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Mirroring a finding in humans, diabetes diagnoses in dogs are significantly more likely to occur in the winter and in the northern US compared to any other season or region, a new study shows.

For the study in PLOS ONE, researchers looked at 960 pet dogs with diabetes mellitus living across the United States. Though the findings dont explain the underlying cause of this correlation, the link with cold weather hints at future possibilities to pursue.

I was surprised we found this connection, even though it had been hinted at before.

This link is something that has been discussed in regard to humans with type 1 diabetes, but its never been rigorously looked at in dogs, says Rebecka Hess, a professor of internal medicine in the University of Pennsylvania School of Veterinary Medicine, and senior author of the study.

Its important to explore because dogs and people live in the same world. If the environmentcold temperatures and seasonalityare important in this disease in both species, it gives us something to look at with further research.

To investigate the relationships between geography, seasonality, and diabetes, Hess and Penn Vet colleagues recruited dogs with the condition from across the US, reaching out to all of the nations veterinary schools, the American Kennel Club, and breed clubs and leveraging social media to gain the broadest sample possible.

Owners filled out surveys about their pets, including their dogs age, date and age at the time of diabetes diagnosis, and state of residence.

For 669 dogs, the date of diabetes diagnosis was known. Of those, 33% were diagnosed in the winter, compared to 24% in the spring, 24% in the summer, and 19% in the fall.

When the researchers looked at geographic regions of the US, the North stood out, with 46% of diagnoses occurring in dogs in this region, compared to 27% in the South, 15% in the central US, and 12% in the West. This is despite the fact that many more dogsmore than 31 millionreside in the South compared to about 24 million in the North and about 13 million each in the central and West regions.

To be honest, I was surprised we found this connection, even though it had been hinted at before. I was always skeptical of the data, says Hess. But when I saw our results, it was quite clear. The findings were strengthened by the fact that diabetes diagnoses were more prevalent in both the winter and the North. Results would have been more difficult to interpret if, for example, we had found increased prevalence in the winter but also in the South.

Of the dogs in the study, 3% developed diabetes before they were 1 year of age. Like the diagnoses made in adulthood, these juvenile-onset cases were also more common in colder months and in the North but did not correlate to any particular breed, the researchers say.

Hypotheses about the connection between colder and more northerly climates and diabetes diagnoses in humans include links to vitamin D deficiency, diet, lifestyle, and viral infections. In dogs, the diet connection seems unlikely, Hess says, as most dog owners feed their pets a commercially available kibble, no matter their location or the season.

In addition, she says, overweight and obese dogs arent at higher risk of developing diabetes, so a connection with exercise, or lack thereof, seems unlikely.

In Hess view, the culprits are more likely to involve how the body processes either vitamin D or insulin. In human studies, lower levels of vitamin D have been connected with an increased likelihood of diabetes. And lower temperatures lead to declines in insulin sensitivity. Hess also says some researchers have floated a connection to a viral infection that may be more prevalent in cold weather.

In future work, Hess says she hopes to delve into the vitamin D connection, perhaps exploring how genetic variability in the vitamin D receptor correlates with diabetes risk. A study that examines a prior history of viral infection could also be revealing, she says.

Given the close relationship between humans and dogs, and the parallels we see when it comes to diabetes, it behooves us to look.

Source: Penn

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More dogs are diagnosed with diabetes in winter - Futurity: Research News

Yii presents a lucky draw prize to a young winner at the event, witnessed by Dr Fam (second left).

MIRI (Aug 22): The 2019 National Health and Morbidity Survey (NHMS) showed an increasing prevalence of diabetes among adults, of which almost half were undiagnosed.

In stating this, Deputy Minister for Tourism, Creative Industry and Performing Arts Datuk Sebastian Ting said according to the survey, almost five per cent of young Malaysians between 18 to 29 years old are diagnosed as diabetics.

It is worrying to see this trend, he said in a text speech read by Miri mayor Adam Yii who represented him at the opening of Miri Diabetes Camp 2022yesterday.

Pointing out that diabetes is a lifestyle disease, Ting said it is primarily affected by ones lifestyle which includes daily activities, dietary choices, eating pattern and the presence of other chronic diseases such as hypertension and dyslipidemia.

Diabetes is a disease that affects many organs, namely the heart, kidneys, eyes and wound healing. Nonetheless, it is reassuring to know that we now have a wide array of treatments for diabetes, available in most healthcare facilities in Miri, he noted.

