Health Delivery

'Complementary therapies' have been in use for thousands of years. Today they are increasingly popular with the general public and many health professionals, especially nurses and general practitioners. Despite the wide availability of conventional medications, over 50% of the populations of most Western countries use complementary therapies. This figure may be even higher in other cultures. Many complementary therapies can be used by people with diabetes, but there are associated risks that need to be considered.

The political and social situation in the Gaza Strip remains tense, with considerable disruption of normal economic and social activity. Such an environment is rarely conducive to the delivery of continuing medical care. In this article Panagiotis Tsapogas, Medical Co-ordinator of the Greek section of Médecins Sans Frontières (Doctors Without Borders) in Gaza, 2002-2003, reports on the difficulties faced by Palestinian people with diabetes in Gaza, and makes a call for the provision of improved diabetes care.

Diabetic retinopathy is a disease of the small blood vessels of the retina, which is the lining of the back of the eye that senses light. Several factors contribute to the progression of this complication of diabetes: poor metabolic control, rapidly improved metabolic control, long duration of diabetes, high blood pressure and pregnancy. Pregnancy-induced progression of diabetic retinopathy can be sight-threatening.

While pre-menopausal women without diabetes are protected from cardiovascular disease (CVD), women with diabetes lose the protective effect of female sex hormones. Consequently, CVD is the leading cause of death and disability in women with diabetes. However, by knowing and controlling the risk factors for CVD, one can do much to prevent or delay its development—even in this high-risk group.

There are no contraceptive methods that are specifically contraindicated in women with diabetes. Given the increased risks associated with unplanned pregnancy, methods with proven high degrees of effectiveness are to be preferred. The most important medical factor which affects the choice of contraception is the presence of vascular complications. For this reason women with diabetes should be evaluated by a physician before making their contraceptive choices. Contraceptive counselling should be an integrated part of care for all women with diabetes of childbearing age.

The metabolic control of diabetes tends to deteriorate during the adolescent years, and this deterioration is more pronounced in teenage girls than boys. Efforts to achieve and maintain excellent blood glucose control are more difficult and less successful in adolescents than in adults. This suggests that the teenage years are a highly vulnerable period for girls with Type 1 diabetes, a time when the risk for the later development of diabetes-related complications may become accelerated.

Diabetes is closely associated with cardiovascular diseases (CVD), particularly heart attack, stroke and ischaemia of the lower limbs. People with diabetes are two to four times more likely to develop these diseases compared to people without the condition. Recent evidence, however, tells us that it is possible to prevent or delay these complications. IDF is very aware of the scale of the problem, and has entered the 21st century with the issue high on its agenda. Diabetes and Cardiovascular Disease has been selected as the theme for this year’s World Diabetes Day campaign.

Care of people with diabetes is in need of improvement. Patients are often left in the dark about their condition and many receive false or unnecessary medication. It has been shown in a recent German study, performed by the Centre for Sociopolitics at the University of Bremen, together with the medical insurance company, Gmünder Ersatzkasse (GEK), that too few people with diabetes are being subscribed much needed medication, too many are taking the wrong type of medication and many are inadequately informed about sensible diet and self-management techniques.

Diabetes has ‘arrived’ in China. This condition was relatively rare among the Chinese population until 20 years ago. As life has become more and more westernized and industrial, the prevalence of diabetes has increased rapidly. The average prevalence rate has increased from just under 1 percent in 1980 to as high as nearly 7 percent in some areas in 1996. Chinese health resources are struggling to keep up with this explosion. However, the Peking Union Medical College Hospital (PUMCH) have an education programme which is producing positive outcomes.

Empowerment is a philosophy that recognizes the fundamental right of people with diabetes to be the primary decision makers in the management of their condition. It represents a more compatible model of care and education needed for a self-managed illness such as diabetes.