Diabetes Voice Digital Issue November 2015 by International Diabetes Federation

November 2015

WORLD DIABETES DAY 2015 - HEALTHY EATING

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GLOBAL PERSPECTIVES ON DIABETES

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Diabetes Voice

Diabetes Voice Online - November 2015

DIABETES VIEWS For all types of diabetes, one common goal: healthy eating Elizabeth Snouffer

DIABETES VOICES Healthy eating challenges for diabetes self-management

THE GLOBAL CAMPAIGN Fighting for ‘Good food’ (Mai Wiru) John Tregenza

Revolution against sugar: Q&A with Jamie Oliver

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WORLD DIABETES DAY 2015 Diabetes advocates inspire action for WDD 2015

AstraZeneca: addressing gaps in diabetes care

Let’s make healthy eating a right, not a privilege

International Diabetes Federation Promoting diabetes care, prevention and a cure worldwide Editor-in-Chief: Rhys Williams Editor: Elizabeth Snouffer Editorial Coordinator: Agnese Abolina Design & Layout: Lorenzo Piemonte All correspondence should be addressed to: International Diabetes Federation Chaussée de La Hulpe 166, 1170 Brussels, Belgium Tel: +32-2-538 55 11 | Fax: +32-2-538 51 14 diabetesvoice@idf.org

Diabetes Voice is available online at www.diabetesvoice.org

© International Diabetes Federation, 2015 - All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without the written prior permission of the International Diabetes Federation (IDF). Requests to reproduce or translate IDF publications should be addressed to communications@idf.org. The information in this document is for information purposes only. IDF makes no representation or warrantires about the accuracy and reliability of any content in the document. Any opinions expressed are those of their authors, and do not necessarily represent the views of IDF. IDF shall not be liable for any loss or damage in connection with your use of this document. Through this document, you may link to third-party websites, which are not under IDF’s control. The inclusion of such links does not imply a recommendation or endorsement by IDF of any material, information, products and services advertised on third-party websites, and IDF disclaims any liability with regard to your access of such linked websites and use of any products or services advertised there. While some information in Diabetes Voice is about medical issues, it is not medical advice and should not be construed as such. Cover photo: © International Diabetes Federation

Diabetes Voice Online - November 2015 DIABETES VIEWS

For all types of diabetes, one common goal: healthy eating Elizabeth Snouffer In the following headlines, diabetes is mentioned, but what type is being discussed exactly? Given that there are different types of diabetes, how does the general public understand the difference when no distinction is made? • Five million adults in England at risk of diabetes • One third of diabetes in the US is undiagnosed • Blood pressure, diabetes, smoking among biggest killers in India: Study The media has a knack for using one word, diabetes, without distinction, to represent type 2 diabetes, and it is hard to blame them. Because the healthcare cost of diabetes worldwide is estimated to be USD 548 billion and because 90%-95% of the 400 million people with diabetes has type 2 diabetes, type 2 diabetes has become the leading global healthcare crisis of the 21st century, and therefore, important news to report. The general public should be aware by now that type 2 diabetes is caused by a genetic predisposition and, in the majority of cases, excess body weight and physical inactivity leading to the body’s ineffective use of insulin. Type 2 diabetes affects children and adults. Further confounding for the public’s understanding of the diabetes health crisis is the fact that type 2 diabetes is largely preventable for the millions of people at greatest risk with rather inexpensive measures such as education and behaviour modification, but it can be hugely expensive to treat with monitoring supplies, medicines, doctor visits, annual eye exams and other routine costs to keep complications at bay. The economic burden of type 2 diabetes is crushing and people feel angry and helpless. Type 2 diabetes is a medical illness, but it is also a social and economic condition with many variables at play. Unfortunately, news reports about type 2

diabetes and the obesity epidemic have become so prevalent that many outlets, in an effort to get the news out as fast as possible, supply poor or unclear information, giving rise to a timeworn effect. News reports about the type 2 diabetes crisis have nearly lost their power to inform or influence. That other 5%-10% of the 400 million with diabetes mainly constitutes children and adults living with type 1 diabetes, formerly known as juvenile diabetes. While exact numbers are hard to determine, in 2014 it was estimated that 500,000 children under the age of 15 years live with this this incurable disease. Type 1 diabetes is not yet preventable. It is an autoimmune disease that occurs when T cells attack and destroy most of the beta cells in the pancreas that are needed to produce insulin. Since the body no longer produces insulin (or produces insufficient amounts), children and adults diagnosed with type 1 diabetes must inject insulin for survival, for life. Many people living with type 1 diabetes aren’t happy that there has became one catch word to represent two diseases for the very simple reason that it confuses the public and reduces important factors related to type 1 diabetes awareness, research and funding. If the diagnosis of a child suffering from type 1 diabetes is delayed, it takes only weeks for severe consequences to set in such as cognitive impairment or ketoacidotic coma which can be fatal. The consequences of high blood glucose for a child or adult with undiagnosed type 2 diabetes are demonstrably less severe, although serious complications can form within years. The differences are important, but there are many common goals for people living with all 3

Diabetes Voice Online - November 2015

types of diabetes. The most important goal for people living with all types of diabetes is to achieve an individualised and safe target as close to normal glycaemia, which for people who do not have diabetes is 4.0 to 5.9 mmol/L (72 mg/ dL to 106.2 mg/dL). HbA1c targets can range from <6% to 7.5% and depend upon a personalised treatment plan. While the targets are similar, the therapeutic pathways to achieving targets can be very different for type 1 diabetes and type 2 diabetes. An adult living with type 2 diabetes may be required to lose a considerable amount of weight to reduce insulin resistance. A young adult with type 1 diabetes may be required to both test blood glucose and inject insulin more than 12 times a day to achieve blood glucose targets. Neither of these tasks related to self-management are easy, but they are different. Achieving targets takes a great deal of individual initiative, discipline and support. No type of diabetes is more or less serious; all types of diabetes are difficult and equally weighted with devastating complications if they are not treated. There is, however, one very common objective that people living with all types of diabetes share and that is a commitment to healthy lifestyle behaviours, including a commitment to healthy eating. A commitment to healthy lifestyle behaviours makes achieving targets possible. (Although it is acknowledged that access to healthy fresh foods is not always possible for people who do not have the means to afford this privilege.) A person living with type 1 diabetes who eats a diet high in processed foods (which tend to be high in sugar, fat and salt) without a healthy level of physical activity is going to have a very difficult time making their targeted HbA1c and avoiding 4

complications. The same is true for a person living with type 2 diabetes. Recognising the differences between types of diabetes is very important to maximize appropriate awareness, diagnosis and treatment. It is important that people at risk for type 2 diabetes understand that, for the most part, the condition is preventable. It is also important for people diagnosed with type 1 diabetes to understand that their disease requires a life-long commitment to a 24/7 schedule of insulin injections and blood glucose monitoring for survival. Perhaps the time has come for the type 1 diabetes community and the type 2 diabetes community to support each other by recognising equal but different challenges in attaining normal glycaemia with a united commitment to healthy eating and other healthy lifestyle behaviours such as physical activity. This yearâ&#x20AC;&#x2122;s World Diabetes Day, will focus on healthy eating as a key factor in the fight to prevent type 2 diabetes and to treat all types of diabetes. This issue of Diabetes Voice is dedicated to discussions about healthy eating and healthy foods access from people living with type 1 diabetes and type 2 diabetes and communities struggling to find sustainable solutions. We also report on the latest news for World Diabetes Day events and activities worldwide. To all people living with all types of diabetes, letâ&#x20AC;&#x2122;s stand together and support each other, recognizing our differences, yet united in action for healthy eating as a cornerstone of wellness and sustainable development. Letâ&#x20AC;&#x2122;s unite for a better tomorrow. Elizabeth Snouffer is Editor of Diabetes Voice.

