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

Malta Independent - - INTERVIEW -

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.

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