Health Delivery

In the late 20th century obesity became an epidemic. The importance of obesity as a risk factor for a number of conditions, including type 2 diabetes, cardiovascular disease, hypertension, gallstones and certain cancers, is well documented. Often associated with insensitivity to insulin, obesity is clearly a key factor in the development of the metabolic syndrome – a risk for both diabetes and cardiovascular disease. In this article, Robert Eckel and Scott Grundy explore the underlying causes of obesity and insensitivity to insulin.

Diabetes, now a global epidemic, is the fourth leading cause of death in Taiwan. The most recent epidemiological data demonstrated that the prevalence of diabetes is approaching 5% and that the number of people with diabetes in Taiwan

It is estimated that around 2 billion children and adolescents worldwide suffer from weight-related disorders. According to the World Health Organization (WHO), more than a billion people are overweight, at least 300 million of whom are obese. As societies continue to embrace unhealthy sedentary lifestyles, fuelled by high-fat, high-sugar processed foods, obesity-related disorders, including type 2 diabetes and cardiovascular disease, are affecting increasing numbers of people at all levels of society and in almost all the countries in the world.

Optimal diabetes outcomes depend on a lifetime of appropriate care, including self-care, education and management. Health professionals require a body of knowledge and skills in order to provide effective diabetes care, education and management. In 2002, a step towards assisting healthcare professionals to gain that knowledge was taken by the International Diabetes Federation’s Consultative

Nobody can single-handedly manage the many and diverse aspects of diabetes. To be effective, diabetes care requires the coordinated input of people with diabetes and a range of healthcare providers, including a diabetes nurse, dietician, psychologist, pharmacist, physiotherapist or podiatrist, among others. Close

Type 2 diabetes is at epidemic proportions among Aboriginal people in Canada – around 15% of the Aboriginal population from 15 years and older. During the 1980s, healthcare providers at the local hospital in Kahnawake Mohawk Territory near Montreal, Quebec, noticed high rates of diabetes among people with cardiovascular

Over the last 30 to 40 years, the death rate from cardiovascular disease has been gradually falling in many countries in the developed world. Improved detection and treatment of high blood pressure and high cholesterol levels, falling rates of smoking, and modern, efficient treatment of emergencies, such as heart attacks, have contributed to a steady decline in the numbers of people dying from cardiovascular conditions. However, according to Jonathan Shaw, this trend could be reversed at the next tick of the global clock.

There is a constellation of metabolic abnormalities which includes centrally distributed obesity, decreased levels of HDL cholesterol, elevated triglycerides, high blood pressure, and high blood glucose (hyperglycaemia). This is known as the metabolic syndrome. Associated with a five-fold risk for type 2 diabetes and two- to three-fold increase in risk for cardiovascular disease, the metabolic syndrome is now considered one of the principal public health issues of the

Foot ulcers are caused by an imbalance between excessive pressure on the sole of the foot and repetitive stress from walking. It does not take much pressure to provoke an ulcer, so the skin has a built-in protection system. Normally, harmful pressure or motion against the skin will set off a protective pain alarm. Unfortunately, in people with diabetes nerve damage (neuropathy), this pressure goes undetected and can cause serious injury. Having lost the ‘gift of pain’, people with diabetes neuropathy often do not notice the problem until an ulcer has formed.

This is the story of ‘Mr L’, a man in Australia with type 2 diabetes and severe diabetes nerve damage (peripheral neuropathy). He developed neuropathy-related ulcers on one of his toes, which remained untreated for a number of months. He faced the prospect of having his left foot amputated. However, this was prevented because Mr L was linked to a multidisciplinary hospital-based diabetic foot clinic.