Diabetes Voice Online - November 2015 DIABETES VOICES

Healthy eating challenges for diabetes self-management Elizabeth Snouffer What is healthy eating? A healthy lifestyle involves many choices and for all people in our modern world today choosing balanced nutrition is a priority to live a long healthy life. Generally, it is recognized that a healthy eating strategy emphasizes vegetables, fruit, whole grains, lean meat and foods low in salt and added sugar. For people living with all types of diabetes, a healthy eating plan is extremely important to meet blood glucose targets and avoid complications related to untreated or poorly managed diabetes. When a person is first diagnosed with diabetes, this is one of the most significant self-care messages from healthcare providers worldwide, and much of what is said in the healthcare setting about nutrition and diabetes is delivered as common sense. However, it is also commonly appreciated that it can be a challenge to put healthy eating, which sounds so simple - even easy, into practice. Add insulin therapy into the mix, required for people living with type 1 diabetes, and matters become much more complex. Careful coordination of carbohydrate intake with medication, physical activity, and other variables including stress must be prioritized to manage blood glucose levels, and for many, survival. In support of the International Diabetes Federation’s (IDF) World Diabetes Day 2015 campaign, which recognizes healthy eating as an important part of the effective management of all types of diabetes, we asked individuals living with diabetes to discuss their greatest challenges related to making the right food choices and sticking to a strategy. In the following contributions, we hear from people who are making a total effort to self-manage diabetes successfully, which for so many millions requires 24/7 vigilance and discipline. CHARLES MATTOCKS (USA) Celebrity chef, film maker and global diabetes advocate, diagnosed with type 2 diabetes in 2011

I was recently at the doctor for a follow up visit. We discovered that my HbA1c was higher than it normally would be and that I had protein in my urine which can be an early sign of kidney disease. Needless to say, I was worried.

don’t need.

As much as I help and share other people’s stories about living with diabetes, I am now becoming a story of my own. Let’s be honest here, I know what I should be doing for my type 2 diabetes and at times, like many other people with diabetes, we just don’t do what’s right for our condition. It’s time to get back on course! My first step is to lose the extra 15 pounds that I

Diabetes Voice Online - November 2015 don’t need. I should be at my ideal weight and that’s that. So I need to start with a plan that allows me to lose 15 pounds and then maybe I can shed more. What works for me is a low carbohydrate, low sugar, and low starch meal plan. A few months back I recently lost 12 pounds and it was primarily from lots of walking! In order to achieve that, I was walking about three times a day for about forty minutes per walk. I drank nothing but water and was eating lean meat and vegetables. As a celebrity chef, it can be hard staying away from the food - heck it can be hard for anyone to stay away from the table. Food is truly a drug that can be used for good and for bad. When society accepts that healthy eating and an active lifestyle can make a positive change then we will be in a much better place. I always go back to what a healthy food choice is for me and my type 2 diabetes. I start with what God gave us and go from there. We can’t go wrong with loads of vegetables and water. We can’t go wrong with small portions of lean meat and limit our total intake. Let’s face it, when I am back in my home country of Jamaica, I go crazy at times. I love curried goat and ackee and salt-fish, the national Jamaican dish! I know some Jamaican foods are the cause for many people suffering in the Caribbean

islands with high cases of type 2 diabetes. But in reality, when I get there I actually slim down a bit because I go on a fresh food diet. If I need to eat on the go, I will make a small meal, like some egg whites or some curried chicken. Now that’s mostly protein and vegetables, low in calories, but these choices still have that great taste. When I am out with friends or family, that can also be an issue that haunts us. I always suggest sticking to quality vegetables and protein. I suggest that people with diabetes grab a steak or some lean chicken, because these options can be tasty but still healthy. Also, grab some steamed veggies instead of the rice, and always make sure your portions are small. Don’t forget if you live with diabetes, you need to make sure what you do today, won’t hurt you tomorrow. Fortunately, I got back to my healthy ways again with a smile on my face and I’m down a few pounds in only a few days and counting. I also got my medical tests back and it’s all clear. I must admit I was very nervous and I know those test results were a wake-up call for me. I don’t miss some of the bad choices I make from time to time and with the holidays coming up, I want to make sure I am heading in the right direction.

HÉLÈNE COLON-RAPHAEL (USA) Grandmother, diagnosed with type 1 diabetes at 23 years

There are many challenges in having diabetes, but I faced one big hurdle when it comes to healthy eating and being social. I declined invitations to friends’ homes because I was afraid of what I was going to be challenged to eat and how it was going to affect my blood glucose. Now, I accept social invitations, with the caveat that I am allowed to bring a dish or a beverage. Bringing something for myself to eat is reassuring knowing that there is something I will feel comfortable eating or drinking. It is important for me to know how certain food or drink will impact my blood glucose and when I do know the number of carbohydrates in my food, I am able to 6

properly dose my insulin. Sometimes I will bring an appetizer, side dish or a beverage, and I make sure I know how many carbohydrates are in each. Otherwise, it is very difficult. I will have to guess, or ask the host what exactly is in each dish which can lead me to take either too much insulin or too little insulin. When deciding on an item to bring to a host’s party, I typically bring homemade hummus, shrimp cocktail, white bean stew or low calorie/no sugar added margaritas. With my strategy, going out socially means I have lower stress, and I can enjoy visiting friends and family at their home.

Diabetes Voice Online - November 2015 KATE CORNELL (USA) Writer, diagnosed with type 2 diabetes at 50 years

My diagnosis of type 2 diabetes changed a lot of things for me, but the biggest change related to food. Everything revolves around food in our society, which makes eating with type 2 diabetes more challenging. Challenging, but not impossible. The way I eat now is dramatically different than the way I ate ten years ago but those changes didn’t happen overnight. Type 2 diabetes is a progressive condition and, therefore, I have made progressive changes to the way I eat. One change at a time. As luck would have it, most of my favourite foods became difficult for me. I couldn’t keep my blood glucose levels where they needed to be if I ate bread, pasta, cereals and potatoes. Some fruits also became off-limits. It was necessary for me to remove those things from my food plan because I do not use insulin to manage my diabetes. Finding alternatives made living with these food changes much more bearable. Alternative flours, such as almond and coconut, allowed me to make breads, cookies and cakes that didn’t spike my blood glucose. Replacing pasta with spaghetti squash or

zucchini made a huge difference! Some might say that I am now following a low carb diet, but I prefer to call it a “no processed carb” diet. I’m choosing to eat whole foods that I (mostly) cook myself as opposed to processed meals or foods that contain too much of what isn’t good for me. I’m fairly successful at home, but eating out, travelling or attending social functions add a layer of difficulty to my food choices. I choose to eat a sandwich with a fork and knife, avoiding the bread. I order cottage cheese or sliced tomatoes instead of potatoes. I travel with my own snacks so that I can avoid fast and convenient foods. Attending a celebration means loading up on salad and having only a taste of that birthday cake. These may seem like sacrifices but I no longer feel deprived. I’m happy to be eating in a way that has made me healthier and will hopefully help prevent complications down the road. I’m lucky to live where I have choices. Visit Kate’s blog on living with diabetes.

