In Senegal, the overall prevalence of diabetes is 2.1%. Above the age of 45, it increases to 5.4%. Men are more affected than women with 2.5% compared to 1.6%. Diabetes is more common in urban areas with 2.9% compared to 1.3% in rural areas according to survey information (STEPS 2015). These statistics have evolved, according to the Ministry of Health and Social Action which has commissioned a new national survey on the prevalence of chronic non-communicable diseases, the publication of which is expected shortly. With World Diabetes Day being celebrated this Thursday, November 14, by the international community, the excuse is there to talk again about this evil which spreads terror. According to Doctor Abdoul Aziz Ly, Endocrinologist-Diabetologist-Nutritionist; Specialist in metabolic diseases and currently in service at the Tivaouane hospital in the Thiès region, diabetes is a chronic pathology, which is serious and constantly increasing. However, it remains underdiagnosed. The specialist believes that the management from diagnosis to follow-up through treatment should not suffer from any flaws because it is responsible for high mortality. To this end, Dr Ly maintains: “Real policies are necessary to master, control and prevent it.” Interview…
What is diabetes?
According to the World Health Organization (WHO), diabetes is a state of chronic hyperglycemia linked to a defect in the secretion and/or action of insulin, linked to genetic and/or environmental factors acting often in concert. This condition is characterized by a continuous disorder in the regulation of blood sugar levels, also called glycemia. This results in an excess of sugar or glucose in the blood and this is called hyperglycemia.
How does this hyperglycemia manifest?
When we eat, the sugar level in the blood increases, the carbohydrates are then transformed mainly into glucose. The pancreas detects the increase in blood sugar and secretes insulin. It works like a key and allows glucose to penetrate the cells of the body, into the muscles, into the fatty tissues and into the liver where it can be transformed and stored. Glucose then decreases in the blood. Another hormone, glucagon, helps release glucose when blood sugar levels drop. In case of diabetes, this regulatory system does not work.
What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes, which affects around 6% of diabetics, formerly called insulin-dependent diabetes (IDD), is usually discovered in young people including children, adolescents or young adults. Type 2 diabetes, which affects 92% of diabetics, generally appears in people aged over 40. However it can be early. Overweight, obesity and lack of physical activity are the leading cause of type 2 diabetes in genetically predisposed people.
Apart from these types of diabetes, have there been any others?
Other types of diabetes concern the remaining 2%. They are divided between gestational diabetes which develops during pregnancy, diabetes secondary to certain diseases or taking medications or even depigmentation.
How to detect diabetes?
As a general rule, everyone should be screened at least once in their life. Screening must be carried out by a fasting venous blood glucose test, carried out in the laboratory. Targeted opportunistic screening of subjects over 45 years of age must be carried out every 3 years. It must be reconciled every year if risk factors are present.
What are these risk factors?
Risk factors are generally excess weight, high blood pressure, familial diabetes when there are diabetics in the family; gestational diabetes or children with a birth weight of more than 4 kg, lipid profile disorders.
How to diagnose diabetes?
The diagnosis of diabetes can be made in the face of the cardinal syndrome: Polyphagia, Weight loss, Polydipsia, Polyuria. In diabetics, a deficiency of insulin is observed. Despite recurrent hyperglycemia, i.e. a particularly high level of glucose in the blood, the satiety signal does not reach the brain and hunger persists, leading to polyphagia. In the absence of insulin, the diabetic patient cannot metabolize carbohydrates. The cells therefore metabolize lipid and protein reserves, leading to paradoxical weight loss, despite the increase in oral caloric intake. Diabetes also induces a dysregulation of the hypothalamic thirst center leading to polydipsia (increase in absorbed liquids) and polyuria (increase in urine volume).
What treatment for diabetes?
The treatment of diabetes is based on a triad. You first need a rich, diversified and balanced diet. To this end, we recommend that the patient eat a “healthy and balanced” diet and avoid restrictions. Dietary advice is the distribution of carbohydrate intake into three meals at relatively fixed times. Therefore, it is necessary to favor foods rich in fiber including whole grains, consume fruits and vegetables every day, avoid consuming sugary drinks, possibly sweetened drinks, favor vegetable oils with unsaturated fatty acids, sources vegetable proteins such as pulses, nuts or animal proteins from fish and poultry but little red meat and derived products.
Alcohol consumption should be avoided. Apart from diet, regular, appropriate physical activity is recommended. In addition to contributing to weight loss, this involves increasing insulin sensitivity and reducing abdominal fat, even in the absence of weight loss. Diabetic patients are therefore recommended to take a brisk walk for 30 minutes five times a week. There is also oral or injectable drug treatment, particularly insulin. The treatment is constantly adapted to the patient’s profile and the progression of the disease. There is therefore no “single” treatment for diabetes but a set of measures that make up antidiabetic treatment.
What complications can arise from diabetes?
Diabetes is responsible for 6.7 million deaths worldwide, or 1 every 5 seconds. Complications of diabetes can result in blindness, foot damage which can lead to amputations, heart attacks, strokes, erectile dysfunction or kidney failure.
Speaking of amputation, is the diabetic foot very feared by patients?
In the most serious cases, foot sores can spread, worsen and become infected, sometimes leading to hospitalization or even amputation. People with diabetes have more fragile feet, we speak of “diabetic foot” to talk about the complications linked to diabetes and which appear in the feet. This fragility is due to several factors including poor blood circulation in the arteries of the lower limbs, reduced sensitivity in the feet and deformation of the feet.
When does a diabetic patient experience depression?
The risk of being depressed is twice as high in type 2 diabetics as in people who do not have diabetes. Psychological suffering leading to depression can appear at different times during the illness. It can manifest itself from the diagnosis, when a disability or pain appears, when switching to insulin treatment or when complications appear.
What is your plea to guardianship and state authorities?
Today, it is essential to raise awareness among the population of the benefit of knowing their glycemic status and define national screening programs. The authority must work to unite stakeholders through collaboration, including diabetics for the control of diabetes in Senegal under the leadership of the non-communicable diseases department of the Ministry of Health around a common program. What is missing is a common agenda with clearly defined goals and targets around which all stakeholders will unite and take action in their own areas of expertise. We must also integrate the prevention and management of diabetes into the framework of primary health care and universal health coverage in order to make medicines accessible at lower cost and establish screening at the lowest of the health pyramid. There must be an appropriation of diabetes by diabetics through the establishment of a national therapeutic education program.
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