It is my wish to look forward to more public educational, awareness events such as this to empower the community in the battle against diabetes. I must applaud Diabetes Malaysia for hosting the annual Miri Diabetes Camp, he said.

Ting also expressed his appreciation to the staff of Miri Hospital for their tireless efforts in treating diabetic patients and managing their complications, as well as the government health clinics in playing the role of primary and preventive care for the community.

The one-day Diabetes Camp which took place at Pullman Hotel was jointly organised by Diabetes Malaysia Association Miri branch and Miri Hospital.

Also present was Miri Hospital director Dr Jack Wong and event organising chairperson, Consultant Physician Dato Dr Fam Tem Lom.

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A new drug that reboots how fat cells use insulin could revolutionise type 2 diabetes treatment and improve the outlook of hundreds of millions of patients globally.

A new drug that reboots how fat cells use insulin could revolutionise type 2 diabetes treatment and improve the outlook of hundreds of millions of patients globally.

The drug, called PATAS, is in development after a team of international researchers, including Monash University, decoded what causes insulin resistance in fat tissue cells. This has been a major stumbling block in treating and preventing type 2 diabetes.

PATAS, which is being developed by AdipoPharma, could be delivered by simple injection and possibly a patch. It may also have the potential to prevent type 2 diabetes, a major global epidemic, largely driven by obesity.

Type 2 diabetes involves high blood sugar levels and is caused by the resistance of body cells such as fat cells (adipocytes) to the action of insulin, the hormone that enables glucose to be properly utilised in the adipocytes and in the rest of the body.

Published in the American Diabetes Association journal Diabetes, the French, UK, USA and Australian teams research found an inability by fat cells to regulate metabolism using glucose causes insulin resistance.

The research was led by Inserm, Frances National Institute of Health and Medical Research, in collaboration with Monash University and the University of Birmingham (UK).

Dr Vincent Marion, the Inserm study coordinator and deputy director at the Laboratory of Medical Genetics in Strasbourg, France, along with his team, designed the breakthrough peptide drug PATAS and has shown that it was able to fix this problem by enabling glucose to be used in fat cells.

Co-researcher Paul Zimmet AO, Professor of Diabetes at Monash University, said the discovery could improve metabolic control of diabetes and reduce the risk of the serious complications of diabetes including heart, kidney, liver and eye disease.

PATAS corrects an abnormality in fat cells by separating two proteins, ALMS1 and PKC alpha, that are associated with insulin resistance by blocking insulin from initiating glucose uptake.

In rodent studies, PATAS reduced the insulin resistance, glucose intolerance and fat build up in the liver (steatosis). Beneficial effects were also observed in glucose intolerant animal models. Similarly, when used on cultured human fat cells in the laboratory and independent contract research organisations, the drug reactivated glucose uptake in the fat cells.

Professor Zimmet said the discovery was potentially one of the most important he had seen in his 45 years of diabetes research. Human clinical trials are likely to start in 2023.

This is a very exciting discovery that could have enormous health benefits, not just for people with type 2 diabetes, but also for patients with other chronic medical disorders caused by insulin resistance including cardiac diseases, and fatty liver and the Metabolic Syndrome, Professor Zimmet said.

Current drugs for type 2 diabetes mainly focus on lowering the high blood sugar level rather than targeting insulin resistance, the underlying cause.

This research study has for the first time, identified the root cause of insulin resistance in adipocytes, a precursor of type 2 diabetes, and developed a drug that reduces insulin resistance and restores normal glucose uptake.

Type 2 diabetes is very costly for global economies and diagnoses are rising and patients are becoming younger, with the disease now frequently detected in adolescents and children.

Diabetes affects 537 million people worldwide, most of whom have type 2 diabetes. The International Diabetes Federation says the annual global cost of diabetes treatment was USD$966 billion in 2021 up more than 300 per cent in the past 15 years.

This diabetes breakthrough emerged following research into Alstrom Syndrome, an ultra-rare genetic disease in children. It is associated with obesity and severe insulin resistance that leads to type 2 diabetes and an accelerated form of liver steatosis and fibrosis. The researchers found that insulin resistance was linked to the dysfunctional protein, ALMS1.

Building on this previous research, the multinational team next discovered that in normal fat cells and upon insulin signalling, a protein called PKC alpha is released from ALMS1 to trigger glucose uptake. With insulin resistance, PKC alpha is no longer released from ALMS1 and hence glucose is no longer absorbed by the fat cells to be utilised.

