Diabetes in Africa
The African continent counts approximately 13.6 million people with diabetes. The Africa Region of IDF, which mainly includes sub-Saharan Africa, counts approximately 7 millionpeople with diabetes. Estimates for the region for 2025 are likely to double and reach 15 million.
•Whereas Nigeria has the highest number of people with diabetes(with approximately
1,218,000 people affected)
•Nigeria also has the highest number of people with impaired glucose tolerance with an estimated 3,85 million people.
•The studies from Tanzania (urban/rural ratio of 5:1) and Cameroon (ratio of 2:1) both
confirm the marked urban/rural discrepancy in diabetes prevalence.
• It is estimated that undiagnosed diabetes accounts for 60% of those with the disease in
Cameroon, 70% in Ghana and over 80% in Tanzania.
Today, Type 1 diabetes, usually caused when the body’s own immune system mistakenly destroys the insulin-producing cells in the pancreas, is still the most common form found in children. But Type 2, often associated with lifestyle factors, rose 30 percent among 10- to 19-year-olds from 2001 to 2009, according to the Search for Diabetes in Youth study.
“A growing percentage of the state’s children ages 10-17 years are overweight or obese, exceeding the national rate for childhood obesity,” according to John Guzzardo, executive director of the American Diabetes Association’s Louisiana office. “Passive activities and our culture’s growing dependence on convenience foods are contributing to this. These negative factors are probably partially to blame for the increase of Type 2 diabetes in children
While Gungor has diagnosed a 6-year-old with Type 2 diabetes in her practice at LSU Health Shreveport, the most common age for diagnosis of Type 2 in children is 13 or 14, right around puberty.
“In puberty, kids produce a lot of pubertal hormones and growth hormone,” Gungor said. “Growth hormone usually works against insulin, so a child who has an intact pancreas would produce more insulin during puberty to overcome that physiological insulin resistance. A healthy pancreas is able to do that. But kids with risk markers are unable to make that adjustment.”
Among the risk factors for Type 2 diabetes are obesity or overweight, family history of diabetes and exposure to high glycemic levels in utero. “If a mother had diabetes during pregnancy, her offspring are at more risk to develop diabetes and conditions like obesity,” Gungor said.”
Mexican-Americans, African-Americans, Pacific Islanders and Asian-Americans also are at greater risk than Caucasian children, Gungor said. While Type 1 diabetes is more common among Caucasian children, Type 2 is more frequently found in ethnic minorities.
Guzzardo said the ADA recommends screening children ages 10 and over every three years if they have two or more risk factors for Type 2 diabetes.
“Red flags include a strong family history for diabetes, high-risk ethnic groups and signs of insulin resistance — fatigue, drowsiness after meals, intense mood changes, hypertension and dark skin patches on the neck and armpit areas,” he said.
The trend toward more pediatric Type 2 cases isn’t limited to the U.S., though. In many countries, children are growing up with a less active lifestyle and different diet than their parents.
“As countries become more industrialized, lifestyle changes,” Gungor said. “More hours are spent by parents at work, kids are at school. And there are cars. Kids are being driven everywhere. Most people try to park at the closest spot to the door. In older days, kids used to play outside a lot, but now there are other factors. There’s time, safety, there’s climate — too hot, too cold. And technology has advanced. We use smartphones, computer games, so kids spend more time in such activities rather than physical play.”
Food and drink also are factors.
“There’s an abundance of food. Food is available readily everywhere and with very small prices you can buy a lot of calories. And then, of course, there are beverages. I will refer to those as caloric beverages, sugar-containing or fat-containing beverages. Instead of water, most kids drink those.”
Gungor said it’s not uncommon when taking patient histories during clinics to find that a child is drinking 20 to 30 ounces of sugar-containing beverages a day. “Just by itself, that means they are getting a lot calories.”
Obviously, some risk factors for Type 2 diabetes are set at birth, but eating a healthy diet and leading an active lifestyle can perhaps prevent the disease or at least delay onset.
And that’s important because developing the disease at such a young age exposes an individual to harmful conditions over a longer period of time.
“The typical scenario is it is diagnosed in the 40s and 50s,” Gungor said. “Those individuals will have some complications, even after diagnosis. But now we are diagnosing this in teens, so we may be faced with kidney complications, eye complications very early on in life. It’s very, very sad, so that’s why I believe in prevention and I want to do more work on that.”
While the genetic factor for some children means it isn’t possible to prevent all cases, parents who help their children have a reasonable nutrition plan and an active lifestyle can improve the chances immensely.
“When I say healthy lifestyle, I’m not referring to organic food or expensive food,” Gungor said. “Maybe try to prepare most of the food at home with just regular ingredients instead of getting ready-made food all the time. Eating more fruits and vegetables, cooking from scratch as much as possible. I know lifestyles are very busy, but still there are things you can do. We don’t have to be gourmet cooks to do that, just basic ingredients and basic recipes can be very fulfilling.”
As part of a prevention initiative, a grant from the Blue Cross Blue Shield Healthy Green and Into the Outdoors project was used to recruit a nurse to serve as a lifestyle coordinator for patients with help from a nutritionist and to organize Children’s Healthy Weight and Activity Clinics. The team has also taken its healthy message into schools.
Gungor stressed the importance of setting a good example for children.
“Kids are very bright. They have great potential. We should try to teach them early on what to choose for their lunch tray and act as role models.”
But that is easier said than done.
“A big issue for children facing Type 2 diabetes is compliance, especially when the entire family is not committed to making lifestyle changes,” Guzzardo said. “Preventing, or at least delaying Type 2, would call for families to become more active and be more conscious of their food intake.”
Editor’s note: This is the second in a series about diabetes and its impact in our local community. On Wednesday, learn about diabetes and nutrition in our Flavor section.
Signs and symptoms of Type 2 diabetes
Type 2 diabetes in children may develop gradually. Some children who have Type 2 diabetes have no signs or symptoms. Others experience:
Increased thirst and urination. As excess sugar builds up in your child’s bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
Increased hunger. Without enough insulin to move sugar into your child’s cells, your child’s muscles and organs become depleted of energy. This triggers hunger.
Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight. Without the energy that sugar supplies to your cells, muscle tissues and fat stores simply shrink.
Fatigue. If your child’s cells are deprived of sugar, he or she may become tired and irritable.
Blurred vision. If your child’s blood sugar is too high, fluid may be pulled from the lenses of your child’s eyes. This may affect your child’s ability to focus clearly.
Slow-healing sores or frequent infections. Type 2 diabetes affects your child’s ability to heal and resist infections.
Areas of darkened skin. Areas of darkened skin (acanthosis nigricans) may be a sign of insulin resistance. These dark patches often occur in the armpits or neck.
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