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There is no cure, but there are things you can do to control your blood sugar. Gestational Diabetes Gestational diabetes is a form of Type 2 diabetes, and it may begin between the 24th and 28th week of pregnancy. All women become resistant to the action of insulin late in pregnancy. Women who have gestational diabetes are not able to produce enough insulin to overcome the insulin resistance and blood sugar goes too high. If blood sugar is too high during pregnancy, it can cause several problems that put the mother or baby at risk.

Comprehensive Diabetes Care The Diabetes Center takes a multidisciplinary team approach to delivering diabetes care. The medical team includes primary care providers, a dietitian, and Certified Diabetes Educator, and nursing staff.

Together, they take care of patients, support families, and provide outreach at community events throughout the year. Staff with the KHC Diabetes Center will: Help you improve diabetes management through education, counseling, blood glucose self-monitoring and insulin training.

Tailor a treatment plan that will normalize your blood glucose levels to help you live a long, healthy life with diabetes. Assist you learn effective self-management skills to reduce long-term complications. Provide diabetes education materials.

Offer nutritional guidance and exercise planning. Deliver exceptional inpatient and outpatient health care services. Diabetes Consultation Services Basic Skills This program is designed for people with Type 2 diabetes, who want to learn basic self-care skills. The basic skills program is offered in an individual or family setting. You will learn about these and other aspects of self-care. These efforts may be valuable in shaping future research, community interventions, and public health and nutritional policies.

As of , approximately million people worldwide had the disease, with million cases undiagnosed [ 1 ]. These cases occurred at disproportionate levels in low- and middle-income countries LMIC [ 1 , 2 ]. Recent reports illustrate steep increases in the global prevalence of type 2 diabetes over the past few decades, and these trends are projected to keep rising over the next 20—40 years [ 3 , 4 ]. At the population level, two factors have been proposed as major reasons for the rapid increase in diabetes worldwide: an epidemiologic transition where communicable diseases have decreased as the major causes of death [ 5 ], and a concurrent nutrition transition characterized by increasingly unhealthy dietary habits, combined with lower levels of physical activity [ 6 ].

Several scholarly articles have illustrated the nutrition transition by describing the increase in the quantity of macronutrients, mainly fats and carbohydrates, consumed per capita in most countries [ 6 , 7 ]. On the other hand, the quality of the diet, specifically of carbohydrates, has significantly and dramatically changed in the past 50 years [ 7 — 10 ], yet has received less attention in the literature.

Thus, there are few examples of how the change in the quality of major staple sources of carbohydrates, along with increased quantity, has been a driving force in the rapid diabetes epidemic within the context of the epidemiologic transition. As this is an imperative worldwide public health concern, substantial effort at the global level is needed to understand the contributors to diabetes and find appropriate solutions for it. To this end, investigators from twelve sites around the world Nigeria, Tanzania, Kenya, India, China, Malaysia, Brazil, Mexico, Costa Rica, Kuwait, Puerto Rico, and USA , representing various stages of economic development and the nutrition transition, have formed the Global Nutrition and Epidemiologic Transition Initiative GNET [ 11 ] to assess the carbohydrate quality of staple foods in each country, and to develop culturally-appropriate interventions that would improve such traditional diets with the overarching goal of preventing type 2 diabetes.

We focus on staple foods contributing to carbohydrate intake, which include rice, wheat, maize corn , millet, sorghum, roots and tubers potatoes, cassava, yams and taro , and legumes [ 12 ]. The goals of this article are to 1 depict the global health crisis of type 2 diabetes in light of the epidemiologic and nutrition transition, 2 posit that worsening carbohydrate quality of traditional staple foods is a major contributor to the diabetes epidemic, 3 exemplify how efforts from a global initiative for diet interventions may serve as a model for other culturally-appropriate programs, and 4 consider the implications of such an initiative on future research, interventions, public health policies and practices, and dietary recommendations.

The global diabetes burden was illustrated with data from the International Diabetes Federation [ 1 ]. In addition, we compiled the results from preliminary studies and current efforts conducted in GNET countries to describe reasons, preferences, and feasibility of consuming staple foods.

The drivers of the epidemiologic transition are multifactorial, but include social and economic growth, urbanization, and globalization of technologies and food production [ 17 ]. Higher gross national products and per capita incomes help generate resources that can help manage and control the overall burden of death, which in turn increases life expectancy at the population level. We depict the epidemiologic transition by contrasting the shift in mortality and population demographics from to Fig.

The general trend has been a steep increase in life expectancy, alongside even steeper declines in crude overall death rates. In most countries, median age has increased slightly, suggesting an older demographic composition. However, distinct characteristics are observed for countries across stages of economic development. For example, in LMIC such as Nigeria, Tanzania, and Kenya, life expectancy remains low despite a dramatic decrease in the crude death rate.

