How critical is diabetes in Indonesia, really?

How critical is diabetes in Indonesia, really?

Tantri Yuliandini, The Jakarta Post, Jakarta

Disparate data found in the kit distributed to the press for
"Diabetes Week" last week was perhaps the best illustration of
how little has been the government's attention to the nation's
health care.

On the one hand, Minister of Health Achmad Sujudi said in his
speech that approximately 2.5 percent of the Indonesian
population suffered from diabetes, of which only about 1.25
million had been detected. On the other hand, the PanduDiabetes
(Diabetes Guide) booklet, published by pharmaceutical company
Merck together with the Indonesian Association of
Endocrinologists (Perkeni), said the 2.5 percent included only
people above the age of 15.

In a separate statement, PanduDiabetes also said the figure
was actually much higher, from five percent to seven percent, or
about 12 million people. This figure at least, was identical to
that announced by the Indonesian Diabetes Association (Persadia)
in January.

Queried about the discrepancies, Anwar Haliyanto from PT Merck
Indonesia admitted there was actually no accurate data on the
incidence of diabetes in Indonesia.

"Integrated research has never been carried out into the
incidence of diabetes in the country. Many regions are doing
their own research, and often over differing periods, so we can't
combine the data to reach a national figure," he said. He
expressed the hope that more comprehensive research would soon be
possible. Anwar also said the "accepted" figure so far was the
2.5 percent as stated by the minister.

This lack of data is by no means exclusive to diabetes, and it
is not unusual to find experts faltering when asked about the
prevalence of many other diseases, like osteoporosis and COPD
Chronic Obstructive Pulmonary Disease (COPD).

Unfortunately, without an accurate figure, there is no way of
knowing how critical the diabetes situation is in the country,
and so concerted efforts to alleviate the situation are
ineffective.

In the meantime, the number of people suffering from diabetes
is growing. The World Health Organization predicted that in 25
years the number of people suffering from non-insulin-dependent
diabetes mellitus in the world would be twice the 150 million it
was in 2001.

Changing lifestyles, changes in diet, reduced physical
exercise, as well as increased human life expectancy, had
inadvertently increased the prevalence of various noncontagious
diseases such as diabetes mellitus, Sujudi said.

In the hope of obtaining a clearer picture of diabetes in
Indonesia, PT Merck, together with the Ministry of Health,
organized a program to check the glucose level of one million
people across Indonesia on March 15. The examinations were
carried out at shopping malls, offices and factory sites.

Besides raising people's awareness of the dangers of diabetes,
data from the free examinations would also be used to show the
incidence of the disease in Indonesia, PT Merck president Rudolf
G. Stock said.

Diabetes mellitus is a chronic disease caused by inherited
and/or acquired deficiency in the production of insulin hormone
by the pancreas, or by the ineffectiveness of the insulin
produced.

The deficiency results in increased concentrations of glucose
in the blood, which can develop into other serious complications
like heart disease, stroke, high blood pressure, circulation
problems, nerve damage and damage to the kidneys or eyes.

The main symptoms of untreated diabetes are increased thirst,
overactive bladder, especially during the night, extreme
tiredness, weight-loss, genital itching or regular episodes of
thrush and blurred vision.

There are two main types of diabetes mellitus. Insulin-
dependent diabetes, known as type-1 diabetes, develops when the
insulin-producing cells in the pancreas have been destroyed. In
their website diabetes.org.uk, Diabetes UK said it was not known
why these cells were damaged, but the most likely cause was an
abnormal reaction of the body to the cells, triggered by a viral
or other infection. This type of diabetes generally affects
younger people.

Type-2 diabetes, or non-insulin-dependent diabetes, develops
when the body develops insufficient insulin, or when the produced
insulin does not work properly, also known as insulin resistance.

People at risk of developing type-2 diabetes are those with a
family history of diabetes, people aged between 40 years and 75
years old, those of Asian or Afro-Caribbean origin, people who
are very overweight and women who have given birth to a large
baby.

"Certain medications, hormones, and steroids can also increase
a person's risk of acquiring diabetes mellitus," said metabolic
endocrinologist Sarwono Waspadji from Cipto Mmangunkusumo
hospital, Central Jakarta.

People with type-1 diabetes need injections of insulin for the
rest of their lives. They also need to have a healthy diet
containing the right balance of foods. Insulin cannot be taken
orally because it is destroyed by the digestive juices. People
with type-1 diabetes usually take either two injections or four
injections of insulin per day.

People with type-2 diabetes need to eat a healthy diet, and
sometimes take additional oral hypoglycemia tablets. These
tablets can help the pancreas produce more insulin, assist the
body make better use of the insulin that the pancreas does
produce, or slow down the speed at which the body absorbs glucose
from the intestine.

There is currently no cure for diabetes, but with correct
treatment, the blood glucose level can be controlled, to give the
patient a relatively normal lifestyle, Sarwono said, adding that
eating healthily and taking regular physical exercise would also
reduce the risk of developing complications.

Diabetes Week also features an exhibition for the general
public, lasting until March 28, as well public seminars on
diabetes on March 25 and March 26 at the Ministry of Health, Jl.
Rasuna Said, South Jakarta.

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If you have diabetes, you will have to make some changes to your
way of life, including:
* Healthy eating -- you may need to change your eating habits.
* Quit smoking, as it greatly increases the chance of developing
a serious health problem.
* Regular physical activity, such as walking, swimming, dancing
or cycling. Consult your doctor or diabetes nurse before taking
up any regular exercise, particularly if you are overweight.
* Regular checkup on blood glucose, and sticking to your
treatment.

Healthy diet:

A healthy diet for people with diabetes is also a healthy diet
for everyone else. Although food choice and eating habits are
important in helping you to manage your diabetes, you should be
able to continue enjoying a wide variety of different foods as
part of a balanced diet.
* Eat regular meals based on starchy foods such as bread, pasta,
chapatis, potatoes, rice and cereals. This will help control your
blood glucose levels. Whenever possible, choose high-fiber
varieties of these foods, to maintain the health of the digestive
system and prevent problems such as constipation.
* Cut down on fat intake, particularly saturated (animal) fats
that are linked to heart disease. Choose monounsaturated fats
like olive oil and rapeseed oil. Use less butter, margarine,
cheese and fatty meats. Choose low-fat dairy foods like skimmed
milk and low fat yogurt. Grill, steam or oven-bake instead of
frying or cooking with oil or other fats.
* Eat more fruit and vegetables. Aim for at least five portions a
day to provide you with vitamins and fiber as well as help you to
balance your overall diet.
* Cut down on sugar and sugary foods. This does not mean you need
to eat a sugar-free diet. Sugar can be used as an ingredient in
foods and in baking as part of a healthy diet. However, use
sugar-free, low-sugar or diet squashes and fizzy drinks, as
sugary drinks cause blood glucose levels to rise quickly.
* Use less salt, because a high intake of salt can raise your
blood pressure. Try flavoring food with herbs or spices instead
of salt.
* Drink alcohol in moderation only. Never drink on an empty
stomach, as alcohol can increase the likelihood of hypoglycemia
(low blood glucose levels).
Source: PanduDiabetes, Diabetes UK