Dr Marion said that in cultured human adipocytes as well as in most relevant animal models, PATAS was able to separate the proteins and restore normal function of glucose uptake and utilisation in the fat cells.

Thanks to PATAS, which rescues the adipocytes (fat cells) that could no longer access glucose, they were once again able to take up glucose and metabolise it to synthesise and secrete healthy lipid metabolites which are beneficial to the entire body for maintaining insulin sensitivity and overall metabolic health, he said.

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Innovative drug could improve type 2 diabetes treatment - Medicine, Nursing and Health Sciences - Monash University

Katherine R. Tuttle, MD, FASN, FACP, FNKF, a nephrologist from the University of Washington and Providence Health Care, discussed new consensus guidelines that call for the early use of sodium glucose cotransporter 2 (SGLT2) inhibitors, GLP-1 receptor agonists, and finerenone in the care of patients with both chronic kidney disease (CKD) and diabetes.

Rising rates of type 2 diabetes (T2D) worldwide are driving up incidence of chronic kidney disease (CKD), but these patients can reduce their risk of early death if physicians make better use of available therapies, starting with sodium glucose cotransporter 2 (SGLT2) inhibitors.

Katherine R. Tuttle, MD, FASN, FACP, FNKF, clinical professor of medicine, Division of Nephrology at the University of Washington, and executive director for research, Providence Health Care, called for a more holistic approach to addressing glucose control while also protecting the heart and the kidney late last month, as she addressed the American Society for Preventive Cardiology, meeting in Louisville, Kentucky.

Despite all that is known about prevention, Tuttle said, Today, 4 out of 10 people with type 1 (diabetes) and 3 out of 10 with type 2 will still develop kidney disease. This is half of all chronic kidney disease worldwide, she said. With 537 million people having diabetes in 2021, that translates into 200 million developing CKD; and the numbers with diabetes are forecast to reach 783 million by 2040.

So, for the foreseeable future, all of us will be seeing more and more people with chronic kidney disease, she said.

Tuttle offered additional data highlighting the interconnected nature of diabetes, heart failure, and CKD, noting the majority of patients with end-stage renal disease have diabetes. Cardiologists treat many of these patients, and they may be the first clinicians in a position to prescribe newer therapies that can halt renal progression. These are the highest risk patients who have the most to gain from what you have to offer, she said.

Not that its been easy to sort through conflicting advice. Guidelines from groups such as the American Diabetes Association (ADA) and nephrology professional society may not have been well harmonized, Tuttle explained, leading to confusion for treating physicians. To that end, she was part a joint effort by the American Diabetes Association and KDIGO (Kidney Disease: Improving Global Outcomes) that presented a consensus statement in June. The statement called for renin-angiotensin system inhibitors and statins to be used as first-line treatment for all CKD patients, including those with type 1 diabetes (T1D). But significantly, multiple other new therapies were included in first-line treatment, even ahead of metformin.

Over the past decade, she said, trials involving SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists, have demonstrated significant benefits to the heart, kidney, and all-cause mortality in patients with diabetes.

Although SGLT2 inhibitors were developed to treat T2D, many other benefits have been discovered because of cardiovascular outcomes trials, which were required by the FDA to rule out any safety issues. When the drug class was shown to have benefits in heart failure and prevention of renal decline, manufacturers launched dedicated trials in these areas; some are still awaiting results.

Tuttle highlighted both a meta-analysis and 2 dedicated kidney studies that had been published this far (EMPA-KIDNEY for empagliflozin is due to report results). Importantly, both the heart and kidney benefits are present, even in this very high risk group of patients with established kidney disease, she said.

Kidney outcomesmeasures of estimated glomerular filtration rate (eGFR) that track kidney decline, showing the need for dialysis or transplanthave shown 40% risk reduction, while composites for heart failure, hospitalization for heart failure, and cardiovascular outcomes have declined 25%. Both are enormous, Tuttle said. Remember, especially people with kidney disease, these are the two major risks in this population. This is really a breakthrough moment for us.

She made special note of the historic significance of the DAPA-CKD study, which led to dapagliflozin receiving fast track breakthrough therapy designations in 2020firsts in nephrology. Results showed a 39% risk reduction for a composite measure of worsening renal function or risk of cardiovascular or renal death among CKD patients already receiving standard of care. Reductions in all-cause death or hospitalization for cardiovascular disease or heart failure were also impressive.

More recently, Tuttle said, trials involving the nonsteroidal mineralocorticoid antagonist (MRA) finerenone, have shown that the potent anti-inflammatory effects have produced positive renal outcomes. (Last year, results presented at the European Society of Cardiology showed finerenone cut hospitalization 29% in the highest-risk patients.)

