I HAVE a confession to make. I am a sucker for traditional Irish dairy fudge. I do not have a sweet tooth, but I do not starve myself of the occasional sweets, chocolates and pastries. If my wife had her way, our house would be a sugar-free zone, bereft of processed sugar, honey and even fruit sugar.
Last Tuesday when I was in Dublin, the charming capital of Ireland, for a meeting, I found some traditional fudge at a famous local chocolatier, Butlers. I was horrified when I read the list of ingredients, especially “sweetened condensed milk”. This was in addition to white sugar, hydrogenised sugar and fructose. I cringed and started a hunt for real Irish fudge, free from sweetened condensed milk, incidentally a key ingredient also of teh tarik, the popular tea served in Southeast Asia.
I finally found a lone brand, O’Malley’s, free from condensed milk and extra sugars. But, the remarks of the assistant at Butlers chocolatier struck me: “I don’t understand why we don’t sell fudge and chocolates suitable for diabetics.” Not that I am a diabetic, albeit I do have my sugar level regularly checked because of my long-term use of steroids for my asthma and I have close relatives and friends who have been plagued by this potential killer and entirely preventable disease.
Coincidentally, last Tuesday, Nov 14, also happened to be World Diabetes Day, aimed at raising awareness of the disease. The latest statistics from the World Health Organisation (WHO) and International Diabetes Federation (IDF) suggest that the world is losing the war against excess sugar in diets because of the demand for cheap processed and fast foods, and a lifestyle well short of the required daily exercise.
There is an estimated 425 million people with diabetes in the world, which is set to rise to 629 million in 2045. This estimate comprises both diagnosed and undiagnosed diabetes. The Western Pacific Region, which includes Malaysia, with an adult population of 1.7 billion, according to IDF, has an estimated 158.8 million people with diabetes. This is expected to rise to 183.3 million by 2045. The region with the highest projected increase for the period is South and Latin America, followed by Africa and the Middle East.
In Malaysia, which has good quality healthcare data, an estimated 3.49 million adults aged between 20 and 79 years have diabetes, according to IDF. But, against a global context, it is the US, India, Brazil and China that have the highest number of child and adolescent diabetics this year although the highest incidence of increased rates were in Finland, Kuwait, Sweden and Saudi Arabia.
Diabetes mellitus, commonly diabetes, is an auto-immune disease due to raised levels of glucose in the blood because the body cannot produce any or enough insulin, a hormone produced in the pancreas which transports glucose from the bloodstream into the body’s cells where it is converted into energy. It is the lack of insulin or the inability of the cells to respond to it that leads to high levels of blood glucose, or hyperglycaemia, the hallmark of diabetes. If neglected, diabetes can lead to multiple organ failure affecting the heart, kidneys, nerves and eyes.
According to WHO, there are basically three main types of diabetes — Type 1 (where one is born with the disease because of genetic and hormonal imbalances), Type 2 (acquired in later life because of environmental, diet and lifestyle factors; this type accounts for the vast number of cases), and gestational diabetes (affecting women during pregnancy).
People with diabetes can live healthy and fulfilling lives as long as they take the prescribed medical precautions combined with a healthy lifestyle.
Theresa May, who has Type 1 diabetes, reached the pinnacle of politics when she became prime minister of Britain. Gary Mabbutt, the former Tottenham captain, refused to be bowed by Type 1 diabetes and went on to win 16 England caps. This summer, he even had life-saving heart surgery.
Diabetes is a great equaliser for it respects no boundaries, ethnicity, class, creed, gender and age.
Type 2 diabetes, usually most common in adults, is now increasingly seen in children and adolescents. It is a costly affliction, but with modest changes in lifestyle and diet, the risk of Type 2 diabetes can decrease markedly.
Data from WHO/IDF suggests that global diabetes healthcare expenditure reached US$727 billion (RM3 trillion) for this year. Despite its relentless march, the prevention and treatment of diabetes remains under-funded. In the United Kingdom, the National Health Service is prioritising people with the highest risk of developing Type 2 diabetes for places on its lifestyle-change programmes, which cover 1.7 million people.
The data is depressing. Diabetes, according to IDF, is the ninth leading cause of death in women globally, with the number at 2.1 million per year. Women with Type 2 diabetes are 10 times more likely to have coronary heart disease than women without it. More than 199 million women are living with diabetes, and this figure is projected to increase to 313 million by 2040. Two out of every five women with diabetes are of reproductive age, accounting for more than 60 million women worldwide. Similarly, one in seven births is affected by gestational diabetes.
We know that diabetes is a ticking time bomb. The United Nations Agenda for Sustainable Development has set a target to reduce premature mortality due to diabetes by a third by 2030. To rely purely on healthcare professionals and politicians to solve the scourge of diabetes is unrealistic. Individuals have to take responsibility.
The writer is an independent London-based economist and writer
