UNFORTUNATELY, diabetes needs no introduction. Due to its ever-growing prevalence, this chronic metabolic condition has become a global health problem. Locally, one in 10 Maltese adults are living with diabetes, of whom around 50% remain undiagnosed.

Diabetes mellitus occurs either when the pancreas does not secrete enough insulin or when body tissues become less sensitive to insulin. The hormone insulin is crucial in maintaining blood glucose control (homeostasis). Therefore, due to insufficient levels of insulin, uncontrolled diabetes mellitus is characterised by elevated blood glucose levels (hyperglycaemia). Sustained hyperglycaemia is menacing since it can lead to serious complications including cardiovascular disease, kidney failure, blindness and amputations.

There are two main types of diabetes mellitus; type 1 and type 2. Type 1 diabetes usually develops during childhood and is a result of a viral infection or an autoimmune reaction which destroy the insulin producing cells, also known as beta cells, of the pancreas. This type is unpreventable. On the other hand, type 2 diabetes generally develops in adults over 45 years of age owing to insulin resistance and is preventable.

So who’s at risk of developing type 2 diabetes? Is it genetics or unhealthy lifestyle choices which predispose us to diabetes? And how can we prevent it?

It is a misconception to assume that only individuals with a genetic predisposition to type 2 diabetes can develop this condition. In fact research shows that type 2 diabetes is a heterogenous disease, meaning that it is caused by the interaction between genetic and environmental factors. Such environmental factors are the result of our poor lifestyle choices. These include:

* Unhealthy eating and a sedentary lifestyle attributing to obesity: It has been found that people who are overweight are 80 times more likely to develop type 2 diabetes. This is because abdominal fat stimulates the release of pro-inflammatory cells which in turn decrease the sensitivity of the body to insulin consequently disrupting glucose homeostasis. 

* Smoking: The nicotine in cigarettes has a similar effect to obesity and contributes to insulin resistance.

* Excessive alcohol: Apart from the fact that alcohol is high in calories and hence contributes to obesity which has a direct link to diabetes, alcohol also raises the blood glucose levels in the well fed state. This will lead to more insulin being required to get the glucose levels back to normal. 

The genetic and environmental factors, be it alone, or in combination contribute to the development of type 2 diabetes by impairing the function of the beta cells of the pancreas, increasing the risk of insulin resistance and obesity. 

Luckily, unlike genetics, lifestyle choices can be modified. Maintaining a healthy weight is of paramount importance to prevent the onset of diabetes. This can be achieved by cutting down on saturated fats and meals rich in carbohydrates and sugars. It is advisable to increase the intake of unsaturated fats, meals high fibre and fruit and vegetables. Moreover, physical activity for at least 30 minutes is necessary to maintain a healthy body mass index (BMI). Regulating alcohol intake and smoking cessation is also recommended. 

The Malta Medical Students’ Association (MMSA) standing committee on public health annually takes the opportunity on World Diabetes Day to raise public awareness about the prevention and management of diabetes.

This year, everyone is invited to join MMSA – Public Health live on their Facebook for a Q&A session on November 14 at 11am with Stephen Fava, a consultant physician, diabetologist & endocrinologist, head of diabetes and endocrine centre and chairperson of the department of medicine at Mater Dei Hospital.

Deborah Caruana and Sarah Anne Schembri are both second-year Medical Students at the University of Malta.



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