What is diabetes? What’s the difference between type 1 and type 2? What’s the situation in Malta in regards to diabetes? Dr Mario J Cachia, a specialist in Diabetes, Endocrinology Internal Medicine, and visiting professor at the University of Malta answer
Diabetes is a condition where glucose (the body’s sugar) is not regulated properly, resulting in high blood sugars persisting for inappropriately long periods of time. If not controlled by the three pillars of therapy (diet, exercise, and medication) it causes major problems with body function. This results in the complications of diabetes, classically leading to eye damage (blindness), renal damage (kidney failure) and nerve/circulation damage (lower limb amputation). However, diabetes is a very high-risk condition for development of heart disease (angina, heart attacks and heart failure). It is associated with strokes but is not a very strong risk factor. Smoking and uncontrolled high blood pressure accelerate the deterioration of these complications.
The classification of diabetes has evolved and there are now many recognised types. However, from a practical point of view, one can still think of diabetes in binary fashion as being type 1 and type 2. From the practical and slightly simplistic point of view, type 1 patients require insulin to survive and this is required at diagnosis. These patients are often in a very unstable state at diagnosis and practically always require admission to hospital. Type 2 diabetes on the other hand, can often be treated with diet and oral medications, and very rarely presents itself in an unstable condition. Type 2 patients may require insulin later in the course of their disease. Although type 1 patients tend to be much younger, and the condition often appears in childhood or early adulthood, this distinction is becoming increasing blurred. The increase in childhood obesity, together with the decrease in exercise, has led to several children being diagnosed with type 2 diabetes in early adolescence.
It is well known that Malta has a very high prevalence of type 2 diabetes. It is estimated that there are around 40,000 individuals with type 2 diabetes. We also have a very high prevalence of type 1 diabetes compared with other Mediterranean countries, but the numbers are much fewer than those with type 2 – around 3,000 individuals.
Management of diabetes in Malta is free if individuals want to use the National Health Service. There are provisions of clinics at Mater Dei and at the heath centres. Drug therapy is basically free, although newer medication is not all available on the NHS. There is provision of specialised foot care services and dietetics. Obviously, all these services are also available in the private sector.