Diabetes Report Eyes on Diabetes Thursday14 November 2019 A complimentary supplement distributed with The Malta Independent.
02 Diabetes Report
World Diabetes Day THE BLUE CIRCLE has been the global symbol for diabetes since 2006. According to the INTERNATIONAL DIABETES FEDERATION the purpose of the symbol is to give diabetes a common identity. It aims to: support all existing efforts to raise awareness about diabetes; inspire new activities, bring diabetes to the attention of the general public; brand diabetes; and provide a means to show support for the fight against diabetes.
One day in November is not enough to raise awareness about diabetes Patricia Cauchi-Farrugia speaks out about the difficulties she, and other parents, whose children are diagnosed with Type 1 diabetes, face. families, are treated with respect. Inclusion policies are also applied to children with health and educational challenges. These children require adaptations to accommodate their needs, and the education system should be prepared and give allowances without posing further challenges to the family”. It took three meetings, and a change in school administration, to obtain the help required, but gladly the end justifies the means, and Patricia now sends her son to school knowing he is taken care of thanks to mutual cooperation. But do all parents manage to get the help they need, without putting stress on the child? She highlighted that there is simply not enough awareness on diabetes and the disease is not taken seriously enough, on a national level. “We should not wait for 14 November to highlight the importance of diabetes, as many of us are fighting and coping with diabetes in silence.” Patricia said that parents, and their children, with Type 1 diabetes should not be overlooked or ignored.
Giulia Magri National Diabetes Day, 14 November, is the day which focuses on a global awareness campaign on diabetes, yet Patricia Cauchi-Farrugia believes that diabetes needs to be given much more importance and awareness. Speaking to Giulia Magri, Patricia delves into her own personal relationship with diabetes: married to Rodney, who has lived with Type 1 diabetes for 27 years, and raising their son, Nick who was diagnosed with Type 1 diabetes at the age of three. “Nick had just started Kinder One, and when the teacher pointed out the telltale signs, it was clear that Nick had diabetes too. The change in our routine was a shock and very emotionally challenging.” She explained that the transition was not easy but they had to keep a positive attitude. She highlighted that by reading, learning and understanding the disease, she is able to raise their son well, despite the condition, and to make sure that he does not feel any less than other children. “It is extremely important to learn about diabetes. The whole family should because a good support system is vital to the person living with diabetes and unfortunately some families remain oblivious about how to manage it correctly.” Patricia notes that having the right attitude, and instilling the same attitude in their own child, is just as important as diabetes management itself. Schools must be better educated and responsible for children with diabetes As parents, Patricia and her husband, have to be prepared for any situation that could arise, with respect to Nick’s diabetes. They believe, however, that educators should also be prepared for their son’s wellbeing. Patricia pointed out that most schools have shown to be unprepared, and untrained, and do not take into consideration the emotional difficulties parents, and children, face. “Many times school administrators make us feel like the trouble-starters for being demanding when in reality we are the victims asking for help and understanding. Many times you find yourself in a very strange position, having to educate the educators”. This is a situation some educators do not appreciate, Patricia went on to say. She explained that it is extremely ironic that she often finds herself in this position, and is made to feel like she is being unreasonable for asking for
Cauchi Family Patricia, Nick and Rodney adaptations to support her child. “I believe that for starters headmasters and assistant heads should all be certified first aiders. As they have the keys to the school and take care of the wellbeing of hundreds of children and staff, they should definitely be qualified first aiders. It should be at least a basic requirement.” It is Patricia that many a time has to remind the educators that her child’s wellbeing is in their hands whilst he is at school and that it is extremely important Nick’s diabetes is not to be taken lightly. “Even children with no conditions can have issues, and our educators must be prepared for anything.” There were times when a nurse came to school to take Nick’s blood glucose reading, which gave distorted and false readings, Patricia explained. Following this, she ensured that Nick learnt how to test his own blood glucose, with the traditional blood test (HGT), getting rid of the dependency on the nurse. “This was a huge milestone for Nick to learn how to be independent. I would then get a call from the school informing me of Nick’s blood glucose readings. This helped us stay on top of the situation, and aid the school in Nick’s wellbeing. We never had any issues and Nick was happy and safe. Diabetes management
