Stephanie Fsadni finds out that diabetes and obesity are inextricably linked, as obesity increases the risk of developing diabetes. The best advice a doctor can give to prevent the onset of both conditions is to adopt a more healthy lifestyle before it gets too late.

Malta has one of the highest diabetes prevalence rates worldwide. Data from the World Health Organisation estimated the number of local patients with diabetes to be 39,000 in the year 2000, and envisaged that this number would rise to an alarming 57,000 by the year 2030.

According to WHO, Malta also has a high incidence of obesity, affecting 28.8 per cent of the population.

The two are inextricably linked, as obesity increases the risk of developing diabetes.

“Total body adiposity, a central fat distribution and the duration and time course of developing obesity are established risk factors for type 2 diabetes,” explains consultant diabetologist Sandro Vella.

Dr Vella says that lifestyle factors account for 90 per cent of the excess susceptibility to this type of diabetes, and obesity is the most important of these factors.

Patients with a body mass index (BMI) exceeding 35 kg/m2 are at “an 80-fold higher risk of developing diabetes over a 10-year period compared to individuals with a BMI of less than 22 kg/m2”.

Dr Vella further explains that obesity – especially central obesity, which affects the abdominal area – is associated with insulin resistance, which renders the body less responsive to the physiological effects of insulin secreted by the pancreas.

In a bid to overcome this problem, the beta cells of the pancreas increase their insulin secretion.

Eventually, their function fails, resulting in the clinical manifestations of diabetes.

First symptoms include weight loss, fatigue, passing abnormally large amounts of urine, excessive thirst and blurring of vision. Most type 2 diabetes subjects progress to insulin therapy in later stages of their disease, when other glucose-lowering strategies, including orally administered drug therapies, fail to achieve adequate glycaemic control.

Several complications can develop, especially if diabetes is not controlled properly.

These comprise large vessel disease with its attendant risk of heart attacks, strokes and limb amputations, as well as small vessel disease, resulting in adverse effects on nerve, kidney and retinal (eye) function.

Dr Vella says the best advice a doctor can give to prevent the onset of both diseases is to adopt a healthy lifestyle.

“A healthy diet, sustained by regular exercise, reduces the risk of obesity in most instances, and has been shown to reduce an individual’s risk of progressing to diabetes,” he says.

However, he points out that not all obese people develop diabetes, and that type 2 diabetes is not uncommon in normal weight individuals.

“Genetic predisposition clearly plays a role,” Dr Vella says.

“Over the years, urbanised and industrialised societies have adopted a sedentary lifestyle. This, coupled with the ready availability of high-energy foods is likely to account for the disproportional increase in diabetes incidence rates in such populations.”

He also suggests regular screening for diabetes among at-risk individuals – “virtually all Maltese”.

Once an individual is diagnosed with diabetes, it is “mandatory” that he does regular follow-up checks to control other risk factors that could cause complications, such as high blood pressure and high cholesterol levels, and identifies and treats any complications.

“Close collaboration between family medicine specialists and allied health professionals, such as diabetes specialist nurses, podiatrists and dieticians, is also crucial in this regard,” Dr Vella maintains.

Diabetes-related complications

Macrovascular complications – disease affecting the large arteries of the body,
resulting in:

■ Coronary artery disease – heart attacks, angina;

■ Cerebrovascular disease – strokes;

■ Peripheral arterial disease – causing leg claudication, leg ulcers and an increased risk of limb amputation.

Microvascular complications – disease affecting the small arteries, resulting in:

■ Neuropathy – disease of the peripheral nerves, resulting, among others, in impaired sensation, tingling and pain, increased risk of ulceration and limb amputation;

■ Retinopathy – disease of the retina, which, if untreated, may lead to blindness;

■ Kidney disease – which can progress to kidney failure and require dialysis.

Diabetes is also a major cause of cataracts.