- A study of diabetes treatment in 55 low and middle income countries found that many of the participants with diabetes were unaware that they had the condition.
- Overall, less than 5% were getting adequate drug treatments and lifestyle advice.
- The researchers pooled data from nationally representative surveys that asked people what treatments they were taking to reduce blood sugar, blood pressure, and cholesterol levels and what advice they had received about diet, exercise, and weight.
- Diabetes medications are cheap and proven to reduce both the risk of diabetes-associated complications and the long-term costs of care.
The International Diabetes Federation notes that of the estimated 463 million adults in the world who have diabetes, almost 80% live in low and middle income countries.
DiabetesTrusted Source increases a person’s risk of a range of disabling and potentially fatal complications, including heart attack, stroke, blindness, and damage to the kidneys and nerves.
Drug treatments for the condition are cheap and proven to reduce morbidity and mortality.
However, the ability of health services in low and middle income countries to diagnose the condition and deliver these treatments is often limited. This inevitably leads to unnecessary suffering and many avoidable deaths.
Doctors at the University of Michigan in Ann Arbor and Brigham and Women’s Hospital in Boston, MA, recently led a study to estimate the scale of the problem.
The researchers drew on data from standardized household surveys in low and middle income countries that included information on blood test results for diabetes and self-reported treatments.
They discovered that only 4.6% of people with diabetes were receiving the whole package of care that the World Health Organization (WHO)Trusted Source recommends for treating the condition in primary care.
While 50.5% and 41.3% of the respondents were taking drugs to lower their blood sugar and blood pressure, respectively, only 6.3% were on cholesterol-lowering medication.
Overall, 32.2% of respondents said that they had received advice on diet. Just 31.5% had received advice on weight loss, and 28.2% on exercise.
“Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low and middle income countries,” says lead author David Flood, M.D., M.Sc., who is a national clinician scholar at the University of Michigan Institute for Healthcare Policy & Innovation.
“It confers a high risk of complications, including heart attacks, blindness, and strokes,” he adds. “We can prevent these complications with comprehensive diabetes treatment, and we need to make sure people around the world can access treatment.”
The research has been published in The Lancet Health LongevityTrusted Source.
Lack of treatment for high cholesterol
The household surveys provided data for a total of 680,102 adults in 55 low and middle income countries.
Blood tests indicated that 37,094 of these individuals had diabetes. However, only 43.9% of them said that they had received a diagnosis.
Even among those with a formal diagnosis, there was room for improvement in terms of drug treatments. While 85% and 57% of those who knew that they had diabetes were taking drugs to lower their blood sugar levels and blood pressure, respectively, only 9% were taking a statin to lower their cholesterol.
The researchers write:
“Our findings suggest that delivering treatment not only to lower glucose but also to manage [cardiovascular disease] risk factors, such as hypertension and elevated cholesterol, among people with diabetes are urgent global priorities.”
Countries with higher incomes tended to have better coverage across all the diabetes treatments.
Coverage was generally highest in Latin America and the Caribbean and lowest in Oceania (Pacific islands) and sub-Saharan Africa.
The researchers have passed their findings to the WHO, which launched the Global Diabetes CompactTrusted Source on April 14, 2021, to step up efforts to prevent and treat diabetes worldwide.
Two-way links with COVID-19
People with diabetes and obesity are more likelyTrusted Source to develop severe COVID-19 infections, and researchers also believe that COVID-19 may trigger diabetes.
Jennifer Manne-Goehler, M.D., Sc.D., one of the authors of the new paper, told MNT that the pandemic has increased the urgency to improve diabetes services in resource-limited contexts.
Dr. Manne-Goehler is an infectious diseases physician at Brigham and Women’s Hospital and a clinical fellow at Harvard Medical School, both in Boston, MA.
She and her colleagues have found that diabetes is associated with “poor early outcomesTrusted Source” for people hospitalized with COVID-19.
“The COVID-19 pandemic has really highlighted how important the intersection between diabetes and infectious conditions is and the far-reaching implications of ensuring everyone with diabetes has access to much needed services,” she said.MEDICAL NEWS TODAY NEWSLETTERKnowledge is power. Get our free daily newsletter.