JOÃO VALENTE NABAIS (PORTUGAL) President of IDF Europe, diagnosed with type 1 diabetes at 12 years

I have been living with diabetes for 35 years. On my journey, I have witnessed several changes in the way food was taught to be managed for insulin therapy. Back to the beginning of my diabetes, treatment was based on one insulin shot of slowacting insulin, and the advice was to base the “diet” (yes it was a “diet”!) on vegetables, meat and fish with only a small portion of carbohydrates. Sweets and similar food were the devil and to be used only for hypoglycaemia episodes (low blood glucose events). With the evolution of diabetes treatment options, including new insulin and monitoring devices, a new world opened up to me. This evolution was extremely positive in all aspects and the freedom to choose a variety of foods is only one of them. But new challenges came along! How can I choose

healthy food with all opportunities available? Carbohydrate counting is like a game, in particular when I am travelling abroad and the food is unfamiliar. Adjusting the insulin dose correctly to exercise and food can sometimes feel like a horror movie. There are apps for smart phones, devices to evaluate the food content and a panoply of tools 7

Diabetes Voice Online - November 2015 to help people with all types of diabetes. I use a few of those to base my decisions, but most of the time I use my experience and what I have learned from other people with diabetes and healthcare providers. Sometimes you make good choices, sometimes not. But, this doesn’t make you a bad person, only human! I try to plan my meals as carefully as possible in order to include healthy ingredients for both food

and drinks (water is the first choice along with red wine or beer) but all have to be tasty and enjoyable. When I travel I like to experience the local food, which can be tricky because most of the time you don’t know the fat or carbohydrate content. For me, this is not a problem as I can always readjust my insulin dose afterwards or eat a sugary supplement (that we must carry all the time) to ensure my blood glucose doesn’t go too low.

SCOTT JOHNSON (USA) Diabetes advocate, diagnosed with type 1 diabetes at 5 years

I believe that learning more about healthy eating would be good for me. It would give me an additional set of tools to manage my blood sugar, and my overall health. Essentially, I’ve allowed myself to look the other way when I eat something unhealthy, especially if I can manage my blood sugar by doing fancy tricks with my insulin. I tell myself it’s OK because diabetes is all about blood sugar management, right? No. I’m justifying unhealthy eating behaviour and using blood sugar as an excuse. Honestly, I’m intimidated by the idea of learning about food. The endeavour seems overwhelming, with conflicting opinions and misinformation throughout the journey. Where do I start? Who do I trust? People living with type 2 diabetes successfully are my heroes here. Their most influential tools are

often food and activity. They may not know how much I admire them or look to them for inspiration and leadership. Why? Because I imagine, at diagnosis, they also had little interest in learning about food. It may have even been an emotional trigger evoking the diagnosis experience all over again. And now, here they are, the challenge overcome, using the power of healthy eating to manage their health. They are setting examples that can often serve us all well, regardless of what type of diabetes we have. I have much to learn from my friends in the community living with type 2 diabetes. Thank you for being brave, inspirational type 2 diabetes leaders. I am ever grateful to you. Visit Scott Johnson’s blog.

DICKY POON (HONG KONG) Student, diagnosed with type 1 diabetes at 6 years

In 2014 I joined a Youth Diabetes Action bike tour for 8 hours a day over a period of nine days. The greatest challenge was managing continuous and vigorous exercise on insulin. During the latter part of the journey, my daily insulin usage actually decreased by 40%! The greatest threat was hypoglycaemia, and even delayed effects of low blood glucose at night. Even with all these challenges, I believe that regular exercise, insulin therapy and managing food all go hand-in-hand. One of my challenges related to eating with 8

Diabetes Voice Online - November 2015 diabetes is how to calculate the amount of carbohydrates in food when eating out at a restaurant or having take-away. In Hong Kong, there are so many restaurants providing different cuisines. One type of food, such as noodles, can be cooked in so many ways with a huge variety of sauces and seasonings, which usually contain sugar. As a result, every time I visit a restaurant where I have never been before, I can only guess the amount of carbohydrates in those dishes, and I often underestimate, which results in a higher blood glucose value. Overall, the food choices available and affordable for students like me on a budget here in Hong Kong are usually not healthy. What I can do is to eat “less unhealthily” and choose dishes with enough meat,

vegetables with less salty or less sugary sauces if possible, and avoid cold drinks which usually contain a large amount of simple sugar. Maybe this challenge can be overcome by bringing packed lunch to school or workplace, which can be prepared at home with the accurate number of carbohydrate calculation for easy insulin dosing at mealtime. Yet, having lunch with friends, classmates or colleagues is a crucial part of my social life, and everyone enjoys eating out. It’s a hard decision to sacrifice my social life for a healthier diet. It’s important to mention that most people don’t care if I have diabetes or not, as it is not the most important characteristic of myself. Generally, I think most of the pressure comes from ourselves.

Diabetes Voice Online - November 2015 THE GLOBAL CAMPAIGN

Fighting for ‘Good food’ (Mai Wiru) John Tregenza In the Western Desert nations of Central Australia, the Pitjantjatjara, Ngaantyatjarra and Yangkunytjatjara people reside on the Anangu Pitjantjatjara Yankunytjatjata (APY) Lands, and refer to themselves as the Anangu (people). Like so many colonized indigenous peoples of the world, the Anangu suffer from poor health, malnutrition and now face epidemic proportions of type 2 diabetes. According to the United Nations Economic and Social Council, type 2 diabetes places the very existence of indigenous communities at risk. Improving food security and turning around the long-standing poor health outcomes for indigenous people in remote communities like the Anangu is a priority for their survival. The Anangu people have endured the loss of access to natural resources, including access to traditional foods, and have now come to rely on foods high in fat, sugar and salt produced, delivered, and distributed by commercial outlets servicing remote areas. Remote communities like the Anangu have come to rely on their local food stores for the vast percentage of their daily food intake. These “convenience”

stores have historically failed to provide nutritional and affordable food to the communities, for many reasons including remoteness and transport costs, lack of effective refrigeration and storage, and maverick unqualified store managers. In the same time frame, western style diseases or non-communicable diseases (NCDs) have increased and over the past two decades end stage renal failure has become endemic in remote communities. As a result, people on the APY Lands are living in a society where type 2 diabetes, obesity, renal failure and death from lifestyle diseases have become a part of the modern community. The most common social event on the APY Lands is a funeral. Evidence suggests that that improving the supply and consumption of healthy food in remote indigenous communities is mandatory to reduce the high levels of preventable diet-related chronic disease, including type 2 diabetes, suffered by indigenous Australians in these locations. In fact, it is estimated that up to nineteen per cent of the national indigenous health

Diabetes Voice Online - November 2015 gap is attributable to diet related causes, including low fruit and vegetable intake. In remote communities, where the external economy is limited to running some cattle and art making, the need for government subsidies for communities like the Anangu is unavoidable to make food affordable for people living below the poverty line, to provide nutrition and health education programmes in the stores and communities and to carry out maintenance and renovations on Anangu houses to ensure residents have functioning kitchens so they can prepare, cook and store nutritious foods. Mai Wiru (Good Food) The cost of treatment and management of the hundreds of people with diabetes is a constant issue for the Anangu community controlled Aboriginal Health Service that is responsible for Primary Health Care on the APY Lands. The level of government funding to the Health Service precludes the necessary public health education and promotion services. Approximately 20% of regular healthcare participants (all ages included in this statistic) of the Nganampa Health Council have diagnosed type 2 diabetes and prevalence increases with age. The majority of APY residents on renal dialysis have type 2 diabetes. “The rates of obesity and insulin resistance syndrome in our communities are now so high that the majority of the adult population over 35 will be affected. This provides a situation in which we are not aiming to target a subset or at risk group of the population with a nutrition strategy but our whole population is both at risk and suffering disease. This is why an effective and sustainable stores service will be an essential prerequisite for changing the health profile in this region,” says Dr. Paul Torzillo, Medical Director of the Nganampa Health Service. Understanding their challenges, the people of the Anangu took the issue of food security into their own hands. Between 1998 and 2003, the regional Anangu organisations Nganampa Health Council and Ngaanyatjarra Pitjantjatjara Yankunytjatjara

