What is a Chronic Disease
A chronic disease is one lasting 3 months or more, . Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear.
Type 2 Diabetes
Is often considered a chronic disease as it meets all of the above definitions , but doses it need to be and should we consider treating it more assertively early on as an acute problem that can become chronic but doesn’t actually have to.
Perhaps more importantly if there is an opportunity to put our diabetes into remission or even better act when we have pre-diabetes shouldn’t we act now.
If there really is a cure for Type 2 Diabetes it is acting at the pre-diabetes stage so that we do not get it in the first place.
Act Early and be Decisive
Type 2 Diabetes is often managed through a conservative step wise approach using a multidisciplinary team and while this sounds like a good strategy it is currently not working well for some.
How Are We Doing
Despite increasingly stringent guidelines for glycaemic control, over 60% of patients with type 2 diabetes do not reach recommended glycaemic targets.(1)
Why Are We not Doing So Well
There may be a number of reasons why we are not doing so well some of these reasons are related to what is in our control as patients while others are related to how well we as health professionals support those with a new diagnosis of diabetes.
One of these is clinical inertia which has been described as the failure to establish appropriate targets and escalate treatment to achieve treatment goals, many believe it is responsible for a substantial amount of the preventable complications of diabetes.
Some of the effects of clinical inertia are due to the system itself this includes health professionals not supporting patients well or spending enough time with them to explain why targets are important. Other factors are entirely within our control including learning as much as we can about diabetes ourselves monitoring symptoms and progress and acting on issues.
How much of a problem is not acting the “Legacy effect”
The the failure to establish appropriate targets and escalate treatment to achieve treatment goals is a particularly concerning problem as we also know that there is also a legacy effect from not achieving goals early in treatment: that is, if we achieve target blood glucose levels soon after diagnosis, we have better long-term outcomes than those who do not reach target levels early, even if control is relaxed later in the course of disease.
Given that we know that we can reverse diabetes with significant lifestyle changes and prevent diabetes at the pre diabetes stage why are we not acting.
We have become so used what the new normal Australian lifestyle is we just accept it and do nothing about it
The new normal Our current lifestyles are neither normal or likely to support us to live a healthy happy life.”We have become so used to our current lifestyle we don’t even know how poor it has become for many of us”
- in 2014 the Australian nutrition survey reveled that over 35% of the food we now eat is discretionary foods (Alcoholic beverages (4.8% of energy), Cakes, muffins scones and cake-type deserts (3.4%), Confectionery and cereal/nut/fruit/seed bars (2.8%), Pastries (2.6%), Sweet biscuits and Savory biscuits (2.5%) and Soft drinks) # this is actually highly likely to be underestimated
- 63.4% of Australians aged 18 years and over were overweight or obese (11.2 million people), composed of 35.5% overweight (6.3 million people) and 27.9% obese (4.9 million people). A further 35.0% were of normal weight and 1.6% were underweight.
- 55.5% of 18-64 year olds achieved more than 150 minutes of moderate physical activity or more than 75 minutes of vigorous physical activity. Nearly one in three (29.7%) managed less than 150 minutes in the last week while 14.8% did not exercise at all in the last week including walking !
- In 2014-15, 49.8% of Australians aged 18 years and over met the guidelines for recommended daily serves of fruit (2 or more serves), while 7.0% met the guidelines for serves of vegetables. Only one in twenty (5.1%) adults met both guidelines
- Australians spent 4.4 hours a week, or 53 minutes a day for a five-day working week, travelling to and from work. This has increased from 3.9 hours in 2002 and getting worse daily.
Targets 6.5 tragets body weight targets BP etc . evidence for acheiving targets early and remission
- Del Prato S, Felton AM, Munro N, Nesto R, Zimmet P, Zinman B. Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract 2005;59:1345–55. Search PubMed