Being an ophthalmologist, Franco Mercieca (November 15) quite rightly emphasises the importance of a national programme to actively screen diabetics’ eyes for retinal problems that could lead to blindness if identified too late.

He also makes at least one other vital point, that the Mater Dei Hospital Diabetic Clinic ought to have a full-time dietician. The far commoner Type 2 diabetes, which is increasingly prevalent around the world (Malta has one of the highest rates, which also explains our highest rate of cardiovascular disease in the Mediterranean), is a disease partly of inheritance and partly of diet and lack of exercise. Too much food (and too much unhealthy food) is at the heart of this emerging pandemic of Type 2 diabetes.

Dietary experts, therefore, have a crucial role in this disease because dietary and lifestyle modification can totally reverse Type 2 diabetes (and partly reverse Type 1) without further need of taking either diabetic tablets or insulin.

There are clinics overseas, particularly in America, which specialise in teaching diabetic patients how to achieve this. In a nutshell, they are taught to base their diet on wholegrain carbohydrates, such as wholegrain bread, wholewheat pasta and brown, red and black rice and to permanently ditch white bread, pasta and rice.

They are taught to base their diet more on vegetables, certain fruits and nuts and that the healthiest food source is legumes (all the bean and lentil family) because they contain protein, fibre and substances, which control blood sugar. Some meats, fish, cheese, butter and olive oil are permitted.

Some of these American clinics have suggested dishes online.

Patients are also advised on food supplements (such as co-enzyme Q10, omega-3, cinnamon tablets and minerals such as magnesium and chromium), which contribute to control blood sugar and diabetic complications. One big problem is that supermarkets are full of enticing but unhealthy foods that probably deserve a health warning label like cigarette packets.

Although about a tenth of the Maltese population is said to be diabetic, an unknown number (possibly as many) are in an undiagnosed pre-diabetic state.

For screening and follow-up purposes, American clinics are now using two blood tests: the haemoglobin A1c (HbA1c) and triglyceride level.

The former monitors blood sugar level over the previous several weeks (more accurate than fasting blood sugar) and high blood triglycerides and low HDL (good cholesterol) indicates risk for diabetes and possibly also for metabolic syndrome with fatty liver and risk of cirrhosis.

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