So, were beginning to build the concept of combination therapy, because these drugs work very differently, she said.

Its extremely important, Tuttle said, for cardiologists to not rely solely on eGFR but also to screen for albuminuria, because that can help catch CKD in its earliest stages, when its treatable. She highlighted trial results that showed how finerenones results are not adversely affected by SGLT2 use, and then presented a case study about their concurrent use. So, the beautiful thing about this is, is not only may these drugs be providing complementary efficacy, but it may be that using and SGLT2 inhibitor mitigates hyperkalemia and allows us to deliver finerenone safely.

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SGLT2 Inhibitors, Combination Therapy Needed to Stem the Tide of CKD in Diabetes - AJMC.com Managed Markets Network

One of the most nuanced areas of diabetes management has become a focal point for diabetes care and education specialists: use of new technologies to improve care. With many in patient-facing roles, optimal uptake and dissemination of information, and the technologies themselves, have led to diabetes technology becoming a main topic of discussion at the Association of Diabetes Care and Education Specialists (ADCES) annual meeting and for good reason. In just the first half of 2022, major regulatory decisions have been made related to Omnipod 5, Eversense E3, and the FreeStylen Libre 3 devices.

With an interest in learning more about the real-world need for diabetes care and education specialists in advancing use of continuous glucose monitoring and other diabetes-centric technology, EndocrinologyNetwork sat down Gary Scheiner, MS, CDE, owner and clinical director of Integrated Diabetes Services, at the ADCES 2022 annual meeting for his perspective on the ever-changing landscape. That conversation is the subject of the video found below:

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The Role of Diabetes Care and Education Specialists on Leveraging Technology in Diabetes, with Gary Scheiner, MS, CDE - Endocrinology Network

Camp Kudzu is having their Kudzu One Day to educate families and kids with diabetes and spreading awareness in Central Georgia.

WARNER ROBINS, Ga. Camp Kudzu is hosting their 1st Kudzu One Day event on Saturday from 10 a.m. - 4 p.m. at Green Acres Baptist Church in Warner Robins.

Families with kids that have type 1 diabetes and are insulin-dependent can register today on the Camp Kudzu website.

There will be educational classes with health experts, camp activities, and snacks and drinks provided.

Check-in time starts at 9:45 AM.

The day will start with Dr. Stephen Ponder who will speak to parents about diabetes education.

Then, Jessica Hutchins, a pediatric endocrinologist with Atrium Health Navicent Medical Center in Macon, will discuss diabetes and mental health.

While the parents are attending classes, the campers and their siblings will create arts and crafts, play camp games, and learn about diabetes.

Families and kids will participate in color wars and a snow cone social.

Camp Kudzu asks that families bring their own lunch food for the picnic.

If you have questions or want more information, you can contact Community Coordinator Caroline Tallman by email at caroline.tallman@campkudzu.org.

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Camp Kudzu hosts event for families and kids with diabetes - 13WMAZ.com

Teachers and school staff of children with type 1 diabetes are being urged by the HSE and Diabetes Ireland to follow new guidelines about their care.

According to Diabetes Ireland, for children living with diabetes, a return to or starting school for the first time also means adapting to their diabetes management, sometimes changing insulin regimes, and thinking about blood glucose monitoring and safety in school.

Diabetes is a disease that occurs when a persons blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy.

It is caused by the bodys own immune system destroying the insulin-making cells (beta-cells) of the pancreas.

Ireland has a high incidence rate of type 1 diabetes in children and adolescents with on average 285 new cases of type 1 diabetes in those under 15 years diagnosed annually. Our country is in the top 25 per centfor diabetes incidence worldwide, according to Diabetes Ireland.

Up to five children and teenagers are diagnosed each week with Type 1 diabetes in Ireland.

There can be an added concern for parents, as well as for the teacher if a child with diabetes is starting school for the first time or changing to a new class or school with a teacher who may not be yet familiar with diabetes.

The younger the child, the greater the involvement in the diabetes management and care of school staff it is, often including special needs assistants.

To help make the transition as easy as possible for everyone, new guidelines have been published by the HSE in an effort to provide useful information and a number of tools and easy-to-follow actions to help school staff to understand type 1 diabetes and the needs of such pupils.

The document sets out clear guidelines that will help structure the conversation and preparations between the family, diabetes team, and school staff. It explains diabetes and diabetes management to teachers and school staff and sets out clear lines of responsibility for all partners.