was never an obstacle.” There seemed to be a challenge when Nick was about to start secondary school, however. “We had to start everything from scratch when Nick was on his way to secondary school. We were scared other schools wouldn’t accommodate us as well as his first school. We learned that it was very much up to the person in charge. When we held meetings with the secondary school administration, two years prior to admission, we informed them of our method of managing diabetes which had worked wonders in the previous school. The feedback we received was defensive and sceptical. Instead of seeing this as a way to reduce the responsibility of the school, the school administration, at the time, was concerned that Nick was going misuse his phone at school.” Patricia was shocked at the reaction of the school and highlighted that this was merely a tool to support his teachers in moments of uncertainty, or concern, and having a diabetic child with a phone is not a cliché but part of diabetes management. “This is not the right way to go about receiving support. It is crucial that all children with conditions, and their
Government procrastinating on provision of the Continuous Glucose Monitoring (CGM) sensors Patricia and many other parents have forked out hundreds of euros out of their own pocket to purchase the continuous glucose monitoring sensor, such as Freestyle and Dexcom, which are systems which provide people with the power to monitor their blood glucose level more efficiently. “Each month we spend €300 on my husband’s and Nick’s glucose monitoring, with no form of compensation,” Patricia explained. She also pointed out that such CGMs have made a big improvement in children’s lives, living with Type 1 diabetes. “If the government has money to spend, health care is the top priority. I don’t see why parents must seek out someone from abroad to buy the CGMs for us. For us to purchase Freestyle, one has to go through so much hassle. At least if we have to buy them, there should be a subsidy, or we are able to purchase them locally.” She explained that the CGM companies only supply and ship to UK addresses, so added burden and payments ensue, as parents must find a UK address and then send the sensors to their own address. This is not a story about diabetes, this is the life of a child who, like many others, is learning to grow with the added challenge of managing a life-threatening condition.
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A Maltese perspective
LET’S TALK ABOUT DIABETES e all hear a lot about diabetes and its prevalence in Malta. Most probably we have a friend or someone in our family living with this condition. Diabetes is a chronic condition in which the body does not produce sufficient insulin to regulate the blood glucose levels or where the insulin it produces is unable to work effectively. If it is not controlled it can lead to very severe consequences, including cardiovascular disease, blindness, kidney failure, and lower-limb amputation. Unfortunately today it is a leading cause of these conditions. Unsurprisingly, therefore, diabetes has a significant impact on the quality of life of the individuals affected as well as their families. Today about 10% of adults in Malta suffer from diabetes. This rises to over 20% in persons aged 60 years and over. In 2016, (late 2015), the Ministry for Health launched the National Strategy for Diabetes. This was a first for these islands. Today, three years down the line much has been achieved. A specialised ward was launched in 2017 at Mater Dei hospital specifically designed for Foot
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complications in diabetes patients. Around 1,000 patients are admitted to this ward annually. Since its inception in 2017, the rate of major amputations has gone down by 30%. The introduction of a broader range of medications provided free of charge to all persons living with this condition was another measure of paramount importance. Up to a few years ago persons prescribed gliptins and repaglinide had to buy these as they were not available free on schedule V. Today a total of 4,379 patients receive these medications via the POYC scheme. By the end of this year, new insulin analogues will be added to the government formulary. This means that this family of medications will also be available free of charge. It is anticipated that around 1,500persons will benefit from this initiative.
