Source: WHO

Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or alternatively, when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.

Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.

Type 1 diabetes
(previously known as insulin-dependent or childhood-onset) is characterized by a lack of insulin production. Without daily administration of insulin, Type 1 diabetes is rapidly fatal. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type 2 diabetes
(formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring in obese children.

Gestational diabetes
is hyperglycaemia which is first recognized during pregnancy. Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms.

Impaired Glucose Tolerance (IGT) and Impaired Fasting Glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

DIABETES FACTS
The World Health Organization (WHO) estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030.

In 2005, an estimated 1.1 million people died from diabetes. Almost 80% of diabetes deaths occur in low and middle-income countries. Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women.

WHO projects that diabetes deaths will increase by more than 50% in the next 10 years without urgent action. Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015.

WHAT ARE COMMON CONSEQUENCES OF DIABETES?
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment.

Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.

Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.

Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die of kidney failure.

Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).

The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

WHAT IS THE ECONOMIC BURDEN OF DIABETES?
Diabetes and its complications impose significant economic consequences on individuals, families, health systems and countries.

WHO estimates that over the next 10 years (2006-2015), China will lose $ 558 billion in foregone national income due to heart disease, stroke and diabetes alone.

HOW CAN THE BURDEN OF DIABETES BE REDUCED?
Without urgent action, diabetes-related deaths will increase by more than 50% in the next 10 years.

To help prevent type 2 diabetes and its complications, people should:

Achieve and maintain healthy body weight.  Be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control. Early diagnosis can be accomplished through relatively inexpensive blood testing.

Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage to blood vessels. Tobacco cessation is also important to avoid complications.

Interventions that are both cost saving and feasible in developing countries include:

Moderate blood glucose control. People with type 1 diabetes require insulin; people with type 2 diabetes can be treated with oral medication, but may also require insulin; Blood pressure control; Foot care.

Other cost saving interventions include:

• Screening for retinopathy (which causes blindness);
• Blood lipid control (to regulate cholesterol levels);
• Screening for early signs of diabetes-related kidney disease.

These measures should be supported by a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use.

Source: beyondblue

NSW Minister for Ageing The Hon. Kristina Keneally will launch a new initiative to combat depression among older people in NSW.

The beyond maturity blues peer education program which is being funded by beyondblue: the national depression initiative has been developed by beyondblue in partnership with Council on the Ageing. The New South Wales program will be conducted by COTA NSW and the NSW Senior Peer Education Centre and will provide information sessions for older people to increase their awareness of depression and where to go for help.

COTA Chief Executive Ian Yates said: "Depression is not a normal part of ageing. It is a health problem, not a weakness. We will address the issue by providing seniors with information that will reduce stigmatising attitudes and increase seniors’ knowledge of where to receive appropriate help. Depression is a treatable illness – information and support is now available."

Beyondblue Acting CEO Dr Nicole Highet said: "Depression is not to be expected in old age, but it is a widespread health problem that’s very often not recognised, misdiagnosed and poorly treated.  Many older people and their carers either aren’t aware of the common signs and symptoms of depression, or don’t want to talk about how they’re feeling, for fear of burdening their families."

In 2006, beyondblue and Council on the Ageing South Australia conducted a successful pilot program aimed at older people to increase their awareness of depression.

This twelve-month pilot project examined the effectiveness of using existing peer support networks to deliver specific depression-awareness education to older people.

"We know that older people are receptive to health information from their peers.  We’re very excited to be working with COTA across Australia on this project.  We hope to make a difference in helping people to recognise depression in themselves or others and most importantly to know how to access help," Dr Highet said.

beyondblue’s evaluation showed the effectiveness of the pilot program. The percentage of people who could correctly identify the incidence of depression rose dramatically after the training.

As a result, the program is now being rolled out nationally through Councils on the Ageing in every state and territory. Trained peer educators will present talks to groups of seniors over the next 18 months.

"It isn’t good enough to tell a person who is depressed that they should just get over it or it’s all their own fault," said Mr Yates.