Women’s Council developed a Regional Stores Policy, Mai Wiru, (Good Food), to take control of the delivery of food and nutrition to Anangu community stores in an effort to ensure access to affordable healthy foods on a daily basis. Today, the Mai Wiru Regional Stores Council has established a commercially efficient and responsible business model and operation for their local stores. While the Mai Wiru Regional Stores Council, and the people in the community, have benefitted from hard work and success in bringing healthier, fresh food to Central Australia, reduced government support has become a barrier to the fulfilment of goals. In sum, without support, development and implementation of the Mai Wiru policy have not been sustainable and, therefore, progress for health and wellness and the push to reduce NCDs, such as type 2 diabetes, has stalled. Early on in the implementation of Mai Wiru the organisers had a saying “It is not about money, it is about health,” but commercial imperatives have reduced the impact for the provision of fresher and more nutritious food. Providing food at an affordable price in these circumstances, without government support and without outside contributions, means the community has no resources to fund the necessary health education programmes required to help people make informed choices about nutrition and pathways to healthier lives. The documentary That Sugar Film recognised the efforts of Anangu taking control of their community stores as a health initiative. The producers 11

Diabetes Voice Online - November 2015 of that film set up the Mai Wiru Sugar Challenge Foundation to support the Mai Wiru Regional Stores to educate and employ Anangu to work in the local stores to help residents make informed decisions about their diet and nutrition, especially in relation to the amount of hidden sugar in food. All State and Federal Departments involved with Aboriginal communities are aware of this situation. Government Ministers and bureaucrats from bottom to top have been lobbied regarding this. Sadly, their response has been underwhelming. Type 2 diabetes and the indigenous peoples of Australia Overall, type 2 diabetes is around three times more common among indigenous people than among other Australians. According to the Australian Aboriginal and Torres Strait Islander Health Survey (updated results, 2012-13) type 2 diabetes is diagnosed in indigenous people at a younger age than non-indigenous people: in the report 5% of indigenous people aged 25-34 years had type 2 diabetes, and up to 39% of those aged over 55 years had the disease. (see Figure 1) It is also worth pointing out that type 2 diabetes is more common for indigenous people living in remote areas than for those living in non-remote areas. Type 2 diabetes is the second leading cause of death for indigenous people; ischemic heart disease is the number one cause of death. Individuals of the Anangu who reach the stage of kidney failure have to leave their communities for dialysis or die at home. The nearest dialysis facility, located in Alice Springs, is anywhere from 450 kilometres (kms) to 800 kms. The Alice Springs dialysis centre is reportedly always full, and many Anangu now have to relocate even further away to Adelaide to receive life-saving care â&#x20AC;&#x201C; a distance up to 1,800 kms from their homes. Many Anangu families in this situation spend all year travelling up and down the Stuart Highway just to maintain family structure and security for survival. Social dislocation caused by diabetes complications such as kidney dialysis is profound. The patient 12

Figure 1: Type 2 diabetes prevalence in indigenous and nonindigenous population (Source: Australian Bureau of Statistics, 2014)

experiences isolation and loneliness in a strange and foreign environment far from family, language and cultural events. Cultural identity suffers from the loss of teaching and learning from one generation to the next. If family members follow their loved ones to the city, the social problems of an impoverished, unemployed and uneducated racial minority in a modern western city creates problems and places significant pressure on family members. The distress for individuals, families and the community contributes to the burden of trauma and grief of a marginalised people. Recently, a nephew informed me from Alice Springs that my brother-in-law advised hospital staff that he does not want dialysis, preferring to go to his family to die in his homeland. Events and decisions like this are a daily occurrence in remote Aboriginal Australia.

For more information: That Sugar Film The Mai Wiru Sugar Challenge Foundation About the Author John Tregenza has over thirty yearsâ&#x20AC;&#x2122; experience working in community development in urban, rural and remote settings. The great part of his work has been in very remote Aboriginal communities throughout Central Australia, from Yalata on the Great Australian Bight to Balgo in the Kimberly. His work has focused on developing Aboriginal community-controlled organisations to address primary health and community social needs.

Diabetes Voice Online - November 2015 THE GLOBAL CAMPAIGN

Revolution against sugar: Q&A with Jamie Oliver Earlier this year, Jamie Oliver got fired up about sugar consumption in the United Kingdom. This led him to produce “SugarRush”, a TV documentary that shows just how devastating the effects of consuming too much sugar can be for millions of people worldwide. Jamie’s determination to put an end to the obesity and type 2 diabetes crisis in the UK has driven him to petition the UK government and parliament for a tax on sugary drinks. If the tax gets passed, it could provide GBP 1 billion (USD 1.5 billion) per year to support much needed preventive strategies relevant to childhood obesity and type 2 diabetes in the UK’s National Health Service and schools. But it’s not just the UK where Jamie is pushing for action! #FoodRevolutionDay is a global campaign to put compulsory practical food education on the school curriculum. Jamie passionately believes that by educating children about food in a fun and engaging way, we can equip them with the basic skills they need to lead healthier, happier lives for themselves and their future families. The International Diabetes Federation (IDF), the Food Revolution Team and of course, Jamie Oliver are collaborating to Act today to change tomorrow and create healthier eating habits, better access to food education and to bring about greater awareness of type 2 diabetes. We had an opportunity to speak to Jamie about his mission and his work with IDF to see what’s cooking! When was the tipping point for you in deciding to take action against sugar consumption both in the UK and worldwide? I’ve been campaigning for better food education for many years now and Food Revolution Day is really the annual focus for that, but I’ve got teams working on various campaigns every single day. A couple of years ago I started talking to medical experts, really clever people, and they all said the same thing: sugar is a major, major problem, putting many people, particularly kids, at great risk for type 2 diabetes. As a reflection of the problem, many children are being admitted to hospital for multiple tooth extractions. Once I’d started to get deeper into the subject, I uncovered this massive, terrifying health crisis. What has been the public reaction to your campaign? Incredible. I started a petition to get the British government to bring in a sugar tax on sweetened fizzy drinks. You need 100,000 signatures before they will even consider a debate, and we hit that

within two days of the TV documentary being screened. The British media has also been great, by and large. Plus, since we started our own, selfimposed sugar levy in my restaurants, we’ve only had one complaint as far as I know. What has been the most riveting moment for you in observing or seeing first-hand the devastating effects of sugar consumption? There have been many, but I think the most difficult moment was watching six-year-old Mario having his teeth extracted under general anaesthetic because they had simply rotted away due to his love of fizzy drinks. What’s a kid of six doing drinking so many fizzy drinks? That’s my first question, but then you find out that this happens to 26,000 British children of primary school age (four to 11) every year. It’s shocking. Thousands of people have signed your petition against sugary drinks calling for a sugar tax on soft drinks with added sugar in the UK and 1.6 million people 13

