'SA black men at more risk of diabetes than women'

With an increase in the number of people developing type 2 diabetes (T2D) in SA, researchers have found that black middle-aged men are more vulnerable to the condition than their female counterparts.

Men aged between 40 and 75 have a higher risk of developing diabetes due to several factors, including unhealthy lifestyles such as low levels of physical inactivity and high calorie/energy-rich but nutrient-poor food choices.

These risk factors lead to increasing levels of excess body fat (adiposity) which increase rates of overweight and obesity. 

Several international and national institutions, including the University of Witwatersrand and the SA Medical Research Council, conducted a study on increased risk for T2D in relation to excess adiposity in middle-aged black SA men compared to women.

The researchers explored if this could be due to sex differences in insulin sensitivity, beta-cell function, and sex-specific associations with total and regional adiposity.

Lead researcher in the study Dr Clement Kufe, from Witwatersrand University Medical School, said SA is experiencing an increase in obesity.

As a result, black SA men are at the greater risk for T2D than women.

“We further found that with increasing fat mass index [FMI] the decline in insulin sensitivity is greater in men compared to women. Increasing FMI is also associated with a more pronounced decrease in beta-cell function in men compared to women," said Kufe.

"The higher risk in men compared to women was independent of smoking and alcohol intake. These lifestyle risk factors were higher in men compared to women."

The study ascertained that men are susceptible to T2D due to increased central adiposity (that is accumulation of body fat around the central regions including the trunk), which explains why for the same level of body fatness, men are less insulin sensitive and have lower levels of insulin secretion and beta-cell function than the women.

The Centre for Diabetes and Endocrinology in SA (CDE) concurs with the study.

The CDE has been involved in many aspects of diabetes care, education, awareness, clinical trials, and technology products since it was founded over 30 years ago.

The organisation advocates a treatment foundation based on greater education and access to healthier food choices.

The aim is to provide a mix of macronutrients (proteins, fats, carbohydrates) and micronutrients (vitamins, and minerals), in appropriate portion sizes to maintain optimum body composition and function for each individual and their context.

Michael Brown, a diabetes specialist nurse at the CDE, shared some of his insights from decades of experience.

"Diabetes is currently the leading cause of death amongst women in South Africa and the second on the list of leading causes of death overall. Driving these figures, 1  in 9 people in SA have diabetes and around one in two people with the condition are undiagnosed. The latter tragedy is that because of the usual lack of symptoms for type 2 diabetes, many people may have the condition for up to a decade or more before they are diagnosed. This means that at diagnosis irreversible complications may already be present.

“But we are always about giving hope! At our health facility we see people living successfully with diabetes every day. The keys to success are earlier diagnosis and intensive, ongoing holistic care to address all risk factors. We guide and support our clients to manage their conditions better, and so to live longer, more productive lives,” said Brown.

So, who is at risk?

It is important for people over 35 years, especially those who have excess "tummy fat", to have their blood glucose and blood pressure checked annually.

The daily increase in new cases of diabetes in SA is sustained by a lack of knowledge about diabetes-related symptoms (passing large volumes of urine frequently together with a raging thirst, extreme fatigue and dramatic weight loss) and the usual lack of symptoms in many people who are at risk.

In addition, limited access to clinics or hospitals in poor rural areas and sub-optimal management of the condition after diagnosis compounds the problem.

Thus, diabetes is maiming and killing many people who, if they had the needed knowledge and support, their deaths could have been avoided.

Despite the increasing prevalence of diabetes, SA does not have an official clear picture of how many people are living with diabetes, receiving any care or receiving optimal care.

We are relying on an estimated figure of 4.6-million people from the International Diabetes Federation.

Said Kufe: "Overweight is when the body mass index [BMI] is between 25 to less than 30 Kg/m2 while obesity is when the BMI is equal to or greater than 30 Kg/m2. Beta-cells are cells that make insulin and as you know insulin is the hormone that controls the levels of glucose in the blood.

"So, when beta cells do not work well, this leads to a deficiency of the hormone [chemical messenger] insulin and a reduced ability to manage blood glucose levels. And this can be due to decreased insulin sensitivity which occurs when insulin is produced in correct amounts by the body but is not taken up and used by the body. Therefore, overweight/obesity leads to decreased insulin sensitivity and beta-cell function."

Generally, people with poorly managed diabetes experience severe health complications such as nerve damage (diabetic neuropathy), kidney damage (diabetic nephropathy), heart diseases (cardiovascular diseases), vision impairment (diabetic retinopathy), stroke, leading to morbidity (being unhealthy) and mortality.

Importantly, these are all preventable.

The CDE is encouraging people to make lifestyle changes to include healthy meals, getting physically active, lose weight, stop smoking and start taking alcohol at a moderate level.

Type 2 diabetes can be prevented, or its onset can be delayed.

And if you have it, diabetes can be managed. You can live a good and better life.

* Molemane is a diabetes activist and a senior journalist at KayaFM