The strategy focused not only on treatment but also on the monitoring of the condition and during 2017 and 2018, all persons taking medication for this condition became entitled to a glucose monitoring meter. An average of 1 million free glucose sticks are issued each month to the 30,292 diabetic patients registered with POYC. This amounts to over 11 million free glucose sticks dispensed per year. This initiative is part of government’s policy to continue to encourage and support patient’s participation in the management of diabetes mellitus in recognition that the on-going monitoring of blood sugar levels by the patient is key to avoiding the complications associated with this condition. In the coming weeks we will achieve another national milestone in the strategic management of this condition.
A fully fledged, Remote Patient Monitoring Service, will be introduced as a pilot project for Type 1 diabetic minors. Remote patient monitoring is at the forefront of the next wave of healthcare innovations aimed at supporting improved health management directly by the person living with a condition. It provides patients or their guardians with a 24/7 tier of support that facilitates the management of the condition and allows patients to take better control of their own healthcare. By flagging anomalous readings in real-time to the patient and as appropriate to care-givers, Remote Patient Monitoring can dramatically improve the management of chronic conditions and patient’s quality of life. It allows patients to maintain independence, reduce the number of times they visit their healthcare provider in-clinic, prevents complications and minimizes personal costs. Remote patient monitoring can also make it easier for care teams to track, manage and engage with patients who need extensive and continuous care, like in case of Type 1 diabetic patients. Information provided by The Ministry of Health.
04 Diabetes Report
Reversing Type 2 Diabetes Reverse your diabetes - and you can stay diabetes-free long-term says Professor Roy Taylor. A 2016 study from Newcastle University showed that people who reverse their diabetes and then keep their weight down remain free of diabetes. Article and photograph courtesy of Newcastle University, UK. n addition, the team found that even patients who have had Type 2 diabetes for up to 10 years can reverse their condition. The 2016 study, published in Diabetes Care, is part of ongoing research from world-renowned Professor Roy Taylor, Professor of Medicine and Metabolism at Newcastle University, who also works within Newcastle Hospitals. The research is part of a growing body of evidence showing that people with Type 2 diabetes who successfully lose weight can reverse their condition because fat is removed from their pancreas, returning insulin production to normal. A previous study led by Professor Taylor, published in 2011, showed that diabetes could be reversed by a very low calorie diet. This caused international interest, but the study was very short as it was only eight weeks and the question remained whether the diabetes would stay away. In this new study, 30 volunteers with Type 2 diabetes embarked on the same diet of 600 to 700 calories a day. Participants lost on average 14 kilograms - just over 2 stone. Over the next 6 months they did not regain any weight. The group included
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many people with longer duration diabetes, defined as more than 8 years and ranging up to 23 years. Overall, 12 patients who had had diabetes for less than 10 years reversed their condition. 6 months later they remained diabetes free. In fact, after 6 months a thirteenth patient had reversed their diabetes. Though the volunteers lost weight they remained overweight or obese but they had lost enough weight to remove the fat out of the pancreas and allow normal insulin production. Professor Roy Taylor said: “What we have shown is that it is possible to reverse your diabetes, even if you have had the condition for a long time, up to around 10 years. If you have had the diagnosis for longer than that, then don’t give up hope – major improvement in blood sugar control is possible.” “The study also answered the question that people often ask me – if I lose the weight and keep the weight off, will I stay free of diabetes? The simple answer is yes!” “Interestingly, even though all our volunteers remained obese or overweight, the fat did not drift back to clog up the pancreas.” “This supports our theory of a Personal Fat Threshold. If a person gains more weight than
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they personally can tolerate, then diabetes is triggered, but if they then lose that amount of weight then they go back to normal.” “Individuals vary in how much weight they can carry without it seeming to affect their metabolism – don’t forget that 70% of severely obese people do not have diabetes.” “The bottom line is that if a person really wants to get rid of their Type 2 diabetes, they can lose weight, keep it off and return to normal.” “This is good news for people who are very motivated to get rid of their diabetes. But it is too early to regard this as suitable for everyone. That is a separate question and a major study is underway to answer this.” Participants in this study had Type 2 diabetes for between six months and 23 years. The team showed that Type 2 diabetes could be reversed even in people who had the condition for 10 years. The team were able to identify in advance participants who would not respond to adequate weight loss by reversing their diabetes as at the start they had almost absent insulin production from the pancreas. The study was funded by a National Institute for Health Research Biomedical Research Centre (NIHR BRC) grant. A larger trial involving 280 patients is already underway. This will examine how successfully people can reverse their diabetes through weight loss simply under the care of their family doctor and nurse.
