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Multifaceted approach to diabetes

Alyson Smith, BSc

By Alyson Smith, BSc

Alyson worked as an NHS nurse for over 40 years, including ten years as a Diabetes specialist. She is passionate about teaching people about living healthy lifestyles as preventative measures against disease.

Medical research from the World Health Organisation (WHO) suggests that nearly five per cent of the world’s population have diabetes. This global health issue is increasingly affecting many regions of the world including the Middle East. According to the International Diabetes Federation, without lifestyle changes, a quarter of the Middle East’s population will be affected by 2035.

Rapid urbanisation and the introduction of the western diet across the Middle East; energy-dense food and refined carbohydrates are having a negative impact on the health of the population. In addition, the fat-saturated food and increasingly sedentary lives of both adults and children continues to compound the issue. With this deadly combination
of overeating, junk food, and low levels of activity, is it any wonder that the onset of diabetes is becoming a major concern?

The evolving eating patterns of the Middle East may be creating confusion with respect to what constitutes a healthy diet and therefore compound the issue. Evidence based studies provide guidance on what is considered to be an appropriate diet for both treatment and prevention of diabetes. However, it is important to provide this information to the general public in a suitable way.

‘Mental health issues can make it more difficult for diabetes sufferers’

Using the noun ‘diet’ can be counterproductive as for most people this implies special meals that one eats in order to be healthy or to lose weight. Messages such as ‘cut out meat’ and ‘eat meals low in trans fats, salt and sugar’ may present a problem for families who have developed their eating habits over generations. In addition to using the word ‘diet’, promotional information with respect to purchasing specific diabetic foods can place an extra burden on diabetics and their family, thereby encouraging inappropriate luxury foods to be eaten. There is no evidence to suggest that these foods are of benefit and in some cases such foods can have a laxative effect.
Health is a positive balance between body and mind. In terms of prevention and treatment; a healthy well balanced diet is recommended for everyone. Avoiding over processed foods and foods with hidden sugars can be achieved by using natural ingredients and preparing and cooking for oneself and family.

A healthy meal plan for people with diabetes is the same as a healthy meal plan for all. Portion size, eating at regular intervals, and drinking sugar free drinks is the simple message to get across without over complicating the message.

This proposed epidemic has the potential to impact on economics and bankrupt healthcare systems. This is just taking into account the cost of providing a full range of health care for both pre-diabetics and diagnosed diabetics with type 1 and type 2 diabetes.

We talk of providing holistic care for the diabetic population, which in fact means much more than dealing with the physical manifestations. Consideration of the mental health of diabetic patients is an integral part of on-going diabetes care. Further economic issues related to the cost of mental health care and loss of earnings may well impact on the overall cost to the healthcare budget of the Middle East.

A study compiled by Iesco Digital Health, the UK’s largest provider of online therapy highlights the scale of mental health problems affecting those living with diabetes.

The study highlighted the health beliefs of young adults (16-34) who felt that their mental health was negatively affected by their diabetes.

Mental health issues linked to diabetes include feelings of loss, stress, anger, panic attacks, depression, anxiety, and eating disorders. Some newly diagnosed diabetics, both young and old can go into a state of denial of their condition, resulting in poor diabetic control and a high-risk of complications.

Mental health issues can make it more difficult for diabetes sufferers to comply with alterations to their diet. A depressed person is also less likely to adhere to their medication or monitoring regimes which are necessary for effective diabetes management and prevention of complications. Symptoms of phobia or anxieties related to self-administration of insulin and self-monitoring of blood glucose levels can reinforce the emotional distress. Not only can poor blood glucose levels lead to long-term complications, but also to distressing short-term symptoms of hypoglycaemia as well as the risks of diabetic ketoacidosis.

A healthy balanced diet contains fresh vegetables

A multi-faceted approach to include a comprehensive assessment for mental health problems should be considered as an integral part of on-going diabetes care. Educating patients to be alert to their changing mental health state and to recognise the early warning signs of anxiety and stress will help to address the emotional and behavioural aspects of living with a life-long condition such as diabetes.

A discussion around mental health within a diabetes-specific consultation should be part of diabetes management. Very often though not always, a patient builds trust with their diabetic specialist provider, therefore, enabling a frank and open discussion around their own mental health.

Providing the opportunity for counselling with an appropriate professional following a diagnosis of a potential mental health issue can make a huge difference to the outcome. High quality cognitive behavioural therapy (CBT) can be a valuable tool providing effective mental health intervention. Online CBT mirrors face-to-face therapy and involves real-time personalised communication between therapist and patient.

The Middle East is facing a whole host of issues related to urbanisation and the emergence of a diabetes epidemic. By adopting a holistic approach to the condition and early intervention including assessment of mental health, the increased burden on healthcare systems can be managed.