Dig deeper into the health topics you care about most. Subscribe to our facts-first newsletter today.Enter your emailSIGN UP NOW
Your privacy is important to us
Limitations of the research
The study authors highlight several limitations in their paper, including inconsistencies across the different surveys in terms of the year they took place, the diagnostic tests that were used, and the age profile of the participants.
These differences and others may account for some of the observed variation in treatment coverage among countries.
The researchers also report that they were unable to get enough data about the availability of counseling to quit smoking.
They write that this is a limitation because smoking is a major contributor to the risk of cardiovascular disease among people with diabetes.
How to manage diabetes
While there is no cure for diabetes, with treatment and self-management strategies, a person can live a long and healthy life.
Diabetes is a chronic disease that affects millions of people around the world. In the United States, 1.5 million people receive a diabetes diagnosis every year.
Diabetes also affects children and adolescents. Approximately 193,000 people younger than 20 in the country have diagnosed diabetes.
The American Diabetes Association (ADA) note in 2017 guidelines that self-management and education are crucial aspects of diabetes care.
Diabetes self-management can reduce blood sugar levels, mortality risk, and healthcare costs, as well as weight in people with excess weight.
In this article, we discuss strategies that people with diabetes can use every day to improve their health.
Self-monitoring
Two important indicators of diabetes control are levels of glycated hemoglobin and blood glucose. Measuring glycated hemoglobin requires a blood test in a doctor’s office, but a person can measure their blood glucose at home.
Doctors recommend that people using insulin check their glucose levels. The right frequency of these checks varies from person to person, but doctors usually recommend monitoring levels before and after meals, at bedtime, and before exercising.
People with diabetes who are not taking insulin should also check their blood sugar levels. Self-monitoring can provide information about the effects of dietary changes, physical activity, and medication on blood sugar levels.
With a blood glucose meter, a person can measure their blood sugar level at any time.
There are also continuous glucose monitors, which provide real-time information about blood sugar levels. These automatically measure levels every 5 minutes through a small sensor inserted under the skin.
When a person uses it appropriately, this type of technology can improve health outcomes.
A healthcare team can use at-home blood sugar readings to modify medication, nutrition, and self-management plans.
Maintain a healthy weight
It is important for people with diabetes or prediabetes to achieve and maintain a healthy weight. When doctors closely monitor weight loss progress, a person more likely to achieve their goals.
Research suggests that, among people with excess weight, modest, consistent weight loss can help manage type 2 diabetes and slow the rate at which prediabetes becomes diabetes.
They also noted that making dietary adjustments can lower glycated hemoglobin levels by 0.3% to 2% in adults with type 2 diabetes. Nutrition therapy can also lead to improvements in the quality of life.
To facilitate these lifestyle adjustments, the ADA recommend consulting a registered dietitian with expertise in diabetes and weight management.
Get good nutrition
Following a meal plan can be among the most challenging aspects of diabetes self-management. Developing a plan with a registered dietitian who is knowledgeable about diabetes-specific nutrition can help.
For some people, dietary changes alone are not enough to control blood sugar levels. Diabetes is a progressive disease, which means that it can worsen over time. The ADA recommend using a combination of medication and nutrition therapy to reach blood sugar targets.
The basis of meal planning involves portion control and favoring healthful foods. The diabetes plate method is one tool designed to help people control their calorie and carbohydrate intakes.
It involves mentally dividing the plate into three sections. Half of the plate should contain nonstarchy vegetables, a quarter can contain grain-based and starchy foods, and the remaining quarter should contain protein.
Exercise regularly
Research has shown that exercise can help control blood sugar levels, reduce cardiovascular risk factors, promote weight loss, and improve well-being.
Researchers behind one study found that engaging in a structured exercise program for at least 8 weeks lowered glycated hemoglobin levels by an average of 0.66% in participants with type 2 diabetes.
The ADA recommend exercising for at least 10 minutes per session and getting a total of at least 30 minutes of exercise on most days of the week.
If a person exercises every day — or lets no more than 2 days pass between workouts — this may help reduce insulin resistance.
Members of a diabetes healthcare team can help develop and tailor an exercise plan that is safe and effective.
