from HIV/AIDS, tuberculosis and malaria combined. In SA the highest prevalence of DM is reported in the Asian and mixed race populations.
Globally, it is estimated that 16% of live births are affected by hyperglycemia in pregnancy. This includes women with gestational diabetes mellitus (GDM) and women with overt DM in pregnancy. It is important to distinguish between hyperglycemia first occurring in pregnancy (GDM) vs diabetes first recognized in pregnancy as the risk profiles differ markedly. It is a sad reality that women are often first exposed to healthcare only when they are pregnant, and as a result they may be erroneously classified as GDM when in fact they have unrecognized DM first noted in pregnancy. GDM is a milder degree of hyperglycemia and occurs towards the latter end of pregnancy. In contrast to overt DM it usually resolves soon after delivery. The current gold standard for diagnosis of GDM is the IADPSG criteria. If WHO criteria for DM during pregnancy is met, it should be classified as overt DM and not GDM. Despite its milder degree, GDM carries an almost eight-fold risk for future diabetes in the mother. The offspring of women with GDM also have a significant increased risk for childhood obesity and diabetes. The fact that two out of every five women with DM are of reproductive age, may perpetuate the vicious cycle of the transgenerational metabolic disadvantage that ultimately leads to DM. GDM accounts for 85% of diabetes in pregnancy and one in seven births is affected globally.
Under the current economic circumstances, across all medical specialities, every cent spent in healthcare must work more effectively and efficiently. GDM provides an opportunity to impact positively on the mother and the unborn fetus, by preventing disease without added cost. It also provides the prospect to build capacity amongst women and girls, as they are key agents in the adoption of healthy lifestyles to improve the health and wellbeing of future generations.
Society at large (both men and women) need to work to curb this epidemic.
Ubuntu - the African philosophy of
‘I am because you are’ underpins an approach of taking care of ourselves so we can take care of others.
With the focus on Women’s health and emerging evidence it is clear that a more aggressive approach to prevention and treatment must be adopted. When considering resource allocation, we need to shift our focus from clinical and preclinical disease to disease-free states or health. We need to focus on primordial prevention- only then will the vicious cycle of metabolic imprinting that casts a shadow over the lives of so many people be broken.
SEMDSA proposes a multi-sectorial approach towards creating environments conducive to health in order to curb the epidemic of diabetes in our country. We propose that it is the duty of the custodians of this rainbow nation to address the current economic and political elements that impacts directly on food security, healthy safe recreation options like outdoor exercise and health education in schools. Marketing and advertising of unhealthy food - like products must be curbed- health must not be traded for money. Early access to health facilities, early diagnosis and screening are essential components of the pro-active care model SEMDSA envisions.
With the above in mind SEMDSA invites its members to become active and instill a long term consciousness of the issues around diabetes not just on WDD 2017, but beyond.
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