It is being funded by Diabetes UK. The research was made possible through Newcastle Academic Health Partners, a collaboration involving Newcastle Upon Tyne Hospitals NHS Foundation Trust, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University. This partnership harnesses worldclass expertise to ensure patients benefit sooner from new treatments, diagnostics and prevention strategies. The diet consisted of: 3 diet shakes per day and 240 grams of non-starchy vegetables taking in between 600 and 700kcal a day for 8 weeks. Volunteers then gradually returned to eating normal food
over the next two weeks with very careful instruction on how much to eat. Volunteers were seen once a month and supported with an individualized weight maintenance programme over the next 6 months to keep weight steady after the weight loss, they were eating around one third less than before the study. For more information on this research visit the Diabetes Research page on the Newcastle University Website. It is important that people with diabetes discuss their management with their own doctor. Remember to always consult with your doctor before embarking on any diet programme.
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Why should you pay for health insurance? e understand that health insurance isn’t cheap, especially when you’re already paying a premium on other insurance services such as home or motor and whatnot. However, the unfortunate reality is that you can never truly foresee what medical treatment you might require, and going without health insurance can end up costing you even more! Learn more about why you should invest in your health.
Investment outweighs expense Even though health insurance is often seen as a bit of a gamble, it will still be your safeguard under the circumstances that you do find yourself needing it.
Privacy With health insurance, you will find that having your own room in a private hospital is actually the norm.
No waiting list Despite the fact that public health care in Malta is both very effective and free of charge, it can still come with some long waiting times. By using private healthcare through health insurance, you can avoid these waiting times without having to expend your own savings. Keep reading to see what else our health insurance policies have in store for you.
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Choose your specialist We understand that for most medically-related incidents, you would prefer to consult with a specialist of your own choosing, and so we promise to provide you with that flexibility!
Financial protection and peace of mind It goes without saying that the greatest wealth is your health. Even though health insurance may seem pricey, the cost of injury or illness can be even higher. Give yourself the peace of mind you deserve.
Our new and Improved benefits As of 2019, MAPFRE Middlesea has introduced a number of new and improved benefits for health insurance. At a reasonable additional premium, clients may benefit from: • Our Routine and Preventive Care Cover which allows
clients to undergo routine tests as well as monitor chronic conditions. After all, prevention is simply better than cure. • A Dental Benefit which applies to all individuals with Inpatient and Outpatient policies and covering a range of dental treatments.
• The Waiver of Standard Exclusions Extension which provides customers with the option to waive standard policy exclusions for Vaccinations, Allergies and Clinic fees at an additional premium. Other improvements also include: • An increase in the limits of our existing table of benefits, • Worldwide cover varying in line with the scheme chosen, and • An extension of our emergency telephone assistance for all levels of cover. • It goes without saying health insurance can help you bypass the mishap of paying for any costs out of your own pocket by safeguarding your medical expenses for you. Visit www.middlesea.com/insurancemt/individuals/health-insurance / for more info.
