Diabetes is a bitch

*My discussion write-up for my EPID5300 class. This is somewhat an informal piece of work and the tone needed to be casual yet informative.*

I would like to discuss the underlying disease that took the life of my father in year 2020. It was not COVID-19 that took him, despite its high prevalence that year, but a silent yet deadly chronic noncommunicable disease (NCD) that is type 2 diabetes mellitus (T2DM). If left untreated, T2DM results in cardiovascular and kidney complications that would eventually end the life of the patient. And this was exactly what happened to him.

Worldwide, epidemiologists analyzed the incidence, prevalence, and burden of suffering of diabetes mellitus and found that ‘approximately 462 million individuals were affected by type 2 diabetes corresponding to 6.28% of the world’s population (4.4% of those aged 15–49 years, 15% of those aged 50–69, and 22% of those aged 70+), or a prevalence rate of 6,059 cases per 100,000’ (Khan et al 2020).

Zheng et al. (2018) identified Asia as the epicenter of the T2DM epidemic, with China and India as the top two epicenters. The ‘major driving factors of the global T2DM epidemic include overweight and obesity, sedentary lifestyle and increased consumption of unhealthy diets containing high levels of red meat and processed meat, refined grains and sugar-sweetened beverages’ (ibid).

In the Philippines, my home country, Tan (2016) stated that a cohort study in 2009 revealed the incidence rate of T2DM was 16.2%. In a 2013 study, it was found that ‘the highest prevalence rate was found among the richest in the wealth index, those living in urban areas, and those in the 60- to 69-year age group in both sexes’ (ibid.).

I guess my father fell under this normal distribution curve of “living in an urban area” and whose age falls within the “60- to 69-year age group”. I would like to dispute the “among the richest in the wealth index” part though, I do not consider myself as being “among the richest” demographic. But red meat, processed meats, refined grains, and sugar-sweetened beverages are commonly found in urban areas, especially Metro Manila, where people can afford and have access to such food items. And according to Zheng et al.’s study, an increased consumption of this unhealthy diet is one of the major driving factors of T2DM. Knowing my father, in addition to his genetic predisposition to diabetes, he consumed this unhealthy diet over the course of his adult life. He passed away at the age of 69.

The studies cited above illustrate how the information and knowledge generated by epidemiological studies for T2DM are powerful instruments in developing appropriate clinical preventive measures and also for plotting the prevalence trajectory of the disease. Zheng et al. (2018) reported that major clinical trials have shown diet and lifestyle modifications are effective in preventing T2DM in high-risk individuals. Moreover, social support and ensuring medication adherence are key to reducing the incidence of T2DM complications. Furthermore, Khan et al. (2020) projected in their modeling that ‘type 2 diabetes will increase to 7,079 individuals per 100,000 by 2030, reflecting a continued rise across all regions of the world. There are concerning trends of rising prevalence in lower-income countries.’

All this epidemiological information, when taken together, can be used in crafting evidence-based policies and decisions by policymakers, which in turn can, optimistically, arrest the incidence and lower the prevalence of T2DM locally and globally. I want to stress the importance of translating research into policy because if research remains static and is not applied in any way, the potential of it to be life-changing will never see the light of day.

 

References

Khan, MAB, Hashim, MJ, King, JK, Govender, RD, Mustafa, H & Al Kaabi, J 2020, ‘Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends’, Journal of Epidemiology and Global Health, vol. 10, no. 1, pp. 107-111.

Tan, GH 2016. ‘Diabetes care in the Philippines’, Annals of Global Health, vol. 81, no. 6, pp. 863-869.

Zheng, Y, Ley, SH & Hu, FB 2018, ‘Global aetiology and epidemiology of type 2 diabetes mellitus and its complications’, Nature Reviews Endocrinology, vol. 14, pp. 88-98.