Diabetes Voice Online - November 2015

have signed the petition for Food Revolution Day. What other initiatives are you planning to raise awareness for obesity and diseases related to obesity, such as type 2 diabetes? Our Food Revolution campaign lives on long after Food Revolution Day! My Food Revolution team continues to raise awareness and provide people with knowledge and resources across our social media channels every day. Amazingly, we have over 2,000 ambassadors in over 110 countries who are our eyes and ears on the ground and help us make noise all year round by working on local initiatives – whether it’s tackling the food served at home, at school or at work, or through passing on their food skills and knowledge to others. From Uruguay to the Netherlands and the USA to Jordan, our ambassadors are out in their communities doing really amazing things. In the UK we are campaigning for our government to announce a strong childhood obesity strategy with clear initiatives aimed at reducing obesity rates across the country. We are also working closely with Brighton Council and the Brighton and Hove Food Partnership (UK) to pilot a brand new 14

scheme called “Sugar Smart City”. It’s a city-wide strategy with many different initiatives – involving businesses, schools, restaurants and food outlets – aimed at increasing awareness of the effect that too much sugar can have on the body, and we are hoping to have a real impact on the consumption of sugary drinks. We will also be launching food education programmes in every primary school across the city, to give every child the knowledge they need to grow up making healthier decisions that will have a long-term impact on their lives. We are hoping that the Sugar Smart City initiative will be able to be replicated in other cities across the UK. Also, through the Jamie Oliver Food Foundation, we have hands-on programmes in communities and schools throughout the UK to empower and teach people how to cook – these are year-round programmes, and honestly, they bring the food revolution to life every day. Of course we’re also working on our plans for Food Revolution Day 2016 and our global advocacy strategy to help turn all those signatures into real changes, so watch this space!

Diabetes Voice Online - November 2015 For World Diabetes Day 2015, what special activities are planned to support IDF’s campaign for “Healthy eating and diabetes?” IDF’s focus on healthy eating, a key factor in the fight against type 2 diabetes and a cornerstone for health and sustainable development, is a really good fit with my campaigns and the community that we’ve built through the Food Revolution. Last year, IDF’s theme was healthy breakfast, so we shared my South American style brunch, and encouraged people to get cooking from scratch. We’ll be supporting World Diabetes Day on 14 November again this year across our social media channels, sharing resources, recipes and content from the World Diabetes Day team to inspire people to use healthy eating as a way to take control of their health. And in the leadup we’ll be encouraging our global community, especially our ambassadors, to get involved. Helping to prevent type 2 diabetes is something that I am really passionate about, so it’s good to get our community behind this initiative, too.

healthier cooking. Ninety percent of diabetes cases are type 2, which is largely preventable, and what we eat and how we look after our bodies has a huge impact. Implementing public health strategies and support to tackle childhood obesity will also tackle type 2 diabetes, as the two are so closely linked. World Diabetes Day and the IDF call on national governments to implement policies to reduce sugar consumption and advocate specific measures to increase access to healthy alternatives, such as fresh fruit and vegetables and clean drinking water in order to help prevent new cases of type 2 diabetes. Essentially, we’re working towards the same thing – a healthier world. It’s key that we arm future generations with the life skills they urgently need in order to lead healthier, happier, more productive lives. I passionately believe this is every child’s human right and I hope you agree.

400 million people live with diabetes today. Act today to change tomorrow is a call-toaction campaign targeting G7 countries to stop the serious rise in diabetes prevalence worldwide by implementing public health strategies and support. What is the link between the #FoodRevolutionDay campaign petition directed at G20 countries for nutrition education in schools and IDF’s call to action? I think better food education is key and our research proves it. As you know, we have a Kitchen Garden Project in the UK which helps schools to grow food and use it in lessons. We know from experience that this leads to healthier, happier kids who concentrate better in the classroom. In addition, Ministry of Food Centres in the UK and Australia, and research done by Deakin University in Melbourne reveal that if you teach people to cook from scratch then their health improves, their confidence improves and naturally they’re also improving the health of their families with

For more information: Healthy Eating and World Diabetes Day SugarRush and the petition Food Revolution Day Jamie Oliver is a phenomenon in the world of food. He is one of the world’s best-loved television personalities and one of Britain’s most famous exports. Jamie has inspired people to spend more time enjoying cooking delicious food from fresh ingredients – and even start growing their own food. His Jamie Oliver Food Foundation campaigns globally for better food education for all. Jamie lives in London and Essex with his wife, Jools and his kids, Poppy, Daisy, Petal and Buddy. 15

Diabetes Voice Online - November 2015 WORLD DIABETES DAY 2015

Diabetes advocates inspire action for WDD 2015

World Diabetes Day (WDD) is the world’s largest diabetes awareness campaign reaching a global audience of over 1 billion people in more than 160 countries. Every year since 1991, WDD focuses on a new campaign theme to address the most significant issues facing the global diabetes community. This year, WDD has become a year-long campaign to reflect the realities of people living with diabetes and focuses on healthy eating as a key factor in the fight against diabetes. WDD 2015 primarily addresses key opinion leaders and stakeholders of the global diabetes community. However, one thing is clear, World Diabetes Day would not be what it is today without the support of IDF’s Members, volunteers and all people connected to diabetes – people living with all types of diabetes, their families, healthcare professionals and more.

Diabetes Voice asked two members of our Young Leaders in Diabetes Programme (YLD) to tell us about their activities for 2015. Hisako Saito (Japan) and Kayla Brown (Canada), like all participants in YLD, work to raise awareness of diabetes and use their platform to advocate prevention, education, access to quality care, and improved quality of life. Hisako has been involved in a national contest especially tailored to the improved nutrition of people with diabetes, where fresh ingredients are the staple. Kayla has dedicated her energy to finding a positive outlet for young women with type 1 diabetes. Likewise, we called on two leading IDF Members to present their WDD events, past and present. The Sociedade Brasileira de Diabetes (Brazil) lights up their nation in blue for diabetes awareness to an extent unlike any other country in the world. The Chinese Taipei Diabetes Association has created a huge buzz with its four-day diabetes cycling event. We hope these contributors inspire you as much as they have inspired their national and local diabetes communities! 16

Diabetes Voice Online - September 2015

CELEBRATING RECIPES WITH LOCAL, SEASONAL FOODS Hisako Saito, IDF Young Leader in Diabetes (Japan) In October 2015, the Japan Association for Diabetes Education and Care conducted a Healthy Recipe Contest aimed at students studying nutritional science in keeping with the World Diabetes Day theme for this year, “Healthy Eating and Diabetes.” The contest was developed to encourage the creation of a variety of healthy food recipes for people with diabetes. There was a lot of enthusiasm for this programme! We received 223 applications from 64 universities and colleges in Japan.

What made the winning recipes so popular? They were the most nutritious and tasty! Fresh seasonal foods are available in food markets for a better price than out-of-season produce and therefore more cost effective for home budgeting. The contest meals were all very colourful and reflected wholesome nutrition in green, red, and yellow. It has become well recognised that colourful plated food signals a well-balanced and nutritious meal. Plus, it is more appealing to the palate.

We divided the contest into recipes for breakfast, lunch and dinner and contest participants were asked to develop a menu for each meal. Recipes were evaluated in part on their ease and simplicity because we wanted to ensure people with diabetes could learn how to prepare the recipe creations on a daily basis. Common ingredients for a normal Japanese diet were encouraged and items like artificial sweeteners or non-fat dairy products were not allowed.

After winning the best award, Keito Asanabe, told the crowd, “It’s sad if a person with diabetes can’t enjoy the same food for family meals. I made dishes for the competition that can be happily shared by everyone.”

Many of the participating students brought fresh vegetables, soybeans and chicken from their home regions to cook in the final round of the contest in Tokyo. Participants were very proud of local ingredients and participants wanted to share the goodness of seasonal vegetables and fruits.

