The number of persons in Malta diagnosed with diabetes is expected to increase to 36,800 by 2035, the latest statistics and predictions by the International Diabetes Federation (IDF) show.

Diabetes has become one of the major killers worldwide, and in Malta in 2014, there were 35,200 Maltese people diagnosed with diabetes. Malta saw 269 deaths from diabetes in the same year and the number of patients with undiagnosed diabetes stood at 12,000. The World Health Organisation predicts that diabetes will be the world’s seventh leading cause of death by 2030.

Parliamentary Secretary for Health Chris Fearne describes Diabetes as a complex chronic condition and its management is highly varied depending on the manner it presents and affects an individual.

 

“There are some persons who are controlled through lifestyle modification. The majority of persons with Type 2 Diabetes require oral anti hypoglycaemic agents however the combination and dosage varies depending on the individual. Some persons with type 2 Diabetes will require insulin instead of or in addition to the oral anti hypoglycaemic agents. Persons with Type 1 Diabetes require insulin regimes. The intensity of blood sugar monitoring again depends on the person and the manifestation of the condition”.

Asked about the estimated healthcare costs for patients with Diabetes, the Parliamentary Secretary explained that “some persons with Diabetes unfortunately develop complications which require ancillary care and hospital treatment or admission. The complexity therefore makes it difficult to estimate the total government expenditure on Diabetes and it is not possible to derive an average treatment cost”.  

The IDF however, attempted to find the mean diabetes –related expenditure per person in US dollars. According to its statistics, in Malta, the mean amount spent on a single patient is $2,114.

“In Malta, the estimated prevalence of Diabetes is around 10% in adults rising to over 20% in persons aged over 60 years. On an annual basis over 30,000 outpatient episodes are registered in the Diabetes clinics at Mater Dei and at the Health Centres,” he said.

“Last year this government introduce a measure where Haemaglucotest (HGT) Blood sugar testing sticks where made available to all patients under 18. This year this government will keep on working on last year’s measure, and from 2016 hgt sticks will be made available for free to all insulin dependent patients. This measure alone is estimated at the cost of €0.5 million annually”.

National Diabetes policy.

By the end of this year the National Diabetes Policy will be in place, the Parliamentary Secretary explained. “This policy will lead to the introduction of numerous practices for the well-being of all diabetic patients. The main points of the policy, which was open for public consultation, are a 24 hour helpline, increased involvement of family doctors and the introduction of new medicines. As of next year a new medicine for Diabetes, gliptins will be introduced in the formulary. This measure is estimated to cost €3.5 million annually”.

In 2014, the global prevalence of diabetes was estimated to be 9% among adults aged 18+ years, the WHO said, with an estimated 1.5 million deaths caused worldwide in 2012. In the UK, an extra 1.2 million people have Diabetes now than a decade ago and the number of those living with the condition has soared by 59.8% since 2005. Malta has one of the highest national prevalence percentages (10.69%) in Europe, with the average standing at (7.87%).

 

Type 1 and Type 2

According to the IDF, Individuals can experience different signs and symptoms, and sometimes there may be no symptoms at all. Some of the signs of diabetes are frequent urination, excessive thirst, increased hunger, weight loss, tiredness, lack of interest and concentration, a tingling sensation or numbness in the hands or feet, blurred vision, frequent infections, slow-healing wounds, vomiting and stomach pain.

“The development of type 1 diabetes is usually sudden and dramatic while the symptoms can often be mild or absent in people with type 2 diabetes, making this type of diabetes hard to detect”.

There are two main types of diabetes. Type 1 diabetes used to be called juvenile-onset diabetes. It is usually caused by an auto-immune reaction where the body’s defence system attacks the cells that produce insulin. The reason this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease may affect people of any age, but usually develops in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. “If people with type 1 diabetes do not have access to insulin, they will die,” The IDF said.

“At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation”.

Type 2 diabetes used to be called non-insulin dependent diabetes or adult-onset diabetes, and accounts for at least 90% of all cases of diabetes. It is characterised by insulin resistance and relative insulin deficiency, either or both of which may be present at the time diabetes is diagnosed. “The diagnosis of type 2 diabetes can occur at any age. Type 2 diabetes may remain undetected for many years and the diagnosis is often made when a complication appears or a routine blood or urine glucose test is done. It is often, but not always, associated with overweight or obesity, which itself can cause insulin resistance and lead to high blood glucose levels. People with type 2 diabetes can often initially manage their condition through exercise and diet. However, over time most people will require oral drugs and or insulin”.

IDF explains that there is a lot of evidence that lifestyle changes can prevent type 2 diabetes.

Obesity, particularly abdominal obesity, is linked to the development of type 2 diabetes, the IDF website read. “Weight loss improves insulin resistance and reduces hypertension. People who are overweight or obese should therefore be encouraged to achieve and maintain a healthy body weight”.

Malta is one of the top European nations when it comes to obesity problems. It is of such concern, that the topic has been discussed in Parliament, been made the topic of a number of surveys and has government scrambling to create bills to help try and solve the problem. The Healthy Lifestyle bill (to combat obesity) is being discussed.

“Physical activity is one of the main pillars in the prevention of diabetes. Increased physical activity is important in maintaining weight loss and is linked to reduced blood pressure, reduced resting heart rate, increased insulin sensitivity, improved body composition and psychological well-being”.

IDF also recommends a balanced diet and cutting smoking (a well-established risk factor for many chronic diseases, including diabetes).

“Both type 1 and type 2 diabetes are serious. There is no such thing as mild diabetes”.