Diabetes is a silent pandemic which the world has learnt to live with, professors in the Department of Podiatry at University of Malta have said.

Tomorrow, 14 November, marks World Diabetes Day, a day dedicated to the condition which is a “global burden which brings about lifelong complications in the body”, Professor Cynthia Formosa said.

The Malta Independent spoke with the two professors, who are currently developing a device which will attempt to reduce the incidence of diabetic foot complications in persons with diabetes.

“Diabetes causes a lot of problems in the body ranging from the eyes to the kidneys, to the feet. This day is for awareness and making people aware that we need to look after ourselves and check ourselves,” Prof. Formosa said.

Professor Alfred Gatt added that to put things into perspective on how big the problem truly is, there are 600 million people worldwide living with this disease. In Malta, about 10% of the population suffer from diabetes, which is quite high compared to figures in northern European countries, where it is less than 2-3%.

Asked why diabetes isn’t given as much importance as a pandemic, as the Covid-19 pandemic was, Prof. Formosa said that diabetes has been with us for many years and people have learnt to live with it.

“It could bring about major complications which include a high mortality rate. Its mortality rate is second only to lung cancer. We speak a lot about cancer but unfortunately, we do not talk much about diabetes,” Prof. Formosa added.

She said that the day serves for awareness for people to think and reflect about it, which could lead to the individual realizing that they should check themselves for diabetes, especially if it runs in the family. Diabetes can often be hereditary.

“This could be a wake-up call for a person to realize that they hadn’t had a blood test in a while,” she said.

The professors were asked what symptoms individuals should look out for with regards to this disease. How do people usually find out they have diabetes? 

The genetic Type 1 diabetes, which often shows up early in life, subjects the patient to daily insulin doses. Type 2 diabetes shows up later in life mostly due to lifestyle changes.

“Symptoms may be insidious, so people wouldn’t notice that they have diabetes until they have a blood check for something else. They end up checking their blood glucose and find out that there is a high glucose in the blood,” Prof. Gatt said.

Prof. Formosa continued that as stated in literature, diabetes has a latency period of four to seven years, meaning that an individual could have been living with diabetes for up to seven years and not know it. Diagnosis, however, is computed from the day you find out you have diabetes.

“That is the problem when we do the screening, as you might have been living with it for already a number of years,” Prof. Formosa said.

Gatt explained that while symptoms may not be so prevalent unless you have high levels of glucose, they could range from urinating often at night, to thirst, loss of weight without changes in diet, hunger, blurred vision, numbness or tingling in the feet, tiredness and dry skin, among others.

How regularly should one go for check-ups? Gatt said that it depends on the risks one has of developing diabetes, such as having someone in the family who has it.

“The older a person gets the more often they should check for diabetes, as well as people who have a certain lifestyle of eating unhealthy foods; people with obesity,” Prof. Gatt said. Prof. Formosa said that she personally things that people over 40 and 50 years of age should go for check-ups yearly.

“Sometimes, as podiatrists, we realize that a person has diabetes because of how the feet presents, for example, feet with very thin shiny skin, loss of hair, the patient might complain of calf cramps in the calf muscles or rest pain when they are asleep. Noticing the development of a wound is also a sign for a check-up,” Prof. Gatt said.

Prof. Formosa said that diabetes could also be diagnosed from a simple fungal infection in the feet.

“The effect of this condition is systemic, so it affects the whole body, particularly the feet. The feet are often neglected and leads to problems such as amputations which in many cases lead to extensive morbidity and mortality as people often die after amputations,” Prof. Gatt said.

The general public does not seem to take diabetes very seriously and the professors were asked why.

“Because it is very difficult to change your lifestyle and the very necessary thing is to change your lifestyle – a healthy diet, controlling calories, eating much less junk food and do exercise,” Prof. Gatt said, also adding that people have gotten lazier, having a feeling of “it will never happen to me”.

Prof. Formosa said that resistance to change to give up a lot of good things is difficult. Diabetes is a lifelong disease which requires a lifetime behavioural change, she said.

Is there a cure? The professors were asked if persons with diabetes can ever be free from the condition.

“At the moment it is controlled. You control diabetes by changing lifestyles. Insulin injections, used to help metabolise the glucose in the body, are used for Type 1 diabetes, while the use of medication, such as Oral Hypoglycaemic Agents (OHAs) tablets are used to control the disease,” he said.

Prof. Gatt added that diabetes does not exist on its own, where in many situations, there are often other conditions which one must control alongside diabetes, such as obesity, higher blood pressure and higher cholesterol levels, which lead to further complications.

Prof. Formosa shed some light on the fact that despite diabetes being a lifelong disease, literature says that if some people catch the disease in the pre-diabetes phase, through diet changes and weight loss, they could reach normal blood glucose levels.

“This would prevent a long list of medications and other complications,” Prof.  Formosa said.

Gatt said that the simplest thing to do when in doubt is to check and have yearly screenings with a podiatrist, who can check the circulation, nerve endings, mobility of the joints and integrity of the skin.

“From the patient’s perspective, the simplest thing that they can do is to check their feet daily. You would be surprised how many people ignore their feet,” Prof. Gatt said.

He said that problems are not always obvious, but sometimes one can prevent acute problems from becoming worse by detecting them and taking action immediately.

“Patients can do things which are pretty much common sense, such as wash your feet daily, dry them well especially between the toes, apply softening creams, use nail files to cut your nails and avoid backless shoes which harden the heel, which could lead to infection,” Prof. Gatt said.

Asked about the progress of their study, which is aimed at reducing the amputation trend and continuously monitoring the feet, Prof. Gatt said that the team is hoping that the device will save many people from complications.

“We are working in many areas where diabetes is concerned, one of the areas is thermography with thermal cameras, and at this stage we are very sure that we can actually detect that a person has foot complications by taking a simple photo, which speeds up the screening process,” Prof. Gatt said.

“The device is at a very advanced stage now, so we are at a point where we have a clinical device at this moment aimed at the clinician who can actually use it on a patient to assess how the patient walks, what the temperatures in the shoe are and how these can be corrected,” Prof. Gatt said.

He said that they will start conducting trials on healthy patients in the next few months.

Prof. Formosa encouraged people with diabetes to become members of the Malta Diabetes Association, where they can relate and talk to people who have the same condition.

The Malta Diabetes Association holds conferences and seminars to serve as education and empowerment, raising awareness on the disease while motivating those with the disease to confront it in the best way possible.

The Podiatry Department at the University of Malta are conducting various research projects related to the diabetic foot by academics and also by post-graduate students.