Do you think you eat differently from others because you have diabetes? I live with type 1 diabetes and I don’t believe in this idea of “diabetic foods.”A healthy diet is an important part of preventing type 2 diabetes and effectively managing all types of diabetes, but what people with diabetes are asked to do is simply eat healthy foods and this is the same advice given to everyone. A good plan for sustainability, health and pleasure is to eat locally grown foods in season, create colourful dishes and enjoy them with your family and friends.

Diabetes Voice Online - November 2015

BRAZIL BRINGS DIABETES AWARENESS TO LIGHT Maria Izabel Homem de Mello on behalf of the Sociedade Brasileira de Diabetes The Sociedade Brasileira de Diabetes’s call to action for 2015 leading to World Diabetes Day is encouraging people with diabetes to practice healthy habits which can result in better blood glucose control for all! A range of activities will be facilitated by Sociedade Brasileira de Diabetes as a means to strengthen this message and help people get into action for diabetes. Recently we encouraged people with diabetes to show results of their blood glucose measurements on our association fan page, and had a great response. We also promoted a healthy cooking competition called “Sweetening without Sugar” which was broadcast on major television outlets, including a showcase on the “Program Dia, Dia” show. We are also excited to announce that we have many iconic locations lit up in blue for diabetes on November 14, 2015. In Rio de Janeiro, the following will be brilliant blue: the Maracanã Stadium with a diabetes screening campaign; the 30 metres (98 feet) Christ the Redeemer Statue (Cristo Redentor) and Sugarloaf Mountain Peak (Pão de Açúcar). In Sao Paulo, we will have the Octávio Frias de Oliveira Bridge (a cable-stayed bridge that is 138 metres tall (453 feet) as well as other locations throughout Brazil.

To promote diabetes education and awareness to the general public of Brazil, we will distribute diabetes information packets at toll roads where there is a large influx of vehicles. The information packets will consist of four topics, one delivered for each week of the month of November. The 1st week will focus on food; the 2nd week of November will look at oral medicines; the third week will focus on insulin therapy; and the last and fourth week will address “body care” issues for people living with diabetes. On November 14, we will hold an interactive flash mob with a symphonic orchestra playing in public places. This World Diabetes Day event will be recorded on video and published on social networks. Look out for it! Our supporters will also be excited to see that we will distribute diabetes communication material throughout Brazil. These promotional items always get a great response from the public and include: posters, t-shirts, headbands, pins and bracelets. Many of these items are available for free and can be downloaded from our website. Many of these t-shirts and headbands will be worn with pride during running and walking events for diabetes awareness held at the 20th Brazilian Diabetes Congress in November 2015 .

Diabetes Voice Online - November 2015

EMPOWERING TEENS WITH TYPE 1 DIABETES Kayla Brown, IDF Young Leader in Diabetes (Canada) WDD has always been an important date for me since being diagnosed with type 1 diabetes in March 2009. Over the past six years, I have created and participated in various WDD events and activities from scavenger hunts to encouraging friends and family to wear blue. The importance of celebrating the 14th of November has both personal meaning, especially for people who live with a type of diabetes, and public impact, by generating greater awareness. For those of us who live with the disease, we are incredibly thankful to Sir Frederick Banting, born on the 14th November 1891, for his discovery of insulin (in 1922), and we are also thankful that we have the knowledge and tools to manage this disease, especially as the number of people with diabetes rises every day. This year for WDD, I plan to focus on the facts and realities of living with type 1 diabetes as a young person. Often people with diabetes are misunderstood. However, people living with diabetes can significantly improve general understanding by sharing their stories. Since July 2014, I have led open sessions, called

“T1 Empowerment”, with a small group of type 1 teen girls based where I live in London, Ontario, Canada. T1 Empowerment gives teen girls living with type 1 diabetes a positive outlet to express feelings about their disease in a safe space. The teens share ideas, vent challenges and create incredibly strong bonds with each other. WDD gives the group an added opportunity to speak to the community about the importance of education, communication and social support when dealing with diabetes. For 2015, we are planning an open T1 Empowerment event at the public library giving participating teens an opportunity to share their type 1 diabetes story in any creative form they wish, whether that’s through public speaking, art, or writing. Our hope is that visitors will gain a greater understanding about type 1 diabetes. Whether you decide to host a blue party or a diabetes scavenger hunt in the park, remember that change for diabetes begins with you. Celebrating WDD, whether big or small, can easily help foster diabetes empowerment for you and for those around you.

Diabetes Voice Online - November 2015

HELPING PEOPLE BREAK THROUGH PHYSICAL LIMITATIONS Kang-Ning Hsu on behalf of the Chinese Taipei Diabetes Association (CTDA) The Chinese Taipei Diabetes Association (CTDA) has provided regional and international diabetes events with great enthusiasm every year for World Diabetes Day. With great preparation and followthrough, the association holds different activities to raise public awareness of diabetes together with other diabetes-related associations, patient groups, government representatives and more. With all these participants, we deliver diabetes awareness with a great impact to a large population. Currently, we are planning to celebrate World Diabetes Day 2015 with many Taiwanese events, including: a cycling event, garden festival, global diabetes walk, monument lighting ceremony and a photo competition. For World Diabetes Day 2014, we had many successful events and activities. They are so popular that the people of Taiwan expect to see a lot from us every year! We boosted diabetes awareness in 2014 and people were inspired to do their best. For the past

three years, we have promoted and managed a very popular cycling for diabetes awareness event which gives participants the opportunity to learn about diabetes. People with diabetes and people without diabetes all ride together. Many participants help people who are cycling with diabetes break through any physical limitations by making their cycling dreams come true. In 2015, a group of people with diabetes cycled a distance of 242 kilometres in a four-day tour in late October accompanied with a professional medical-care team. The support and encouragement they received was key for their success! By bringing together professional teams, government representatives, people living with diabetes, and the general public, all Taiwanese people can better understand the importance of nutrition and management for diabetes care. We hope Taiwanâ&#x20AC;&#x2122;s educational activities are a significant and fun way to promote action for diabetes change.

ÂŠ Chinese Taipei Diabetes Association

Diabetes Voice Online - November 2015 WORLD DIABETES DAY 2015

AstraZeneca: addressing gaps in diabetes care How do you tackle a disease that impacts nearly 400 million people1 across the globe? “It all starts with the science,” according to Mark Mallon, Executive Vice President of the International Region for AstraZeneca. For AstraZeneca, a global pharmaceutical company, delivering novel treatment options for people with diabetes is a top priority. Mallon and his colleagues work to achieve this goal through sharply focused clinical and early-stage research efforts, patient-centric programmes, strategic collaborations and a diverse portfolio of medicines. Driven by science, AstraZeneca is helping effect change in the treatment paradigm for people with diabetes. Diabetes Voice had an opportunity to learn more about AstraZeneca’s role in improving outcomes for people dealing with the daily challenges of diabetes in a brief chat with Mark Mallon. Currently, there are approximately 400 million people living with diabetes worldwide, and the greatest percentage live in low- and middleincome countries.1 What is AstraZeneca’s commitment to people living with non communicable disease, especially type 2 diabetes, in the developing world?

to better understand how diabetes treatment patterns evolve globally. The study is unique in its true global nature and coverage of “data blind spots,” and will enable the establishment of longterm registries for the first time in many countries.

From the staggering number of people living with diabetes in developing countries, it’s clear that any efforts to address the global burden of the disease must place a special emphasis on reaching lowerincome populations.

AstraZeneca is focused on the concept of “treating the whole patient” which speaks to the heart of both the systemic nature of diabetes complications and person-centred care. Can you talk a little about AstraZeneca’s commitment to care for people living with diabetes in this regard?

