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World Diabetes Atlas – 5th Edition



As regular readers will recall, this week I am attending the World Diabetes Congress – with well over 14,000 attendees, the largest ever world congress on this issue.

For readers, who are not familiar with the International Diabetes Federation (!DF), it may be worth pointing out that the IDF is an umbrella organization of over 200 national diabetes associations in over 160 countries. IDF’s national diabetes associations are divided into the following regions: Africa (AFR),Europe (EUR),Middle East and North Africa (MENA), North America and Caribbean (NAC),South and Central America (SACA), South East Asia (SEA) and Western Pacific (WP).

Thus, the IDF, which has been in operation since 1950, represents the interests of the growing number of people with diabetes and those at risk.

The mission of IDF is to:

“advance diabetes care, prevention and a cure worldwide.”

Its strategic goals are to:

  • Drive change at all levels, from local to global, to prevent diabetes and increase access to essential medicines.
  • Develop and encourage best practice in diabetes policy, management and education.
  • Advance diabetes treatment, prevention and cure through scientific research.
  • Advance and protect the rights of people with diabetes, and combat discrimination.

(interestingly, these goals are reminiscent of those of the Canadian Obesity Network, Canada’s National Obesity organization, with the difference perhaps that obesity is a much larger issue than just diabetes).

Amongst the many activities and resources provided by the IDF, one that readers may find of particular interest (and one that can be a great time waster for readers who are looking for new ways to procrastinate) is the interactive World Diabetes Atlas, now in its 5th edition (just released last month).

The atlas exemplifies just how many folks around the work (especially in South Asia) are affected by type 2 diabetes – interesting, an obesity map of the world would look almost identical, except that the numbers would be far greater (only about 15-20% of obese people actually go on to develop diabetes – but may well have other weight-related health problems).

One of the notable features of this congress is the massive industry exhibit – not quite as extensive as those at cardiology or oncology meetings but, by a significant magnitude of scale, larger than any industry exhibits seen at obesity meetings. This is of course because diabetes management (although never curative) is big business, with countless new classes of anti-diabetic drugs in the pharma pipelines to add to the many oral and injectable treatments that are already out there (not to mention the vast blood glucose monitoring and insulin pump industries).

While there is no doubt that these companies are providing excellent products and services that make the life of people with diabetes so much easier and help reduce the horrible risks of this condition, one can only wish that in the not too distant future, a similar arsenal of treatments and management tools may become available for those struggling with obesity and its myriad sequelae (EOSS 2-4).

While the hope is not to ‘cure’ obesity (I am not sure we can actually do that), having effective obesity treatments that fill the vast therapeutic gap between ‘eat-less-move-more’ and bariatric surgery are urgently needed.

Not only would this reduce the global burden of diabetes but hopefully also the global burden of the over 20 other chronic conditions that are strongly associated with excess weight (including many cancers).

Unfortunately, neither the current regulatory framework for new launching new obesity medications nor the necessary investment into training health professionals to better manage obesity or into research to find better treatments comes close to the actual size of the problem (just count how many Canadian medical schools actually have a chair in obesity – I know of two).

So although there is an appreciable number of talks and sessions on obesity (including the ones the I am giving and chairing), the focus of this congress is of course on managing diabetes and its complications.

Unfortunately, as I have said before, managing type 2 diabetes without addressing obesity is largely ‘palliative’ care.

Obviously, not a popular view at this conference.

AMS,
Dubai, UAE

4 Comments

  1. On low carb diet, the management of BG and insulin resistance is done mostly from the low end by the liver, so the problems becomes much smaller. Obesity is the result of insulin resistance. To beat obesity, we must manage insulin resistance.

    Biochemical hunger, biochemical cravings and appetite control are all much easier to deal with from a good low carbohydrate diet, as are weight issues. Here is a video that describes a good low carbohydrate diet for other reasons:

    http://www.youtube.com/watch?feature=player_embedded&v=KLjgBLwH3Wc

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  2. fredt, it seems doubtful to me that obesity is a result of insulin resistance, since many people who are classified as obese (including myself, actually) are not insulin resistant.

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  3. DeeLeigh; Not Insulin resistant, EH. By what measurement? To gain weight, part of you is insulin resistant.

    Insulin in the portal vein is 2 to ten time higher concentration than circulating. In order for the majority of insulin and glucose to get past the liver, the liver becomes insulin resistant. First pass effect. Once glucose starts circulating, the muscles suck up most, (also a first pass effect) until they are getting near full, and then each cell becomes insulin resistant, as the method of stopping over feeding. The fat cells are still taking in glucose and fat. The insulin resistance test is looking at whether the fat cells are insulin resistant. Once those at cells become insulin resistant, we are on our way to excess glucose, and all those related problem. Insulin resistance starts in the liver, and then muscle cells, before the fat. Look it up in biochemical references. By the time the test says “insulin resistant” we are well in weight gain, and likely dealing with obesity issues.

    To really beat the weight problem, we must eat to deal with insulin resistance at the liver, and maintain insulin sensitivities at the muscle cells level.

    Good diet is a learned, both information and behavior. The problem comes when we have biochemical, social, emotional cravings of hungers, or food clue hyperpalatability appetite stimulus issues that get us started into overeating/addiction or addiction like behaviors, which we then must overcome along with the other listed.

    It is not a single problem, but a whole group that must be overcome in one massive strike, with lots of external resistance and wrong information from all sides.

    The only way to develop a suitable diet is with real information about the food and what it does to our body. We need very little carbohydrate, adequate protein, and some essential fats. The remainder can come from either fat or carbohydrates. The downside of carbohydrates is high insulin, insulin resistance, and appetite stimulation. As a ex-obese person, I do not need appetite stimulation.

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  4. fredt- I’m not gaining weight currently and have not gained a significant amount since I was a teenager (I’m 42). I have a high but stable BMI. Since I don’t restrict calories, I don’t have a problem with cravings or bingeing. I’m not a big fan of meat, so I have zero interest in the paleo thing for myself. It’s great to hear that you’re happy with the way you eat, but it’s not the right type of diet for everyone.

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