Half of people with diabetes do not know they have the disease

• COVADONGA DÍAZ

Updated on Friday, 13 November 2020 - 14:30

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Diabetes is a silent and treacherous disease that does not initially cause pain but that, if not controlled properly, causes damage that when it manifests already has important repercussions at the cardiovascular, brain and kidney levels.

The data are striking:

and when it is diagnosed the patient may have accumulated years of progression of the

in which it has progressed uncontrollably.

This Saturday is the World Day of a disease that, if not controlled, tremendously deteriorates the day to day of patients and can shorten their life between 6 and 8 years but that, and therein lies the good news, in its most form The common

.

Diabetes is a disease related to a malfunction of insulin, a hormone secreted by the pancreas and whose function is to regulate the amount of glucose we have in the blood and our body uses, that is, the level of fuel that important organs need of our body to function as the heart muscle and the brain.

"If the amount of gasoline is not adequate, things start to go wrong", explains graphically Juan Carlos Obaya, Primary Care physician.

There are several types of diabetes, although two are the most common.

In

, which is the one that usually appears in childhood and in young people, the pancreas does not manufacture the necessary amount of insulin.

In

, which is the most common form in the population over 40 years of age, the problem is not so much the insulin production capacity, which is sometimes manufactured even above the levels considered normal, as the resistance of the body to this hormone, that is, "insulin does not exercise its function properly and glucose does not reach its destination, accumulating in the body and causing inflammatory changes in vascular, kidney, brain and heart tissue", describes Javier Escalada, director of the Endocrine and Nutrition area of ​​the Navarra University Clinic, and president of the Spanish Society of Endocrinology and Nutrition (SEEN).

The incidence of type 2 diabetes has been increasing in recent years,

, since it is a disease that is fundamentally related to unhealthy lifestyle habits, such as inadequate diet and sedentary lifestyle .

It is currently estimated that almost 14% of the Spanish population has diabetes, a figure that rises to 25% in those over 75 years of age.

One of the most worrying data is that of underdiagnosis, that is, the population that has the disease but does not know it, and it is estimated that one in two people with diabetes is in this situation.

Consequently,

.

And if it is not diagnosed it will be difficult to develop strategies to control its disease.

That is why it would be so important, as both doctors agree in pointing out, to develop

strategies for

diabetes, that is, to go looking for the disease with a detection test in the population with suspicion that it may have it, especially from 45 years of age.

"It is necessary to actively seek diabetes," insists Escalada.

"It is very important that from a certain age Primary Care goes to look for the disease and that this is also done from specialties such as nephrology, cardiology or internal medicine that are in contact with patients diagnosed with other pathologies and who can also have diabetes without knowing it, "says Obaya.

And the fact is that the data is very striking.

, regardless of what that cardiovascular disease is.

In people who are overweight or obese, their glucose regulation mechanism is also much more likely to not work properly.

In addition, there is the situation on many occasions that the person who may have diabetes "sometimes prefers not to consult and chooses to look the other way, which delays the diagnosis; he knows that he leads unhealthy lifestyle habits and adopts a evasive attitude, which in the long run has fatal consequences. This must be reversed, "says Obaya.

Relationship with other diseases

In fact, many patients with diagnosed cardiovascular disease do not discover that they have diabetes until they experience a cardiovascular event.

Furthermore, "between 20% and 30% of lower limb ischemias that we diagnose are a consequence of diabetes and

."

The data serve to understand the enormous impact of diabetes as it relates to other diseases.

There is also the circumstance that there is another entity prior to diabetes, which is known as

, when the person already suffers an alteration of the metabolism of basal glucose that is not considered diabetes but which is causing cardiovascular damage.

This is one of the fields in which specialists consider that more work should be done "to avoid this transition from prediabetes to diabetes," says Ángeles Álvarez, a nurse at the Goya health center in Madrid.

Both diabetes and prediabetes are cardiovascular risk factors, which means that they increase the risk of ischemic heart disease, that is, angina or acute myocardial infarction;

of cerebral affectation, that is to say, of ictus;

peripheral arterial disease, which results in difficulty walking and pain in the legs, and heart failure, that is, failure in the function of the heart due to damage to the pump that makes the body unable to maintain flow that the patient needs to meet their needs.

Damage to the heart

The damage of diabetes on the heart is such that there is already talk of a specific cardiomyopathy of the diabetic patient.

All this cascade of reactions has its origin in hyperinsulinism and glucose accumulation, which are fatal for the endothelium, or what is the same, for the vascular tissue that extends throughout the body and that constitutes a kind of highway.

"As a

, which is known as atheroma plaque, which does not allow the blood to flow properly. The risk is double because if that plaque is fragile and unstable and detaches can cause a plug, that is, a thrombus, "explains Obaya.

Complications occur both on large highways and on small secondary roads, that is, both in the large vessels of the body and in those of small caliber.

And although macrovascular complications are more serious, it is the microvascular ones that most deteriorate the quality of life of the patient and his family because they affect him continuously in his day-to-day life.