Here at AstraZeneca, we believe that real progress in improving diabetes outcomes globally is rooted in ensuring that patients have access to the medicines they need. We are taking action by delivering patient support and access programmes within emerging markets. For example, in the Middle East, our “By Your Side” and “Home Injection Program” initiatives help patients understand how to correctly take their medicines via educational tools and medical services. Approximately 2,000 people have participated in the programme to date.

Our approach of “treating the whole patient” stems from our commitment – in diabetes and across the company – to putting patients at the centre of everything we do. One of the biggest challenges in treating diabetes is the fact that so many people with diabetes face serious, sometimes life-threatening comorbidities. We can only improve outcomes for these individuals by looking beyond glycaemic control to better understand an individual’s overall health, with a particular focus on areas such as weight, renal and cardiovascular effects.

We are also addressing gaps in data commonly seen in emerging markets, where clinical studies may not be as readily available. By conducting a large, real-world observational study, we are aiming

AstraZeneca currently has medicines in the fastestgrowing classes of anti-diabetic products. Through our clinical research programme, we’re continuing to build the body of evidence to support our 21

Diabetes Voice Online - November 2015 medicines’ benefits in treating both diabetes and its associated comorbidities. For example, we are conducting several large cardiovascular outcomes trials, which should further advance our understanding of these outcomes in patients with type 2 diabetes.2,3 IDFs dedication to professional healthcare education is best reflected in D-NET, the first international forum aimed at enhancing diabetes education and management around the globe. How does AstraZeneca help healthcare professionals worldwide understand the concept of “one patient, multiple strategies? Disease education is important to us at AstraZeneca, as supporting healthcare providers in their efforts to learn more about managing diabetes ultimately helps their patients. We provide numerous tools and resources for healthcare professionals to help them understand and act upon the benefits of treating people with diabetes proactively. For example, through the launch of the “EVOLVE for Diabetes” programme this year, we are connecting with specialists, primary care and allied health to offer comprehensive resources for the healthcare community on all aspects of diabetes. We also recently partnered with Project Hope on a community-based programme in China that will encourage diabetes education among healthcare professionals at regional primary health facilities. We are now looking for ways in which the synergies between D-NET and EVOLVE can be harnessed to create the best possible learning environment for HCPs working in diabetes prevention and care. Through these efforts, we aim to empower healthcare providers to more effectively treat people with diabetes earlier in their disease progression and achieve control sooner. The traditional stepwise approach can leave patients uncontrolled and at risk of developing complications due to hyperglycaemia. We intend to help change this paradigm through education. AstraZeneca collaborates with a wide variety

of academic, scientific and patient advocacy organisations committed to diabetes, including IDF. How do collaborations focused on diabetes research, care and advocacy foster innovation? Collaboration brings together the best thinking across industry professionals, academia, advocacy organisations and policymakers – exactly what we need to solve the growing world health issue that diabetes presents. At AstraZeneca, we are working closely with the diabetes community to cocreate solutions that support disease prevention, encourage professional education and advance care for patients at all stages of their disease. From a research perspective, approximately 70% of our current pipeline projects are run in collaboration. These initiatives allow us to explore important new directions in clinical research and increase our understanding of the underlying mechanisms of diabetes. With our partners, we’re investigating methods for restoring the function of pancreatic beta cells, reversing kidney damage in diabetic nephropathy and addressing comorbidities such as obesity and cardiovascular disease. Our collaborations also go beyond the portfolio, enabling us to reach the diabetes community in unique ways to foster awareness and advocacy. Through our longstanding relationship with the IDF, we participate in programmes such as World Diabetes Day to help raise the global profile of the disease and encourage ongoing action to address its burden. Mark Mallon is responsible for the growth and performance of AstraZeneca’s International region, which predominantly includes AstraZeneca’s commercial businesses in Asia Pacific, Russia, Latin America, the Middle East and Africa. He is based in Shanghai, China. References 1. IDF Diabetes Atlas, 6th edn. Poster Update 2014, International Diabetes Federation Accessed September 2015. 2. Multicenter trial to evaluate the effect of Dapagliflozin on the incidence of cardiovascular events (DECLARE-TIMI 58). AstraZeneca, 2015. Last accessed October 2015. 3. Does Saxagliptin reduce the risk of cardiovascular events when used alone or added to other diabetes medications (SAVOR- TIMI 53); ClinicalTrials.gov. Accessed October 2015.

Diabetes Voice Online - November 2015 WORLD DIABETES DAY 2015

Let’s make healthy eating a right, not a privilege

This year, the World Diabetes Day (WDD) campaign represents the rights of all people worldwide to have access to healthy food which if prioritized will save lives, reduce the global burden of diabetes and save billions in lost productivity and healthcare costs. The International Diabetes Federation (IDF) believes the right to access healthy food is a critical preventive strategy for type 2 diabetes. IDF also recognizes that healthy eating is a critical tool to promote effective self-management of all types of diabetes. Healthy eating is a cornerstone of successful diabetes management along with a comprehensive healthcare strategy and medicine, such as insulin. No matter how you choose to get involved in the WDD campaign for 2015, here are a few key facts that will help you take a stand for diabetes in your community: • Diabetes is a huge and growing burden: whilst some 387 million adults were living with diabetes in 2014, this number is expected to skyrocket to around 600 million people by 2035. • A healthy lifestyle could prevent up to 70% of type 2 diabetes, and healthy eating can help reduce risks. • A healthy diet containing leafy vegetables, fresh fruit, whole grains, lean meat, unsweetened yogurt and nuts can help reduce a person’s risk of type 2 diabetes and reduce complications in people with diabetes. • More of us will develop and live with type 1 diabetes. While type 1 diabetes cannot yet be prevented, a healthy lifestyle is an important part of effective management of the disease. • Encouraging healthy eating habits in young children is key to halting the rise of the diabetes epidemic. By ensuring the health of future generations, we take a step toward ensuring sustainable development. WDD 2015 around the world WDD is the world’s largest diabetes awareness campaign with around 500 events organised for 2014 in more than 100 countries. The list that follows represents a regional variety of IDF Members and other organisations with activities for 2015!