In addition to exercising regularly, it is important to avoid spending long periods in a seated position. Breaking up sedentary periods every 30 minutes can help with controlling blood sugar.MEDICAL NEWS TODAY NEWSLETTERKnowledge is power. Get our free daily newsletter.
Dig deeper into the health topics you care about most. Subscribe to our facts-first newsletter today.Enter your emailSIGN UP NOW
Stop smoking
The ADA advise all people with prediabetes or diabetes to avoid tobacco products, including e-cigarettes.
People with diabetes who smoke have higher risks of cardiovascular disease, premature death, and diabetes complications, as well as less blood sugar control, compared with people who do not smoke.
Take medication regularly
Nonadherence is a medical term for not taking medication as prescribed.
If a person with diabetes does not take their medication as recommended by a doctor, it can lead to:
- lower success rates in achieving clinical targets
- increased complications
- increased likelihood of early mortality
- increased overall healthcare costs
A diverse range of issues can contribute to medication nonadherence. Some may relate to psychological, demographic, and social factors. Key elements can include the cost of treatment and difficulties with healthcare providers and the healthcare system.
People who have a good support network are more likely to take their medication as prescribed.
Doubt about the seriousness of diabetes and the effectiveness of a treatment plan can keep a person from taking their medication, and this can lead to complications.
Nonadherence seems to be more common among people who have chronic diseases with symptoms that are not obvious. Also, complex treatment plans can be challenging to follow.
The quality of the patient-doctor relationship is often a key factor in nonadherence. It is important for doctors to address a person’s reasons for not following the treatment plan.
Likewise, it is important to raise concerns about diabetes treatment with the doctor, who can adjust the plan to help ensure that targets are being met and no complications develop.
Researchers have estimated that the collective cost of medication nonadherence for diabetes, high blood pressure, and high cholesterol in the U.S. was $105.8 billion in 2010.
Takeaway
Diabetes is not curable, but a person can help manage it at home. This often involves following nutrition and medication plans.
For a better outcome, it is important to stop smoking, and many programs are available to help.
A person with diabetes or prediabetes should also be physically active and maintain a healthy weight. A diabetes care team can help develop and tailor an exercise plan.
Blood glucose meters and continuous glucose monitors can help a person track their progress and see the effects of self-management techniques.ADVERTISEMENT
Last medically reviewed on June 27, 2019
8 sourcescollapsed
Medically reviewed by Maria Prelipcean, M.D. — Written by Jessica Caporuscio, Pharm.D. on June 27, 2019
Latest news
- COVID-19 lockdowns saw increased screen time and sleep problems
- Fainting and vaccination: What to know and what to do
- Deep sleep may help clear the brain of Alzheimer’s-related toxins
- Treating COVID-19: Are we overusing antimicrobials?
- Moderately high blood pressure: Exercise should be first-line treatment
Was this article helpful?
List of tests for diabetes
It can take time for the symptoms of diabetes to appear. However, a doctor may be able to detect the condition in its earlier stages by performing various medical tests.
These tests can detect different forms of diabetes, including type 1, type 2, and gestational diabetes.
In this article, we describe the types of diabetes and the tests that detect them, including their processes and results. We also cover home testing kits and when to see a doctor.
Type 2
Doctors can use several different tests to detect type 2 diabetes. In a person with this condition, the body produces insulin but is unable to use it effectively.
Hemoglobin A1c
One of the most common diabetes tests is the A1c test.
The doctor may also refer to this as the hemoglobin A1c, HbA1c, or glycated hemoglobin test. It measures the attachment of glucose (blood sugar) molecules to hemoglobin, which is a component of red blood cells.
The A1c test results indicate a person’s average blood sugar level over 3 months. If this level is higher than 5.7%, it shows that there is a consistent, unusually high amount of glucose in the blood, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
A person does not have to fast before this test, which just involves taking a small blood sample.
A doctor may diagnose diabetes based on the results of an A1c test alone. However, the only form of diabetes that it can detect is type 2 diabetes.
