Preventing type 2 Diabetes ( PH 35 NICE)

NICE National Institute for for Health and Clinical Excellence in UK which makes recommendations to NHS ( National Health System) in UK published new guidelines of Preventing Diabetes Type 2 ( this type of diabetes is influenced by lifestyle )

State of Kuwait is one of the leading countries with high incidence of Diabetes Type 2 due to high rates of obesity, high energy foods- especially fat-saturated ( fast food), lack of regular activity and exercise.

NHS defines diabetes as follows:

Type 2 diabetes

Diabetes is a group of disorders with a number of common features characterised by raised blood glucose. In England the four commonest types of diabetes are:

·      type 1 diabetes

·      type 2 diabetes

·      secondary diabetes (from pancreatic damage, hepatic cirrhosis, endocrinological disease/therapy, or anti-viral/anti-psychotic therapy)

·      gestational diabetes (diabetes of pregnancy).[1]

The underlying disorder for type 2 diabetes is usually insulin insensitivity combined with a failure of pancreatic insulin secretion to compensate for increased glucose levels. The insulin insensitivity is usually evidenced by excess body weight or obesity, and exacerbated by over-eating and inactivity. It is commonly associated with raised blood pressure and a disturbance of

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[1] This is an edited extract from ‘Type 2 diabetes’ (2006) NICE clinical guideline 66.

blood lipid levels. The insulin deficiency is progressive over time, leading to a need for lifestyle change often combined with blood glucose lowering therapy.

Type 2 diabetes is diagnosed in adults who are not pregnant by a glycated haemoglobin (HbA_1c) level of 6.5% (48 mmol/mol) or above[1]. A type 2 diabetes diagnosis can also be made by[2]:

·      random venous plasma glucose concentration the same or greater than 11.1 mmol/l; or

·      fasting venous plasma glucose concentration the same or greater than 7.0 mmol/l; or

·      2-hour venous plasma glucose concentration the same or greater than 11.1 mmol/l 2 hours after 75 g anhydrous glucose in an oral glucose tolerance test (OGTT).

In patients without symptoms, the test must be repeated to confirm the diagnosis using World Health Organization criteria^{2, 3}.

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[1] World Health Organization (2011) Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus [online]. Available from www.who.int/diabetes/publications/report-hba1c_2011.pdf

[2] World Health Organization (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation [online]. Available from www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf

NICE also identified interventions which are succesful in reducing risk of contracting diabetes type 2:

 Trials have shown (Gillies et al. 2007) that behavioural interventions help reduce the likelihood of type 2 diabetes developing among people with pre-diabetes. For example, the Finnish diabetes prevention study (Tuomilehto et al. 2001) showed that the risk of these individuals developing type 2 diabetes is reduced if they achieve one or more of the following:

·      reduce their weight by more than 5%

·      keep their fat intake below 30% of energy intake

·      keep their saturated-fat intake below 10% of energy intake

·      eat 15 g/1000 kcal of fibre or more

·      are physically active for at least 4 hours per week. "

MIDWIFE`S NOTES:
Every woman in Kuwait who has risk factors: overweigh, high energy intake diet ( fast foods) and small amount of physical activity should make changes before she plans pregnancy in order to have healthy pregnacy and better delivery outcomes.