Clinical Care

The importance of identifying children who are at risk of developing the metabolic syndrome cannot be underestimated. The syndrome is a cluster of risk factors

Aged 42 years, ‘S’, friend and colleague of the author, weighed 204 kg. Now, three years later, after undergoing intensive dieting and psychotherapy, she has lost nearly 10% of her body weight. But she remains 38 BMI units over and above the 30 kg/m threshold for the ‘obese’ category; she is in the range of ‘morbid obesity’. In a few weeks she will undergo dramatic abdominal surgery for this condition. Rhys Williams tells her story.

Ground-breaking research findings from the end of the last century demonstrated that the disabling and potentially life-threatening chronic complications of type 1 diabetes can be delayed or prevented by early and intensive blood glucose control. However, this strict and demanding regimen can present a major challenge for young people with the condition.

Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality worldwide, representing 60% of all deaths. Contrary to common perception, 80% of chronic disease deaths occur in low- and middle-income countries. This invisible epidemic is an underestimated cause of poverty and hinders the economic development of many countries. Sub-Saharan Africa carries the highest burden of disease in the world, the bulk of which still consists of the communicable diseases HIV/AIDS, tuberculosis and malaria.

During the last decade, insulin pump therapy has gained widespread acceptance in the treatment of children and adolescents with type 1 diabetes. In some of the European and North American paediatric diabetes centres, more than half of the young people with diabetes try to simulate a normal pattern of insulin secretion by means of an insulin pump (continuous subcutaneous insulin infusion).

The onset of coeliac disease, together with type 1 diabetes, influences glycaemic control, and more precisely the development of hypoglycaemia. These conditions share a similar genotype. The main problem of coeliac disease is intolerance to gliadin, a gluten protein found in cereals such as wheat, rye and barley; the only treatment is a gluten-free diet. Spomenka Ljubic and Zeljko Metelko report on the growing body of evidence linking coeliac disease and other autoimmune disorders, including type 1 diabetes, and describe recommended procedures for its diagnosis and treatment.

Breastfeeding has numerous advantages for mothers with diabetes and their babies. Nursing mothers have lower insulin requirements and better control of their blood glucose; breastfed babies may have a lower risk of developing diabetes themselves. Alison Stuebe describes these potential benefits and highlights the special needs of breastfeeding mothers with diabetes.

Early intervention to prevent or delay type 2 diabetes benefits people who are at high risk of developing the condition in terms of increased life expectancy and quality of life. It also benefits societies and healthcare systems in economic terms. In order to address the growing impact of type 2 diabetes, the International Diabetes Federation (IDF) Task Force on Prevention and Epidemiology convened a consensus workshop in 2006. Its primary goal was the prevention of type 2 diabetes in developed and developing countries.

Fasting during Ramadan, one of the five pillars of Islam, is an obligatory duty for all healthy adult Muslims. Ramadan, a lunar month, can last for 29 or 30 days, and its timing changes with respect to seasons. Depending on the geographical location

Puberty is a period of rapid and radical physical, psychological and social change during which a child, in physiological terms, becomes an adult capable of reproduction. Adolescence refers as much to the psychosocial characteristics of development during puberty as to the physical changes. Adolescents with diabetes, who need to adhere to a complex medical regimen based around self-care throughout this period of development, face a series of particular and considerable challenges.