These countries also have a younger population based on median age. India and China also show dramatic decreases in overall mortality, but with stronger economic growth and improvements in health care, their life expectancies and median age are higher than in lower income countries. These higher income countries have a less steep increase in life expectancy, and the decrease in death rate has stalled or even reversed in recent years.

Crude death rate reflects the number of deaths over a given period divided by the person-years lived by the population over that period. Life expectancy is the average number of years of life expected by a hypothetical cohort of individuals who would be subject during all their lives to the mortality rates of a given period.

Median age is the age that divides the population in two parts of equal size. Tanzania includes Zanzibar. Malaysia includes Sabah and Sarawak Full size image The epidemiologic transition also involves shifts in the causes of morbidity and mortality [ 5 ], with a general trend for communicable, maternal and malnutrition conditions being gradually replaced by chronic, non-communicable diseases NCD as the main cause of death, which becomes more pronounced as the transition progresses.

The shift in cause of death is partly driven by a transition in the types of risk factors, with physical inactivity and overconsumption of energy and energy-dense nutrient-poor foods as key contributors [ 19 ].

To illustrate this, we show the uneven distribution between age-standardized death rates of total communicable, maternal and malnutrition conditions and specifically for infectious diseases and respiratory infections and total NCD and specifically for cardiometabolic conditions and cancer in GNET countries, according to the stage of transition Fig.

Cause-specific death rates were age-standardized to the WHO global standard population by applying age-specific death rates for the country to a global standard population. Mortality estimates are based on analysis of latest available national information on levels of mortality and cause distributions as at the end of together with latest available information from WHO programs, IARC and UNAIDS for specific causes of public health importance.

Cardiometabolic conditions and cancer includes malignant and other neoplasms, diabetes mellitus, endocrine disorders, and cardiovascular diseases. Total non-communicable diseases additionally include diseases in sense organ, respiratory non-infectious , digestive, genitourinary, skin and musculoskeletal, as well as congenital anomalies, oral conditions and neuropsychiatric conditions Data for Puerto Rico is from , obtained from the Centers for Disease Control and Prevention, National Vital Statistics Reports Final Data for Population used for computing death rates are postcensal estimates based on the census estimated as of July 1, Infectious diseases include influenza and pneumonia, and HIV.

Total communicable diseases additionally include infant deaths exclusive of fetal deaths. Cardiometabolic conditions and cancer include diseases of the heart, essential hypertensive disease, cerebrovascular diseases, diabetes, and malignant neoplasms. Causes of deaths included for Puerto Rico differ from those for the other counties, thus caution should be made when comparing death rates Full size image Early-transition countries are characterized by considerably high burdens of both communicable diseases and NCD.

While infectious and respiratory diseases tend to comprise the majority of communicable diseases, these countries also have to manage deaths from maternal and malnutrition conditions pregnancy- and childbirth-related, and nutrient deficiencies, as classified by WHO [ 20 ]. Countries in ongoing transition show much lower death rates from total communicable diseases, which are far exceeded by the number of deaths from NCD.

The malnutrition experienced during fetal or early development and childhood may predispose individuals in these countries to eventual NCD [ 21 ]; and this risk becomes exacerbated with overconsumption of energy and energy-dense nutrient-poor foods in adulthood as these populations gradually adopt unhealthy lifestyle patterns [ 22 , 23 ]. Inadequacies in health care resources and health delivery infrastructure in these countries also fuel the high NCD death rates.

These inadequacies may include limited availability of or access to affordable preventative care or treatment regimens that could help manage risk factors of NCD, as well as of sufficient or well-equipped clinical facilities and staff [ 24 , 25 ].

As we move into transitioned countries, the death rates from communicable diseases become much lower, but the burden from NCD prevails, especially cardiometabolic conditions and cancer. Socioeconomic progress has facilitated efforts in controlling malnutrition and infectious diseases as individuals have more economic resources to afford sufficient foods, and countries can provide food assistance programs and infectious diseases prevention and control measures for their residents.

But socioeconomic progress has also enabled the costly epidemic of NCD in several ways, such as boosting urbanization which is related to unhealthy lifestyles and globalization and mass production of food items which may be of lower quality. Type 2 diabetes deserves to be singled out because of its impact and role as a harbinger of other complications or NCD with similar underlying metabolic pathology.

Global burden of diabetes The rise in prevalence of type 2 diabetes at the global level has been well documented, particularly in south Asia, Latin America and the Caribbean, central Asia, north Africa, and the Middle East [ 3 ]. Projections indicate that diabetes will reach pandemic levels by , with the most notable increases in LMIC countries [ 4 , 26 ].