Fasting plasma glucose test
The fasting plasma glucose (FPG) test requires a person to have no food or drink for 8 hours before giving a blood sample. The doctor’s office tends to schedule it early in the morning, and the test usually involves taking blood either from a finger, which some healthcare professionals call a “finger-stick test,” or from a vein in the arm.
Random plasma glucose test
A random plasma glucose (RPG) test also tends to involve a finger stick or taking blood from an arm vein. The major difference between this test and an FPG test is that an RPG test does not require the person to fast in preparation.
Type 1
Type 1 diabetes can be difficult to diagnose. It develops when the body does not produce enough insulin, a hormone that it needs to process blood sugar.
Without treatment, type 1 diabetes can cause a person’s blood sugar levels to rise very high. Treatment involves injecting insulin.
If a doctor suspects type 1 diabetes, they will check whether a person is experiencing its symptoms, which can include extreme fatigue and flu-like symptoms.
The doctor can also use the following tests:
- FPG: This blood test indicates how well the body is processing glucose.
- Oral glucose tolerance test: For this test, a person will need to fast and then drink a solution that contains glucose. A healthcare professional will then measure blood sugar levels every hour for 2–3 hours.
- A1c: This test can indicate average blood sugar levels over the past 3 months, but the results can be incorrectly low in people with type 1 diabetes.
If the results are inconclusive, the doctor may order any of the following tests:
- C-peptide: The pancreas produces this protein alongside insulin. Low levels of C-peptide in the blood can suggest low levels of insulin.
- Insulin autoantibodies: This test checks for the presence of proteins that target and destroy insulin.
- Glutamic acid decarboxylase autoantibodies: Doctors use this test to check for the presence of antibodies that can destroy enzymes in insulin-producing cells.
- Insulinoma-associated 2 autoantibodies: The presence of these antibodies can also indicate that the body is attacking the cells that produce insulin.
- Islet cell cytoplasmic autoantibodies: The Juvenile Diabetes Research Foundation estimate that 80% of people with type 1 diabetes have this type of antibody.
- Zinc transport 8: This test identifies antibodies that kill insulin-producing beta cells.
A doctor may only be able to make a conclusive diagnosis after seeing the results of several of these tests.
Gestational diabetes
Doctors typically use two tests to diagnose gestational diabetes, which develops in pregnant women.
Glucose challenge test
A doctor typically performs this test between 24 and 28 weeks of pregnancy, according to the NIDDK. It is usually the first test for gestational diabetes.
The glucose challenge test requires a person to drink a beverage that contains glucose. An hour later, a healthcare professional will draw blood to measure the level of glucose.
A result of 135 milligrams per deciliter (mg/dl) or higher may indicate that the body is not processing glucose correctly.
To confirm a diagnosis of gestational diabetes, the doctor will recommend an oral glucose tolerance test.
Oral glucose tolerance test
This test requires the woman to fast for 8 hours and then give a blood sample. Next, she will drink something that contains glucose, and a healthcare professional will draw blood once an hour for at least 2 hours.
If blood sugar levels remain high throughout this period, this can indicate gestational diabetes.
Home testing
Some tests are possible for people to carry out themselves at home. These include:
Blood sugar testing
Home testing kits can measure blood sugar. The specific components of the kits vary, but most include:
- lancets for pricking the finger
- test strips to collect the blood
- a machine called a glucometer that evaluates the sample and gives a reading
A doctor will determine a person’s target blood sugar levels, and they will also explain which results indicate the need for medical attention.
Urine ketone testing
A different type of home test evaluates the urine for the presence of ketones, which the body produces by breaking down fats for energy. Ketones usually indicate that the body has too little insulin.
Most pharmacies sell these kits. The test involves collecting a urine sample, then inserting the provided strips into the urine. These will indicate the presence of ketones.
If ketone levels are moderate or high, a person should usually seek medical attention.MEDICAL NEWS TODAY NEWSLETTERKnowledge is power. Get our free daily newsletter.
Dig deeper into the health topics you care about most. Subscribe to our facts-first newsletter today.Enter your emailSIGN UP NOW
Your privacy is important to us
Results
According to NIDDK, the following are the general ranges of diabetes test results. The doctors may use these ranges when considering a diabetes diagnosis.