The document also includes a Personal Pupil Plan to agree on current diabetes management and the needs of a child. This includes information such as personal hypoglycemia symptoms, what to eat during hypoglycemia, and when to check glucose levels and deliver insulin.

The school can have a personalised information pack for all their pupils with type 1 diabetes.

Dr Kate Gajewska, Diabetes Ireland Research and Advocacy Manager explained that for parents, the challenge of leaving a child on their own or under the care of others can be very stressful so good preparations and effective communication with school staff is vital and will help to reduce the feeling of uncertainty.

Dr Gajewska added: We hope this online resource will be helpful and we strongly recommend involving the childs diabetes team early in the planning and communication process and the guidelines will be of great help to everyone involved.

The online resource has separate sections for parents and carers, and the teachers and school staff. The first section includes tips on how to start planning for back to school early, explains how to prepare the school and what to expect, provides information on special needs assistance and requires non-teaching support, gives tips on healthy lunchtime snacks, and how to support the child from the mental health and well-being side.

In the section for teachers, SNAs and other staff educational materials about type 1 diabetes, hypo and hyperglycemia and diabetes management are provided, as well as information on how important it is for their mental health and well-being to be included in school life.

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Teachers and school staff of children with type 1 diabetes urged to follow new guidelines - BreakingNews.ie

This transcript has been edited for clarity.

I'm Dr Neil Skolnik. Today we're going to talk about Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association, which was put together with designated representation from the American College of Cardiology.

The big news here is that early detection of presymptomatic heart failure utilizing annual screening with N-terminal pro B-type natriuretic peptide (NT-proBNP) or troponin is now recommended. It turns out that although we don't think about diabetes and heart failure the same way that we think about diabetes and vascular disease or microvascular complications of diabetes, heart failure is a very common complication of diabetes. Approximately 22% of all patients with diabetes eventually develop heart failure. In fact, it's two to four times more common in people with either type 1 or type 2 diabetes than in those without diabetes.

Risk factors for heart failure in both for type 1 and type 2 diabetes include duration of diabetes, poor glycemic control, uncontrolled hypertension, hyperlipidemia, higher body mass index (BMI), microalbuminuria, renal dysfunction, ischemic heart disease and peripheral vascular disease.

Heart failure classification includes stage A, which is people who are at risk for developing heart failure. That's essentially everyone with diabetes. Stage B, which is our focus today, can be thought of as presymptomatic heart failure or preheart failure. These are people who have an echocardiogram with evidence of structural heart disease, abnormal cardiac function, or elevated natriuretic peptide or cardiac troponin levels. Classification of heart failure includes symptomatic heart failure (stages C and D), which are the subjects of a different discussion.

The reason for these new guidelines is recent good randomized trial evidence showing that appropriate treatment of people at risk for heart failure who have elevated NT-proBNP levels (eg, people who have preheart failure or stage B heart failure) can reduce the risk for left ventricular dysfunction, newly diagnosed heart failure, and heart failure hospitalization.

That leads to the main recommendation of this consensus statement: annual testing of brain natriuretic peptide (BNP), NT-proBNP, or high-sensitivity cardiac troponin to identify the presence of stage B heart failure. The cutoff value for BNP is 50 pg/mL, and for NT-proBNP, it is 125 pg/mL.

Patients who are identified in this manner should receive an echocardiogram and then, based on the results of the echo, be treated with appropriate medications that include renin-angiotensin system blockade (either an angiotensin-converting enzyme [ACE] inhibitor or an angiotensin receptor blocker [ARB]), a sodium-glucose co-transporter 2 (SGLT-2) inhibitor, and other medications per the AHA/ACC heart failure guidelines, summarized here.

These are big, important new recommendations that are easy to implement and have the potential to make a big difference for our patients with diabetes. I'm Dr Neil Skolnik, and this is Medscape.

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Don't Wait for Symptoms! Annual Heart Failure Testing in Diabetes: New Recommendation - Medscape

Table 1 shows the demographic characteristics of 41 participants. There were 24 females and 17 males, with 16 participants in their 30s, 14 in their 40s, and 11 in their 50s. Ethnic distribution followed 61%, 15%, and 20% for Chinese, Malay, and Indian, respectively.

