Bermuda’s war against diabetes
Generally speaking, you actually are what you eat. And if you eat a diet consistently high in sugar, processed food and saturated fat, you are more likely than not a diabetic-in-waiting.
The prevalence of type 2 diabetes in Bermuda, at once one of the most common and preventable chronic health conditions in the world, has reached genuinely alarming levels.
By almost any measure, Bermuda is a world-beater when it comes to a disease that owes far more to lifestyle choices than genetic or environmental factors.
Some argue Bermuda is already contending with what amounts to a full-blown, public health crisis, given the island’s disproportionately high concentration of existing type 2 diabetes cases.
And with dozens of new cases likely to be diagnosed this year, it may be tempting to conclude that we are losing the war against diabetes. Tempting but not entirely correct.
The Bermuda Diabetes Association will tell you that for many years the island as a whole was simply waging the struggle on the wrong battlefield. Treatment, rather than prevention, was Bermuda’s primary focus.
But in recent times the emphasis has shifted. The diabetes association, which has long made prevention its primary focus, has now been joined by the Ministry of Health, insurers and other private and public agencies in putting the causes of the disease at the forefront of the struggle.
Consequently, any number of education and information campaigns are now under way in Bermuda, aimed at raising public awareness of diabetes and changing patterns of behaviour that can lead to the onset of the disease. And there’s more than a little statistical and anecdotal evidence to suggest some progress has already been made. This is heartening news because without significant changes in our increasingly sedentary lifestyles and appalling diets, there is a genuine risk that Bermuda could now be producing a generation that will not outlive its parents.
Bermuda certainly wasn’t alone in forgetting that an ounce of prevention is often far more effective when dealing with diabetes than any number of after-the-fact treatments. This week’s well-attended World Health Day ceremony at City Hall was, like hundreds of similar events held around the globe, given over to the goal of diabetes prevention.
Marking the first time in its 66-year history that the World Health Organisation has selected a non-communicable disease to target on the global health awareness day, diabetes was chosen precisely because it has now attained epidemic proportions.
Directly and indirectly, diabetes claims millions of lives around the world every year and is crippling national health budgets. The number of people living with diabetes has almost quadrupled since 1980 to 422 million adults. World Health Day amounted to an urgent call to global action on diabetes, which diabetes association chairwoman Debbie Jones said has particular relevance to Bermuda, where the disease has been on the upswing in recent decades and where its sometimes devastating impact has been experienced by hundreds of families.
As in any war, we should first define the nature and scope of the struggle, and identify the enemy. The diabetes in question here is not what is commonly referred to as type 1, or juvenile, diabetes. That occurs when the body produces little or no insulin and a hormone is required to move blood sugar into the cells for energy. Type 1 diabetes cannot be prevented.
Instead, Bermuda, like most countries, is contending with a spike in type 2 diabetes. Accounting for the vast majority of all diagnosed cases on the island, with type 2 diabetes, either the body doesn’t produce enough insulin or the cells ignore it.
Left uncontrolled, type 2 diabetes can cause all manner of severe complications, including amputation of the legs and feet, blindness, heart disease, kidney failure and stroke.
Diabetes or complications caused by the disease are now among the leading causes of death in Bermuda: the grim fact is diabetics are 1˝ times as likely to die as people of the same age who don’t have the condition. The snowballing impact of diabetes on the community has been placing an ever-increasing strain on the island’s health system for many years now.
But many of the more debilitating side-effects of diabetes can be avoided with medication and the appropriate lifestyle changes. That’s why the Bermuda Diabetes Association has for so long emphasised the importance of getting a diagnosis as soon as possible and following through with treatment plans. It is recommended that Bermuda residents should be checked regularly for signs of the onset of the disease by the age of 40.
But what most frustrates the BDA and Bermuda’s health authorities is that this form of the disease is largely avoidable in the first place with proper diet and regular exercise. There’s a direct cause-and-effect relationship between diabetes and another health crisis confronting Bermuda: obesity.
Not everyone who is obese will develop type 2 diabetes, of course, and not everyone with type 2 diabetes is overweight. But the two are inextricably linked. Research demonstrates that while diabetes is diagnosed in only two of every thousand normal-weight people, some 18 out of every one thousand obese people develop the disease. Particularly worrying is that obesity in Bermuda’s children and adolescents has been on the rise in recent years. Early obesity not only increases the likelihood of adult obesity and diabetes, it also increases the risk of heart disease in adulthood.
The proliferation of fast foods, processed foods and drinks high in sugar content over the past 25 years are significant contributing factors to both Bermuda’s obesity and diabetes epidemics.
The average smoothie, for instance, contains the equivalent of about 34 teaspoons of sugar — or about five times the recommended daily intake. To consume an equivalent amount of sugar in actual food, you would have to eat four peaches, nine limes, 30 lemons and 30 strawberries. And no one, of course, would ever want to eat food that way.
Education is incrementally changing the habits of Bermuda’s diabetics and those at risk of developing the condition. And it’s certainly encouraging that a growing number of Bermuda families are heeding the message to eat less and exercise more.
However, while it’s fair to say Bermuda may have finally started to turn the tide in the war against diabetes, we are still a long way from being able to declare victory. Far too many of us remain diabetics-in-waiting; too many of us remain potential casualties.