A1c
- normal: less than 5.7%
- prediabetes: 5.7–6.4%
- diabetes: 6.5% or higher
FPG
- normal: 99 mg/dl or under
- prediabetes: 100–125 mg/dl
- diabetes: 126 mg/dl or higher
RPG
When levels are 200 mg/dl or higher, a person could have diabetes.
Summary
A doctor or trained diabetes educator can provide more information about the tests and their purposes.
Most are blood tests, although a urine ketone test can also indicate whether the body has enough insulin.
Following a diagnosis, the doctor may use some of these tests to track the effectiveness of a person’s diabetes care plan.ADVERTISEMENT
Last medically reviewed on July 12, 2019
5 sourcescollapsed
Medically reviewed by Deborah Weatherspoon, Ph.D., R.N., CRNA — Written by Rachel Nall, MSN, CRNA on July 12, 2019
Fruits for people with diabetes
- List of fruits for diabetes
- Fruit and diabetes
- What is the glycemic index?
- Benefits for diabetes
- Other health benefits of fruit
- How much fruit should I eat?
Eating fruit is a delicious way to satisfy hunger and meet daily nutritional needs. However, most fruits contain sugar. This has raised questions about whether fruits are suitable for people who have diabetes.
Diabetes is a chronic but manageable condition in which the body struggles to control the levels of blood sugar.
Is fruit dangerous for people with diabetes? This article will suggest fruits to eat and avoid if you have diabetes, as well as examining the relationship between fruit and blood sugar.
List of fruits for diabetes
Below is a list of fruits divided by GI index, as reportedTrusted Source by the U.S. Department of Agriculture (USDA).
Low GI and GL fruits
Some fruits have a GI of under 55 and a GL under 10, including.
- apples
- avocados
- bananas
- berries
- cherries
- grapefruit
- grapes
- kiwi fruit
- nectarines
- orange
- peaches
- pears
- plums
- strawberries
Medium-GI fruits (GI of 56 to 69)
A fruit with a GI of between 56 and 69 is considered to be a medium-GI food. All fruits listed below still have GL levels under 10.
- honeydew melon
- figs
- papayas
- pineapples
High-GI fruits
Fruits with a GI higher than 70 are high-GI and a GL of greater than 20 is high GL. While these are safe to eat with diabetes, it is important to eat larger quantities of lower-GI fruits instead.
- dates (high GL)
- watermelon (low GL)
Fruit and diabetes
The American Diabetes Association (ADA) advises that any fruit is fine to eat for a person with diabetes, so long as that person is not allergic to a particular fruit.
A meta-analysisTrusted Source published in 2014 in the British Medical Journal found higher fruit intake was significantly associated with a lower risk of type 2 diabetes.
The preparation of fruit, however, can affect blood sugar. Fresh or frozen fruits are better than processed fruits straight from a can or jar, such as applesauce and canned fruit. Processed fruits also include dried fruit and fruit juices.
People with diabetes should eat processed foods sparingly or avoid them completely. The body absorbs processed fruits more rapidly, leading to higher blood sugar levels. Processing fruits also removes or reduces levels of certain key nutrients, including vitamins and fiber.
The National Institute of Diabetic and Digestive and Kidney Diseases (NIDDK) recommends that people with diabetes should avoid fruit juices or canned fruits with added sugar.
Fruit blends like smoothies also have high sugar content and are more rapidly absorbed leading to higher spikes in blood sugar.
What is the glycemic index?
For a person with diabetes, one way to select safe and suitable fruits and other high-carbohydrate foods is to check the glycemic index (GI).
GI is a rating of foods on a scale from 1 to 100. The score indicates how quickly the food item may raise blood sugar levels.
High GI foods are absorbed faster than medium or low GI foods.
Glycemic load (GL) takes into account the GI of a food plus the number of carbohydrates in a serving. GL may be a more accurate way of assessing how food affects blood sugar management over time. Low-GI and low-GL foods are better for helping control blood sugar levels.
People may be surprised to learn that many fruits have a low glycemic index. People digest starchy vegetables, such as potatoes and grains, more rapidly, so these have a higher GI index.
The longer a carbohydrate-rich food is cooked, the higher the GI value. Fat, fiber content, and cooling carbohydrates after they have been transformed into resistant starches via cooking can all dramatically lower GI values.