Table 2 presents a hierarchal thematic scheme of the novel findings. We identified 5 main themes, each with 3 sub-themes: (i) perceptions of diabetes, (ii) sources of perceptions, (iii) relational identity between food and T2D, (iv) perceived losses from healthy eating in T2D, and (v) perceived gains from physical activity in T2D. Even though the findings are categorized by the domains of inquiry, all the sub-themes are interrelated and create the narrative of the given context.

All the participants were aware of diabetes with a good understanding of its risk factors, like obesity, family history, dietary habits, and sedentary lifestyle. Commonly cited symptoms included increased thirst, frequent urination, changes in weight, and sweet pee which attracted ants. A few responded there would be no visual symptoms until a blood test has been taken. Participants also had a good understanding of the disease progression. Apart from the cost of treatment, the initial stages of the disease management were perceived as inconvenient due to the daily medications and diet considerations.

If I had it, I had to take medications regularly and properly. I had to bring medications with me. Its inconvenient. If I were to be in a social setting, Id be like, Oh, Im sorry, I cant eat this or drink that or like I need to take my medication. Then, people would look at me weirdly. Id be like, Should I explain or not? (30s, F, Chinese)

Later stages of T2D were perceived as disastrous to quality life due to the complications arising from T2D. Many participants were concerned that they may become a burden and be unable to care for others. Complications of T2D were associated with disabilities that could cause (loss of) ability to work, (and) ability to live independently.

There is a risk of complications like having kidney problems, amputations, or maybe even blindness, or losing your sensitivity, your extremities. These are the complications that someone with diabetes will have to anticipate. But if I develop complications that result in me developing blindness or limb amputation, that one will be quite disastrous to the quality of my life. (30s, M, Chinese)

However, most participants expressed that the development of these complications would be far away, and the progression from the initial stage to complications would be slow. They believed such a slower progression of diabetes compared to other diseases meant that it was not as life-threatening and that diabetic patients have an opportunity to control and manage diabetes with medication and lifestyle adjustment.

You may have diabetes, but it may not happen like a one-shot. For diabetes, first, you have medication to manage it. You have time for treatment. You still can control in a way. You can try to minimise potential injuries. It will not get fatal as compared to heart disease where it strikes up, the recovery time and saving the person is very acute (30s, M, Chinese)

Participants said they actively seek expert knowledge only after specific triggers like health screening results or hearing about T2D diagnosis from their social circles. Some participants found the amount of information and use of jargon overwhelming, and the information on actionable steps sometimes contradicting.

I usually inquire into a condition when somebody I know is diagnosed with the condition. It usually takes a few searches to understand because there are many sources, which tend to be overly clinical in their jargon, which is not very helpful and only targeted to medical professionals. Usually, the contradictions are not in the diagnosis but understanding if it is major or minor, or if any meaningful action should be taken. (50s, M, Chinese)

Hence, many lay perceptions were influenced by the media portrayal of diabetic patients. Participants recollected that the characters with diabetes in the media were often in the later stages with limb amputations, which were somewhat disturbing. However, diabetes was rarely reported as a cause of death, even if it was an underlying health condition.

To me, diabetes is a bit far away. We hear about stroke and heart attacks when the media reports that somebody collapsed while jogging. Whereas, when somebody dies from diabetes, we dont usually read it in the papers. You might die of heart attack with a pre-existing condition of diabetes. But people just report your heart attack. Diabetes tends to be at the back of everybodys mind. It exists, but the media doesnt put it in the spotlight that often. (30s, M, Chinese)

For participants who had family, relatives, or friends with T2D, their perceptions of the disease cause, risk, and consequence of diabetes were influenced by what they observed and heard from the patients. In particular, participants who had parents and relatives with late stage-associated conditions, their descriptions about the impact of T2D on life were specific and vivid.

She suddenly started to bleed very badly after just gently scratching a black spot, but she didnt feel any pain. She passed out at home because of the excess bleeding. We had to call the ambulance, and she had to go for another operation for her leg. When you have diabetes, it will take longer for the wounds to be healed, so it took her a long time to heal. This is a real problem. (40s, F, Indian)

Common factors influencing perceived risk among participants were poor health screening results, obesity, positive family history, and unhealthy practices, especially around dietary choices. Many participants perceived that having too much sugar was the main cause of diabetes, which translated to reduced perceived susceptibility of T2D among those who did not have many sugary foods.

I think my risk is very low. I am someone who is not into sugar - I dont drink bubble tea, I don't have a lot of sweets, biscuits or cakes or chocolates. I dont have that kind of craving. (40s, F, Chinese)

Several participants said when friends and families speak about diabetes, it is usually candidly referring to having too many sweet food items. However, the colloquial reference to sweet foods and sugar as the cause of diabetes did not reduce the consumption of these foods.