Diabetes Voice Online - November 2015 AFRICA In Sudan, the National Childhood Diabetes center, in collaboration with Jabir Abuelizz Diabetes Center, Eldaw Hajog Mini Diabetes Clinic and Elzubair Musa Charity Diabetes Clinic have planned a variety of activities throughout the country from 12 to 18 November. These include diabetes health day campaigns at various clinics, the annual WDD Charity Night, diabetes educators courses, and prescheduled meetings with Federal and State Ministries of Health. EUROPE In Belgium, the International Diabetes Federation (IDF) will hold an exclusive and interactive roundtable discussion in Brussels on November 12 to promote the importance of acting together to promote healthy eating and ensure access to healthy food. The event will also mark the release of the diabetes prevalence, mortality and expenditure figures from the IDF Diabetes Atlas Seventh Edition. In Denmark, Danish pharmacies and healthcare centres in collaboration with the Danish Diabetes Association invite the public to test their risk of developing diabetes and have their blood glucose level measured at a large number of locations around the country. Several iconic buildings around Denmark will be lit in blue, among them the castle of Kronborg in Helsinore. Hamlet will not attend the event though. In France, the International Diabetes Federation Europe Region (IDF Europe) is organising a lunch debate on “Diabetes: Youth and Sport” on Tuesday 27 October at the European Parliament in Strasbourg. Therese Comodini Cachia MEP (Malta) and Nicola Caputo MEP (Italy) will host a debate addressing the many challenges faced by young people with diabetes. The role of physical activity and sport in the management of type 1 and type 2 diabetes and the prevention of type 2 diabetes will be a key focus. Other awareness raising activities at the European Parliament during the week include: promotion of healthy lunches, an informational exhibition area and opportunity for people to take a blood glucose (BG) test, reflecting the importance of regular BG testing and early diagnosis. The purpose of bringing the WDD campaign into the heart of the EU Parliament is to encourage policy makers to implement effective strategies and policies for the prevention and management of diabetes. In the United Kingdom, Diabetes UK will launch a new campaign - Taking Control - in the week leading up to World Diabetes Day to make sure more people get access to diabetes education to help them manage their condition well. For the campaign, people who have taken diabetes education courses will discuss how it has changed their life. While finding better ways to support healthcare teams to encourage people with diabetes to sign up for a diabetes education course, the campaign will also assess if people with diabetes are receiving the necessary opportunities through the healthcare system to learn about their diabetes, and therefore become better skilled to manage the condition. MIDDLE EAST AND NORTH AFRICA In Qatar, the Qatar Diabetes Association (QDA) celebrates WDD in conjunction with the rest of the world. On 13 November, the QDA will hold an awareness walkathon around the lake of Aspire Park in Doha that will also feature blood glucose tests and nutrition counselling. The length of the walk is approximately 1 kilometre and participants will be provided with free t-shirts, caps, healthy snacks and water at the event. In the United Arab Emirates, International Diabetes Federation (IDF) leadership will participate in a Global NCD Alliance Forum convening in Sharjah on November, 13-15 entitled “NCD Advocacy and Accountability in the Post-2015 era.” IDF will lead a lunchtime session, Uniting to Meet the 24

Diabetes Voice Online - November 2015

Challenges of Diabetes, on November 14th. The goal of the session is to foster full participation from NCD leaders for strategizing, and together choose one new unifying idea to fight diabetes and advocate change for a healthier world today. NORTH AMERICA AND CARIBBEAN In Canada, November is Diabetes Awareness Month, and to celebrate, the Canadian Diabetes Association (CDA), Manitoba & Nunavut Region, is hosting a special evening in support of Manitoba Diabetes camps and their “Youth in Action” Programme on November 14. The 7th annual Best Banting Evening 2015 will provide guests with the opportunity to mix and mingle with friends, colleagues and distinct members of the community. Live and Silent Auctions will be featured with a fantastic array of prizes. The event will be hosted by Canadian Broadcasting Corporation (CBC) top news anchor, Janet Stewart, and also feature world renowned hypnotist Sailesh Jiawan. In Trinidad and Tobago, the Diabetes Association of Trinidad and Tobago is holding a day-long Diabetes in the Limelight Jamboree. This festival will include diabetes education, foot examinations, screenings of blood glucose and other diagnostic tests, a weight clinic, vision testing, storytelling for children, artwork displays, a diabetes education poster competition, and several education booths including information on nutrition and much more! In the USA, the American Diabetes Association is organising a Luncheon Symposium and Expo in North Texas on November 12 that will feature distinguished speakers from the local community who will give their perspective on the health and welfare of the region and provide updates on health and wellness programmes that are working. Among the speakers will be the Mayor of Fort Worth, Betsy Price who spearheaded the city’s initiative to become one of the nation’s first Blue Zone major cities, helping people live long and better lives. SOUTH AND CENTRAL AMERICA In Brazil, the Sociedade Brasileira de Diabetes will light up the following locations in Rio de Janeiro in brilliant blue along with complementary celebrations: the Maracanã Stadium with a diabetes screening campaign; the 30 metres (98 feet) Christ the Redeemer Statue (Cristo Redentor) and Sugarloaf Mountain Peak (Pão de Açúcar). In Sao Paulo, the Octávio Frias de Oliveira Bridge (a cable-stayed bridge that is 138 metres tall (453 feet)) will be lit, as well as other locations throughout Brazil. In Costa Rica, the Asociación Salvadoreña de Diabéticos is holding a “Stop Diabetes In El Salvador” walk and will attract more than 2,000 people with banners, balloons, musical bands, all dressed up on blue, and creating awareness on diabetes, culminating with a Health Fair. SOUTH EAST ASIA In Bangladesh, a World Diabetes Day flash mob will be organised in the Shahbagh neigbourhood of the capital city Dhaka. Hundreds of people are expected to participate and create awareness about diabetes. WESTERN PACIFIC In Australia, Diabetes South Australia (Diabetes SA) will be celebrating World Diabetes Day with a seminar for people living with type 1 diabetes. The seminar will be held at the Adelaide Convention Centre, on November 11, and will focus on Innovations in Diabetes Management. The seminar provides 25

Diabetes Voice Online - November 2015 a unique opportunity to learn about the latest studies and technological advancements in the field of diabetes. Diabetes SA will also be heading to the city’s Rundle Mall on November 13 to help raise the community’s awareness of the prevention of type 2 diabetes by handing out the Australian Type 2 Diabetes Risk (AusDrisk) Assessment Tool for people to calculate their own risk. In New Zealand, throughout November, Diabetes New Zealand will put the Mobile Diabetes Awareness Service on a roadshow visiting 30 towns and cities across the country. On WDD, it will stop in Porirua, a city 25 minutes north of the capital city Wellington. Porirua is home to a significant number of Maori and Pacific people who are at higher risk of diabetes. In Taiwan, the Chinese Taipei Diabetes Association (CTDA) will celebrate WDD 2015 with many Taiwanese events, including: a national marathon cycling event, a garden festival at Sun Moon Lake, CTDA’s annual diabetes walk, a monument lighting ceremony at Wenwu Temple and much more. See how WDD 2015 is being marked all over the world and share your own event information at www.idf.org/wdd-events For more information about IDF networks and participation online: • Participate in WDD events and share your photos with the diabetes online community. You can also take a blue circle selfie and share it on social media channels. • Or join social media to be part of the conversation around WDD! Follow us IDF on Twitter and create your own #WDD Tweet or share one of our suggested tweets. Twitter @WDD: https://twitter.com/WDD Facebook: www.facebook.com/worlddiabetesday LinkedIn: https://www.linkedin.com/company/international-diabetes-federation YouTube: https://www.youtube.com/user/IntDiabetesFed

Make HEALTHY EATING a RIGHT, not a privilege CONSISTENTLY

HIGH blood

DIABETES

SUGAR LEVELS

If left unmanaged can result in serious health complications

DIABETES

1. CHINA

World’s

is the rd most populous country

2. INDIA

3. DIABETES 4. USA

Global healthcare expenditure

9 IS SPENT ON in

DIABETES CARE

HEALTHY EATING and physical activity

DIABETES poses a THREAT to GLOBAL SUSTAINABLE DEVELOPMENT

COULD PREVENT

IS AN IMPORTANT

UP TO

PART OF

70%

of type 2 DIABETES

EFFECTIVELY M A N AG I N G

type 1 DIABETES

All figures from the IDF Diabetes Atlas Update 2014

HALT the diabetes EPIDEMIC www.worlddiabetesday.org #WDD

ONSI TE AS OF REGISTAT IO 30 NO VEMB N ER DAY R ATE €330 STUD

ENTS €110

30 November – 4 December

Learn. Discover. Connect. SCIENTIFIC PROGRAMME Chair: Bernard Zinman Deputy Chair: Nam Cho Basic & Clinical Science Diabetes in Indigenous Peoples Education & Integrated Care Global Challenges in Health Living with Diabetes Public Health & Epidemiology

Steven Kahn Malcolm King Unn-Britt Johansson Gojka Roglic Gordon Bunyan Edward Boyko