Most of these countries are also in early or ongoing transition. Because diabetes and its comorbidities tend to predispose to some infectious conditions [ 28 ], the rise in diabetes in these early transition countries is even more alarming as they are still managing the burden of infectious diseases.

China and India pose a distinctive situation, as their booming populations, economic growth, and urbanization rates, put them on the trajectory for a substantial increase in diabetes [ 26 , 30 — 32 ]. By , these two countries will remain as the two top countries with the highest absolute number of diabetes cases, increasing to nearly 80 million estimated for India from 32 million in , and to 42 million for China from 21 million in [ 26 ].

Another contributing factor is that many Asians have experienced considerable adversity, including malnutrition, during fetal and early life development [ 33 ], and these stressors may translate into genetic susceptibility to disease manifestation in adulthood through epigenetic mechanisms [ 33 , 21 ].

Compared to other transitioned countries, Costa Rica has a relatively low diabetes prevalence, yet metabolic control among diabetes patients has been shown to reflect the measures observed in other industrialized countries [ 36 ]. The US is usually considered the benchmark of westernization and epidemiologic transition, and the prevalence of diabetes in this country is 9. Still, among transitioned countries participating in GNET, Kuwait has the highest diabetes prevalence, with nearly a quarter of the population having the disease as of Kuwait has experienced tremendously fast economic growth, accompanied by adoption of unhealthy lifestyles since the end of the Gulf War in the early s, likely contributing to the rapid increase of diabetes cases.

Of note, the rates of diabetes in Kuwait and many LMIC countries have not been standardized for age, which underestimates the reported prevalence and future burden of diabetes, because these countries generally have younger populations than developed countries. The case for improving carbohydrate quality for diabetes prevention A prevailing indicator of carbohydrate quality is the glycemic index GI , which ranks carbohydrate-rich foods according to their postprandial glycemic response relative to a reference carbohydrate source [ 47 ].

Foods and beverages with a high GI are hypothesized to contribute to the development of type 2 diabetes by rapidly increasing postprandial glucose concentrations and insulin demand, or postprandial free fatty acids that trigger insulin resistance [ 48 , 49 ].

The amount of carbohydrate consumed also has an effect on postprandial glycemic and insulin responses. To reflect both carbohydrate quality and quantity, the measure of glycemic load GL estimates the product of the GI value of a given food multiplied by its carbohydrate content per serving [ 50 ]. The majority of observational studies suggest a positive association between GI or GL slightly weaker for GL and risk of type 2 diabetes [ 50 — 55 ]. Foods with a low GI or GL are generally rich in dietary fiber; which has been shown to have beneficial effects on diabetes risk and insulin sensitivity [ 58 — 60 ].

Whole grains are a major source of fiber in the diet and tend to have low GI values. In contrast, refined grains lack most of the germ and bran, which are removed during milling, resulting in the loss of numerous health-conferring constituents such as fiber, vitamins, minerals, lignans, resistant starch, phenolic compounds and phytochemicals [ 61 ].

Studies looking at specific whole grain foods have reported similar findings. The protective relation with brown rice has been shown by others, as well as with whole grain bread and wheat bran [ 65 ]. Clinical trials measuring biomarkers of diabetes risk with intake of whole grains have reported mixed results.

In general, short-term feeding trials support the notion that switching to a whole grain diet may improve insulin response [ 67 , 68 ]. By properly addressing such limitations, replacing consumption of refined staple foods, such as white rice, with whole grain sources at the population level is one of the diabetes-prevention strategies being explored in GNET countries.

Legumes are another source of carbohydrate with high dietary fiber content, numerous phytochemicals, and low GI that are being considered in GNET countries. A cross-sectional study in Costa Rican adults found that increasing the ratio of beans to white rice, and limiting the intake of white rice by substituting beans, was associated with better levels of cardiometabolic risk factors [ 19 ].

Intervention studies have shown improvements in glycemic control after increasing the intake of legumes [ 71 , 72 ]. Jenkins et al. These findings reinforce the notion of promoting or reintroducing intake of legumes in the diets of countries that have undergone or are undergoing nutrition transition. Finally, the evidence is scarce for the effect on diabetes risk of other staple carbohydrate sources, such as corn, roots, and tubers, as well as minor grains such as quinoa, barley, millet, and sorghum.

Consumption of potatoes, which have glycemic properties equivalent to refined grains, has been associated with higher risk of type 2 diabetes [ 74 ]. A small intervention study among healthy non-obese adults that evaluated the GI of five mixed meals, some of which included plantains, corn, yams, and cassava, found that the GI of these meals were all similarly low [ 75 ].

Ancient grains amaranth, barley, millet, quinoa, sorghum, spelt, whole-wheat couscous have higher fiber content than white rice [ 76 ].

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