When you have a gathering, you look at the amount of food and sugar. Then, you casually say like this is going to get me diabetes. But its a form of a joke than anything serious. (40s, M, Malay)

Participants were asked to share how they thought their lives could be impacted if they were to be diagnosed with T2D. A common perceived loss was related to the restriction of diet to manage T2D.

If I had diabetes, I would have to have a more restrictive lifestyle. I would not be able to eat as much of the food that I enjoy snacking, eating ice cream and things like this. I myself have sweet tooth. For me having to be a bit more restrictive would be quite a downer (30s, M, Chinese)

Many participants shared that the diet restriction was particularly impactful in Singapore as the local food culture is important in shaping the Singaporean identity. With the variety of food, there were expectations of having a certain level of culinary experience during social gatherings.

Given that we are Singaporeans, we love to eat. It is difficult to maintain a healthy lifestyle or a healthy diet. Our culture is about eating we have a fusion of food and all kinds of foods from all around the world. Even if healthier, people do not want to meet friends over a fruit platter. They will meet for a Korean barbeque. So, from a cultural perspective, its very hard to disconnect from food. (30, M, Chinese)

Participants defined good food as tasty and cheap and shared that people are willing to travel significant distances in search of good food. Singaporeans take pride in finding food that has the best value for money, and this pursuit is often a topic of conversation among friends and family.

I think it is difficult for people to control their diet. Singaporeans like to travel around to find food to eat. They might be living in [a neighbourhood in the east], but they do not mind travelling to [a neighbourhood in the west]. They want the best food that they can get for the three dollars fifty cents. They will talk to each other about where to go and what to eat. They enjoy eating so much and want total value for money in getting the best bang for their buck. (40s, M, Indian)

Participants pointed out the convenience, ease of access, and budget-friendly options; hawker centres located within every public housing estate providing diverse local cuisines quickly and cheaply. Furthermore, in recent years options of delivery service and the availability of all types of cuisine, one can access cheaper and more delicious food any time, from the comfort of home.

When you are craving something, or you want to eat something, usually I must travel all the way there. But now everything is a lot easier to eat something, and it will come to your doorstep. Even if I am tired or it is late at night, and I feel like having ice cream, there is [food delivery platform]. So, there are a lot more opportunities to indulge in these kinds of things. (30s, F, Chinese)

Conversely, many participants pointed out that healthy food options are more expensive and can take a long time to prepare.

In Singapore, the faster and cheaper options are unhealthy. So, if you want to prepare healthy food, and you have working hours, you need to make a lot of sacrifices like wake up early or prepare it the night before. And the ingredients for healthy meals are not cheap. (40s, F, Malay)

When speaking of restrictive diet and healthy eating, participants alluded to a loss in their lifestyle due to reduced enjoyment and impaired social interactions associated with food. Social relationships and celebrations are centred on food, and declining food or refusing to eat could be interpreted as an insult to the host. This was mentioned by participants across all the ethnic groups.

Youre stopping me from eating my favourite food, you know? I rather die. What makes it really hard is that any form of Chinese celebration has got to do with food. The bigger the celebration, the more food we have. Its like, if you dont eat, youre extremely rude its insulting not to eat something that is placed before you. (50s, M, Chinese)

Many participants also shared that eating provided a source of enjoyment and that some participants turned to food when they were upset or stressed. While some participants shared that they exercise to de-stress, some participants shared that they eat to de-stress. A participant mentioned the endorphins released when exercising, while another said the same but when indulging in delicious food. While there was awareness for the need to mitigate the effects of unhealthy eating, it came in the form of compromising other meals instead of giving up the pleasure derived from unhealthy foods.

The only thing that Im doing now to control my eating is trying not to have breakfast in the morning. I will just try to have lunch and dinner, but it is usually not controlled. I should stop eating less fried food. But I dont think I can give up fried chicken that easily. Its just really too good to give up. (30, M, Chinese)

Similarly, some participants expressed that they justify their eating habits by having earned their calories after exercising and consider their indulgence as a reward. The influence of social media culture was also reported, where people post pictures of the aesthetics of the setting and the food. Participants shared that social identity is associated with food and enjoying life, and rarely with healthy eating in the context.