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TYPE 2 DIABETES: losing even a small amount of weight may lower heart disease risk eople with type 2 diabetes are often encouraged to lose weight. And recent studies have shown that losing a lot of weight can reverse diabetes, meaning the person no longer has to take drugs to treat their disease. Unfortunately, most people struggle to lose large amounts of weight and keep the weight off. However, there has been little research on the impact of losing a moderate amount of weight – which would be an easier goal for most people. Our latest study shows that losing a moderate amount of weight could reduce the risk of heart attack and stroke, the most common complications of diabetes. Our team assessed weight change in 725 people who were newly diagnosed with type 2 diabetes. The participants had their weight measured at the time of their diagnosis and again one year later. We focused on weight loss in the year after a diabetes diagnosis, as weight loss early on may be more beneficial than weight loss later. People who lost at least 5% of their weight in the year after they were diagnosed with type 2 diabetes had a 48% lower risk of cardiovascular disease after ten years, compared with
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people who kept the same weight. People who lost weight also had significantly lower blood glucose (sugar), blood pressure and cholesterol levels one year after they received a diagnosis compared with people who kept the same weight. The results couldn’t be explained by age, sex, smoking or medication as these “confounders” were taken into account in our analysis.
While our study showed potential long-term benefits of just 5% weight loss, past research has mostly focused on larger amounts of weight loss. In a US study, people with type 2 diabetes who lost 10% of their weight in one year had lower rates of cardiovascular disease after ten years compared with people who maintained their weight or gained weight.
But unlike the participants in our study, participants in the US study were not newly diagnosed with diabetes. They had, on average, been diagnosed seven years before the study started. It is possible that smaller amounts of weight loss soon after diabetes diagnosis may be just as beneficial as larger amounts of weight loss later on. Our study participants were
from the east of England and most were white, so the results may not apply to other populations. Also, most participants in the study were overweight or obese at the time of diabetes diagnosis. So the results don’t suggest that people with diabetes who are a normal weight or underweight should lose weight. However, our findings emphasise the potential benefits of even modest weight loss for people with type 2 diabetes. Being diagnosed with type 2 diabetes may inspire some people to make changes to their lifestyle to try and lose weight. Intensive diet and exercise programmes have been shown to help people with diabetes to lose weight. Unfortunately, there are no established guidelines in the UK for doctors to provide patients with weight-loss support and most patients don’t have access to these programmes. Yet evidence from our study suggests that some people can lose weight after being diagnosed and hence lower their risk of cardiovascular disease, even without a weightloss support programme. So people with type 2 diabetes may want to consider focusing more attention towards setting moderate weight-loss goals.
European soft drinks industry on track to meet commitment to reduce added sugars by 10% by 2020 he soft drinks industry is the only sector to have officially committed to the EU’s 10% added sugar reduction target by 2020 as laid out in its sugar reduction. The industry has now delivered on that pledge – accelerating the pace of its ongoing sugar/kcal reduction in soft drinks available to more than 500 million people across the EU. In 2017 Malta’s soft drink producers were the first European beverage companies to commit to this Sugar Reduction Pledge. This decision will contribute to the delivery of the European soft drink industry (UNESDA) 10 per cent sugar reduction commitment. The initiative responded to changing consumer preferences regarding sugar intake and the
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calls from Member States and the European Commission for a coordinated approach to reformulation and sugar reduction. To reach this ambitious target, we reformulated existing products including the use of low-calorie sweeteners; introduce new products with no or reduced sugar and lowcalorie sweeteners. There are some false perceptions surrounding low-kilojoule sweeteners, particularly aspartame, the main sweetener contained in sparkling beverages. Having more information about the sweeteners used in beverages can help you make informed decisions and better understand the role beverages can play in an active, healthy lifestyle that includes a sensible, balanced diet and
regular physical activity. More than 200 scientific studies and food regulatory bodies across the world including Food Standards Australia New Zealand (FSANZ), Food and Drug Administration in the US (FDA) and the UK’s Food Standards Agency (FSA), support the safety of aspartame as a non-nutritive sweetener.
To achieve this target we also increased the availability of smaller pack sizes to allow portion control and moderation; invested in the promotion of drinks with reduced or no sugar to educate and actively encourage consumer choice towards low and no calorie products and committed to monitor the progress of added sugar
reduction achieved using independent external research and to share this with stakeholders. The industry remains committed to furthering its efforts to help create a healthier environment across Europe and encourages other sectors to join and accelerate the pace of progress through similar pledges.