Benefits for diabetes
Eating enough fiber plays an important role in managing diabetes.
A diet high in soluble fiber can slow the absorption of sugar and control its levels in the blood. Many fruits are high in fiber, especially those with the skin or pulp included.
Many fruits are filling because of their high fiber and water content.
Diets containing enough fruits and vegetables can reduce the risk of obesity, heart attack, and stroke. Obesity has been linked to type 2 diabetes.
Fruits are high in fiber and nutrients, so they are a good choice in meal planning. Fruits that have been processed such as applesauce and fruit juices have had their fiber removed and should be limited.MEDICAL NEWS TODAY NEWSLETTERKnowledge is power. Get our free daily newsletter.
Dig deeper into the health topics you care about most. Subscribe to our facts-first newsletter today.Enter your emailSIGN UP NOW
Your privacy is important to us
Other health benefits of fruit
The good news is that fruit is healthy to eat for people with diabetes, according to the NIDDK.
People with diabetes should eat a balanced diet that provides enough energy and helps to maintain a healthy weight. Some fruits are high in sugar, such as mangoes, but can be part of a healthy diet in moderate amounts.
Fruits can also satisfy a sweet tooth without resorting to candy and other foods with low nutritional value. Most fruits are high in nutrients and low in fat and sodium. Fruits also often contain nutrients not found in other foods.
Bananas contain potassium and tryptophan, an important amino acid. Citrus fruits like oranges and grapefruits are high in vitamins A and C, which are powerful antioxidants.
How much fruit should I eat?
Most guidelines recommend that adults and children eat five servings of fruits and vegetables each day. This does not change for people with diabetes.
The United States guidelines recommend that people fill half of their plate at each meal with fruits and vegetables.
People with diabetes should focus on non-starchy vegetables for 50 percent of the meal, rather than depending on fruit. The remaining half of the meal should be protein and high-fiber starches like beans or whole grains. Many experts also recommend including healthy fat at each meal to encourage feeling full and enhance absorption of antioxidants and vitamins.
One serving is a medium-sized fruit, or a serving the size of a baseball. Smaller fruits, such as berries, have one-cup as the serving size.
A half-cup is also the serving size for processed fruit products, such as applesauce and fruit juice. The serving for fried fruits like raisins and cherries is 2 tablespoons per serving size.
Like vegetables, it’s great for people to eat a variety of fruits to get their needed nutrients, as well as to enjoy their varied flavors.
Dietary tips
To achieve the desired five servings of fruits and vegetables per day, people should aim to have fruit or vegetables throughout the day.
Here are a few ideas to help with menu planning:
Citrus fruits
Citrus fruits are versatile and easy to add to meals. Add lemons and limes to seafood, sauces, or glasses of iced tea or water.
People can make their own fruit water by adding citrus slices to a pitcher of water. Let the water sit overnight to create a refreshing drink.
Berries
Berries are tasty when eaten raw and can also be cooked into a compote to spoon into oatmeal or meat.
Put whole fresh or frozen berries into a saucepan with a tablespoon or two of water. Cook on medium or low heat until the berries have broken down into a thick sauce.
One serving is half a cup.
Apples
Apples are a popular fruit. They are delicious raw for a snack or dessert. When cooked, apples have a deeper flavor, making them a favorite in cooked desserts when spiced with cinnamon or ginger.
A recipe from the ADA suggests marinating apples in a small amount of honey and spices and then cooking them on a grill. To finish, roll the apples in crushed walnuts or pecans.
While still containing honey, this is a healthier alternative to many apple-based baked goods.
Avocados
Avocados are high in fat, but they contain monounsaturated fat, the type of fat that is beneficial for the body.
They are eaten raw and can be served sliced, in salsas, or as guacamole. Avocados are easy to prepare by slicing them in half around the pit. Discard the pit and mash the avocado.
Add herbs and vegetables to taste. Lime or lemon can also be added to avocado for a citrus boost.
Article by: Fruits for diabetes: Options, GI, and benefits (medicalnewstoday.com)
Photo by Mykenzie Johnson on Unsplash