It is estimated that diabetes shortens life between 6 and 8 years and at the same time greatly deteriorates the years of life due to this involvement of vital organs, without forgetting diabetic retinopathy, which is perhaps the main concern of patients due to the blindness that it can cause.

Thus,

.

Another data for concern: diabetes is the main cause of non-traumatic amputation of the lower limbs in industrialized countries, due to the damage it causes at the vascular level in the vessels of the legs.

And

, although not all patients progress to transplantation, but many end up on dialysis.

Scientific societies are also currently concerned about the repercussions that the current Covid pandemic and changes in the health organization may have for the population with diabetes.

On the one hand, they recall that this pathology is a risk factor for poor prognosis in patients admitted for Covid.

"In general, they are more obese, are older and have more comorbidities, that is, more previous disease," says Juan Carlos Obaya.

In addition, last spring's confinement meant an average weight gain of three kilos in the general population, a fact that the SEEN wants to draw attention to, given the link between obesity and overweight, and diabetes.

Interestingly, if for some patients with type 1 diabetes, confinement seems to have had positive consequences, in that it is a younger population that had more time to take care of themselves at that stage, in patients with type 2 diabetes, who are the majority , the confinement has been very negative.

In addition, in recent months, chronic patients have moved away from their specialists and interrupted their periodic check-ups and this can have fatal consequences, which is why the SEEN draws attention to the importance of

.

Alarming appearance of type 2 diabetes in children

The good news is that type 2 diabetes is a disease that can be prevented and doing so is not complicated, it is enough to adopt healthy lifestyle habits, especially related to the practice of physical exercise, the follow-up of an adequate diet, with the Mediterranean diet as a key tool, and smoking cessation.

In addition,

, not only for glucose control but also to reduce cardiovascular risk and protect the heart of these patients.

And improving prevention is essential because all the forecasts of the international health authorities regarding the evolution of diabetes fall short.

The data in recent years has always been worse than expected.

And the reason is the

for diabetes.

In fact, experts consider it striking that cases of type 2 diabetes are already being seen in children, "something that a few years ago was unthinkable for us," says Javier Escalada.

In fact, a new term,

has been coined

.

Ángeles Álvarez insists on the same idea, for whom "it is key to work on childhood obesity."

The point is that due to the delay in diagnosis, when the patient is diagnosed with diabetes "he is sometimes very deteriorated", explains Javier Escalada.

And this is unfortunate because currently very effective drugs are available to control the disease, which are all the more effective the sooner treatment is started.

"It is sadly common for a patient to appear with a foot injury that is actually a diabetic foot injury and at that moment is when he is diagnosed," says nurse Ángeles Álvarez.

A key profile in the approach to diabetes is that of the nursing staff because it is a disease in which the education and training of the person in its management is essential.

It is also a figure that accompanies the patient with diabetes throughout their illness.

Ángeles Álvarez lives her work with passion.

From his experience, he considers key "to explain to the patient from minute one what the natural history of this disease is, which

. Maybe if every time the patient's glucose rises he would experience some kind of pain it would be easier".

For this reason, it explains the symptoms and helps them to know how to interpret them.

"20% of patients who suffer from hypoglycemia change their habits because they have such a bad time that they do everything possible to avoid it. But the objective is to try to avoid these crises, especially the glycemic swings that cause so much damage."

This nurse explains to her patients that diabetes is like a table that needs four legs to remain stable.

One of them is related to diet, taking into account that

. But many people think that it follows it and it is not. In addition, it cannot be given to patients the diet that we have in the drawer for everyone, decisions must be personalized and it is important to agree with each patient ".

Another of the pillars is physical exercise that must include both aerobic and strength activity

.

"It is no use telling the population to go for a walk, without further ado, of course that walking is good but you have to give precise and complete guidelines. It is necessary to reach a certain heart rate, which we must individualize, and a wall or a chair is enough to be able to perform strength exercises, while a patient should not be more than 48 hours without physical exercise and perform at least 150 minutes a week ".

The third leg of the table is related to

.

"It is not enough to say take a little sugar when you feel hypoglycemia, which we must teach to recognize; the patient must know exactly what to eat, how long to wait, know what we know as the rule of 15, what types of carbohydrates of carbon they are convenient for him ... I teach them to count rations, to know how to exchange them since depending on what they eat they will need more or less insulin. Needs change with diet, exercise and menstruation, among other factors ".

Therapeutic education is the fourth pillar "and here nursing plays a fundamental role

because if this fails, the rest will fail and it is a process that must be maintained throughout life as a chronic disease that it is and in which it is difficult to maintain the established guidelines permanently, even no matter how conscious the patient is. "

Precisely the importance of nursing in the management of diabetes gives an idea of ​​the slogan

, chosen this year by the International Diabetes Federation on the occasion of the celebration of World Disease Day, which is celebrated this Saturday November 14th.

It is a slogan with which we want to give prominence to the essential role that these professionals play in the prevention, detection, control and monitoring of this disease and who emphasize the importance of education and financing to support their work.

According to the criteria of The Trust Project

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