People eat to survive. But for me, I live to eat because I love to eat. So, if Im not happy, I need to eat to be happy. I love food. To continue eating unhealthy food, I compensate for it by doing more exercise. So, I had the calories burned to eat. If I dont exercise and eat, Ill get fat or something like that. But if I exercise and eat, it can balance out, right? Nowadays, people post their food on social media. Wow, theyre so yummy! But, if you burn a fish at home, you wouldnt post on social media. You will only post nice and presentable ones. (40s, F, Chinese)

Demanding work environments and familial responsibilities created multiple competing priorities even though exercise is desirable. These responsibilities often lead to sacrificing sleep, poor eating habits, and exercise time to meet these expectations. Participants shared that Singapores competitive work environment creates high-stress situations. There is an expectation to constantly improve skills and qualifications to ensure job security.

Stress is one contributing factor. People tend to eat more and badly when they have stress. People want to have job security. Now there is digital disruption, so you can become invalid, which is quite scary. So, we need to upgrade ourselves. I have attended many courses, and I will attend more, so there is no time to exercise sometimes even though I want to. (40s, M, Others)

Participants, especially mothers, shared that time for themselves when they could exercise is seen as a luxury or culturally challenging. A Muslim woman shared how she felt different and watched when running with a hijab, a head covering worn by many Muslim women. Internalised expectations of clothing worn during exercise contrasted with wearing a hijab, creating potential psychological barriers.

Im making a conscious effort, but it is really tough for me to find a time with kids, work, and everything. Most of the days, as a working mom, I seldom get time for myself to do what I want. You feel good about yourself with those endorphins. It is very good to mentally detox by getting away from home and kids. But, when I ran in the park, I used to feel a bit shy and embarrassed because I was wearing hijab, and then I felt like everyone was looking at me (30s, F, Indian)

Despite these challenges, there is interest to engage as several participants shared their rewarding experiences from physical activity. When talking about physical activity, participants alluded to a gain, citing how they feel lighter and good after exercising. Participants shared that initial adoption of physical activity was often in response to an external cue, including a worrying health screening result or a recent loss of life. Accountability through exercise programmes or friends or incentives were cited as facilitators of engaging in physical activity. However, the reasons to sustain behaviour were to ensure they could maintain their physical appearance, retain independence and physical mobility to continue doing the things they enjoy, or continue experiencing the immediate benefits and enjoyment of certain exercises.

I dont want to be obese or unhealthy. I dont want to inject myself all the time or spend my hard-earned money on doctors or medications. So, I exercise. Then, Ill feel lighter. Ill feel good, fit. Ill be happy, and I can do a lot of things. Through all these exercises, my muscle wont be so stiff. I can do a lot of things together with my children. I can cook for them and continue to work. Then I can go travel if money permits. (50s. F. Chinese)

Many participants also reported that observing self-improvement by tracking progress acted as positive feedback for their self-efficacy, and in return, motivated them to exercise further or longer. Participants who exercise regularly also pointed out that exercise is a more individual activity, and therefore it is not affected like healthy eating by its social context.

One day you cycle down a road, you see some things and buildings. Then the next time, you motivate yourself to cycle further. Its with running also in my mind, I will motivate myself to jog slowly. And then now I can run to this place, to that place, and then further. Then slowly, I can run back. It motivates me. So every time, you look for a new goal to achieve. I can go somewhere further, you know? (40s, F, Chinese)

Continued here:
Lay perceptions of diabetes mellitus and prevention costs and benefits among adults undiagnosed with the condition in Singapore: a qualitative study -...

Diabetes is a condition in which the body cannot properly process sugar. Sugar is an important source of energy for the body, and the pancreas produces a hormone called insulin to help convert sugar into energy. However, in people with diabetes, either the pancreas does not produce enough insulin or the body cannot effectively use the insulin that is produced. As a result, sugar builds up in the blood instead of being used for energy (via Healthline).

Over time, high blood sugar can lead to serious health problems such as heart disease, stroke, kidney damage, nerve damage, and vision loss. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is usually diagnosed in children or young adults, while type 2 diabetes is most common in adults over the age of 40. However, type 2 diabetes is on the rise in children and teens due to obesity.

The symptoms of diabetes can vary depending on how high the blood sugar level is. Some people with diabetes may not have any symptoms at all. In general, the early symptoms of untreated diabetes include frequent urination, unusual thirst, feeling tired all the time, and slow healing of cuts and bruises. If blood sugar levels continue to rise, other symptoms may include weight loss, constant hunger, confusion, blurred vision, and numbness or tingling in the hands and feet.

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Is There A Link Between Diabetes And Anemia? - Health Digest