World Diabetes Day 2023

Every year, the 14th of November is World Diabetes Day, a day dedicated to raising awareness about diabetes. In the past 10 years, I've reflected on this day in various Monday notes, starting back in 2013. This year, I take a closer look at whether there has been any significant progress in the last decade.

In my 2013 note, I began with the definition of diabetes according to The International Diabetes Federation (IDF). Back then, it was described as a chronic condition occurring when the pancreas could no longer produce insulin, or when the body couldn't effectively use the insulin it produced. The IDF's definition hasn't changed much in 2023, apart from a few sentences being shortened.

The 2023 definition still emphasises insulin's role as a key to allowing glucose from food to enter cells, producing energy. It's highlighted that all carbohydrate foods break down into glucose in the blood, and insulin facilitates its movement into cells. Not being able to produce or use insulin effectively leads to high blood glucose levels, known as hyperglycemia, associated with long-term damage to the body.

I find it noteworthy that the word "glucose" is mentioned five times in the definition, underscoring its significance. It's also acknowledged that all carbohydrate foods contribute to glucose in the blood.

The categorisation of diabetes has expanded over the years. In 2013, there were two types (Type 1 and Type 2), but in 2023, gestational diabetes mellitus (GDM) has been added as the third type. Type 1 diabetes (T1D) now affects a broader age range, and its autoimmune nature is still not fully understood. Type 2 diabetes (T2D) is still the most common, accounting for over 90% of cases. Gestational diabetes occurs during pregnancy, affecting both mother and baby.

All three types of diabetes can be better managed through lifestyle interventions. For instance, a low-carb diet, as advocated by Richard K. Bernstein in his book "Diabetes Solution," has proven effective for optimal T1D management. T2D can be put into remission primarily through dietary changes, and GDM risks can be mitigated by controlling blood glucose levels during pregnancy.

Despite these insights, diabetes prevalence has surged over the years, with 537 million cases reported in 2023, compared to 371 million in 2013. The projections are alarming, estimating 643 million cases by 2030 and a staggering 783 million by 2045. The IDF attributes this rise to factors like urbanisation, an aging population, reduced physical activity, and increasing obesity.

However, I challenge this perspective, suggesting that a fundamental issue lies in glucose handling. This post questions prevailing dietary recommendations from both the IDF and the American Diabetes Association (ADA), advocating for a shift towards very low-calorie or very low-carbohydrate diets. The fear of fat is identified as a major hindrance, preventing progress in diabetes management.

In conclusion, while the definition and types of diabetes have seen minimal changes over the past decade, my reflections on World Diabetes Day prompt a call for a radical shift in dietary recommendations and a reevaluation of strategies to address the escalating global diabetes epidemic.

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