"Seniors talking to seniors through our peer education program is a very effective way of getting the message across. People who are depressed need help. This project will provide support to enable seniors to access that help."

Source: Tony Ferguson Weightloss Program

Tony Ferguson’s recipe of the Month:

1 Large Eggplant, peeled and chopped into thin circular slices
2 Medium zucchinis, sliced lengthwise
Olive oil spray
Salt to taste

For Ricotta mix
600g low fat fresh ricotta
125g frozen chopped spinach
1 Tablespoon parsley
1 Tablespoon of oregano
1 Tablespoon of basil
2 Tablespoons of shallots, chopped
1 Teaspoon of garlic powder
Salt to taste

For Tomato sauce
½ Medium onion, finely chopped
2 Cloves of garlic, crushed
3 Medium ripe tomatoes
Olive oil spray
½ cup water
1 Tablespoon of basil, chopped
2 Tablespoons of tomato paste

Method

Preheat oven to 180 degree celsius.
Heat large pan over medium heat and lightly spray with olive oil spray.
On both sides, lightly toast the eggplant and zucchini slices, adding salt on the surface and placing lid on pan to steam (cooks them faster).
Put ricotta and spinach in large bowl, add herbs (parsley, oregano, basil), garlic powder and salt to taste, combine well.
Obtain a medium saucer pan and spray with olive oil spray, add onion and crushed garlic and toast till golden.
Add chopped tomatoes, tomato paste and water and combine well. Then add basil and simmer for 5 minutes.
Get a 20cm by 30cm rectangular baking dish and spray with olive oil spray.
Place one layer of eggplant slices (half of the eggplant slices) on the bottom of dish.
Follow by a layer of ricotta mix (about one third of mixture), evenly spread.
Follow by half the tomato sauce mixture, spread evenly.
Follow by a layer of zucchini (all of the zucchini).
Follow by a layer of ricotta mix, evenly spread.
Follow by two thirds of the remaining tomato sauce, spread evenly.
Follow with a final layer of eggplant (all of the remaining eggplant).
Add left over ricotta mix and drizzle remaining tomato sauce over it.
Bake in 180 degrees celcius oven for approximately 30 minutes or until it goldens on the top.
Serve with a side salad.

Source: Diabetes Australia

On 21st May 2007 the New England Journal of Medicine reported on a new analysis which highlighted the possibility of increased risk of heart attack (myocardial infarction and death from cardiovascular causes) through the use of rosiglitazone (AVANDIA) by people with type 2 diabetes.

Diabetes Australia is closely monitoring the situation. It is important to note that the report is based on a preliminary study, which by its design cannot be definitive. The authors of the recently published study themselves state that it has important limitations and the results have ‘considerable uncertainty about the magnitude of observed hazard’.

Diabetes management should be monitored and assessed on an individual basis through consultation between patient and doctor. However Diabetes Australia suggests that people with type 2 diabetes who take rosiglitazone (AVANDIA) should not stop using this medication until they have discussed their ongoing use of this medication individually with their GP or specialist. If a decision is then made to discontinue rosiglitazone (AVANDIA), alternative treatments to maintain diabetes control will need to be considered.

In Australia, we have a robust system whereby medications are approved and constantly reviewed by the Therapeutic Goods Administration (TGA).

The TGA carries out a range of assessment and monitoring activities to ensure that therapeutic goods available in Australia are of an acceptable standard. This assessment and monitoring in turn protects the health and wellbeing of the Australian public.

Unless or until the TGA takes action in relation to the use of rosiglitazone (AVANDIA), Diabetes Australia’s recommendation is that people who are on this medication should discuss with their doctor whether it is appropriate for them to continue to take the medication by weighing up the risks and benefits.

Diabetes Australia advises that people with diabetes take this opportunity to discuss heart disease risks with their treating doctor.

A copy of the New England Journal of Medicine report can be seen on the Diabetes Australia website along with a statement issued by the TGA.