Understanding Prediabetes and its Risk Factors
Meet Aggrey, a 47-year-old man who has spent 15 years of his life working behind a desk. He has grown overweight, what with a lifestyle that as he claims, does not allow him time to work out.
“All I do is sit and work at my computer, scheduling meetings and attending most of them. This is what makes up my life and I know it’s not right. I fear that if I don’t do something, I could get sick!”
Aggrey is right and when he went in for his third wellness checkup, his doctor gave him a prediabetes diagnosis. “Prediabetes?”
What is prediabetes?
This is a condition in which your blood sugar levels are higher than normal but not high enough to be type 2 diabetes.
The normal blood sugar range for people without diabetes is between 4% and 5%. When it increases to between 5.7% and 6.4%, you have a high chance of developing diabetes. This is the range at which one is diagnosed with prediabetes; the range at which Aggrey’s blood sugar level was. Levels above 6.5% mean you are diabetic.
To get a diagnosis, your doctor will likely consider an average report of tests taken over two to three months.
How do you know if you have prediabetes?
Prediabetes generally has no symptoms. We, therefore, advise that you get regular wellness checkups especially if you are at risk of developing it to enable early treatment.
Are there risk factors that can lead to prediabetes?
Aggrey represents many people whose lifestyles have led them to develop prediabetes. There are however various other risk factors that can lead to its development. These are;
- Weight — Being overweight or obese increases your chances of developing prediabetes. Increased weight, especially around your belly, is a risk factor.
- Large waist — Men with waists larger than 45 inches and women with waists larger than 35inches risk developing diabetes. This is because the extra fat cells around your waist can cause your body to become insulin resistant.
- Gestational diabetes — Having diabetes while pregnant increases the risk of developing the illness later in life. Additionally, if you’ve had a baby weighing more than 4 kgs at birth, he/she risks developing the illness.
- Inactivity — Lack of exercise or physical inactivity contributes to an increase in weight and is also a risk factor of prediabetes.
- Polycystic ovary syndrome (PCOS) — You risk developing prediabetes if you have PCOS.
- Age–As you age, the chances of developing prediabetes also increase. People who are 45 years or older, like Agrrey, are therefore at a higher risk.
- Sleep problems — Cases of sleep apnea and inconsistent sleep patterns such as those experienced by people working shift hours also increase the risk factor.
- Family history — Prediabetes is hereditary. Having a parent or sibling with type 2 diabetes puts you at risk of developing it.
- Blood pressure — If you have high blood pressure or take medication for it, you could be at risk as well.
- Low HDL cholesterol and/or high triglycerides also place you at a high risk of developing prediabetes.
When to get tested for Prediabetes
As we mentioned earlier, prediabetes does not show actual symptoms, so as medics, we advise you to schedule regular wellness checkups every once or twice a year for you and your family. We, however, cannot rule out certain instances when either one of you may need to hasten a glucose screening test. These are:
- If you have heart disease.
- If you show signs of insulin resistance- This happens when your body produces insulin but fails to respond to it as it should.
- If you notice darkening of the skin around the neck, elbows, knees, armpits and knuckles.
Does Prediabetes always Progress to Diabetes?
Statistics show that 70% of people who get diagnosed with prediabetes eventually develop diabetes. Obviously, the sure way to know is by getting your blood sugar tested.
But there are symptoms that your doctor will check with you during your diagnosis to know if your condition has developed to diabetes. These are:
- Increased thirst
- Frequent urination
- Blurred vision
Find out as much as you can from your doctor and share any concerns you may have about this condition.
1. If you have prediabetes, you should have screening for diabetes annually.
2. To have Bp monitoring at least once weekly.
3. To check weight measurements at least once weekly.
Prediabetes is best managed through lifestyle changes. The objective for this, as your doctor will advise, is to prevent or delay diabetes. There are various ways this can be done:
Diet — Incorporate more fruits, vegetables, whole grains and olive oil in your food.
- Go for foods that are low in fat and calories, and those that are high in fibre.
- Replace sugary drinks with water, coffee and tea.
There are numerous ways you can make this lifestyle transition and still serve nutritious and tasty meals for your family.
Exercise — Try a mild work out to keep your body active for at least 30 minutes every day or most days.
Weight — If you are overweight or obese, try to lose some weight by working out and change your eating habits. Aim to lose up to 9kgs and keep up the weight-loss plan until you reach your goal.
Smoking — Stop smoking.
Medication — If you are at a very high risk of developing prediabetes, your doctor may prescribe medicine to control your cholesterol and high blood pressure. This helps to prevent or delay progression.
Children with prediabetes need to also undertake similar lifestyle changes as adults to contain and prevent diabetes. We, however, do not recommend medicine to be administered to them.
At worst, untreated prediabetes can lead to type 2 diabetes. This can further lead to complications such as:
- Heart disease
- Kidney disease
- High cholesterol
- High blood pressure
Aggrey decided to make healthy life choices and got into a workout program. He cut down on red meat and takes more fruits. He has lost a substantial amount of weight and today, he enjoys a healthy lifestyle.
Prediabetes is a warning illness that requires you to take action now. Fortunately, you can start with small steps and avoid its acceleration into diabetes. Be active, eat a healthy and encourage your family members to visit your healthcare centre for regular wellness checkups. A step in the right direction can make save generations from avoidable illness
TUMOR MARKERS & CANCER SCREENING
AAR Healthcare is a leading medical service provider and is one of the largest providers of outpatient healthcare services in East Africa, with a network of 40 outpatient centres and 2 hospitals. In Kenya, AAR Healthcare has 21 outpatient centres serving over 300,000 patients annually from across the social divide.
At AAR Healthcare, we employ professional medical staff and use internationally approved disease management protocols and drug formulary supported by the state of the art information technology systems to provide consistent treatment for our patients from anywhere in East Africa.
Established in 1984, AAR Healthcare has a strong history in clinical risk management and provision of preventive care embodied in our robust health promotion program that runs in all 21-outpatient centres in Kenya. This ensures that our clients receive quality affordable healthcare all under one roof. Our outpatient centres have qualified medical doctors, specialists, radiology services, fully functional laboratories and pharmacies. We have integrated internal and external international quality assurance programs into all our operations.
The AAR wellness program is designed to promote and support the health, safety and well being of our patients and help meet the unique needs of each of them, whether they are healthy or dealing with a new or ongoing health issue. Every year, we screen >5,000 people for lifestyle illnesses including but not limited to diabetes, hypertension, cancer and kidney disease. The individuals found to have high health risks or confirmed disease are identified and enrolled in a health promotion program, which includes linkage with medical doctors and specialists for treatment.
TUMOR MARKERS & CANCER SCREENING
What are tumor markers?
Tumor markers are chemicals typically produced by cancerous cells in the body. The level of the tumor markers can be measured in the blood, urine, saliva or other body fluids. Some tumor markers may be produced by non-cancer cells therefore; high levels of a tumor marker would need further investigation to ascertain whether the cause is cancer.
For example, we use the PSA (Prostate-Specific Antigen) test to screen for cancer of the prostate however; prostate gland infections also cause a rise in PSA levels, therefore, further investigation is usually required to differentiate whether the high level of PSA is due to cancer or infection.
Typically, doctors have used tumor markers to confirm the diagnosis of cancer when they suspect cancer for example when there is a growth or other symptoms and signs of cancer. It is important to note that the symptoms of cancer usually come in the late stages of the disease; early on, cancer has no symptoms.Tumor markers are also used to monitor cancer treatment including response to treatment and to check if the cancer has come back after treatment.
Which tumor markers are available?
There are as many tumor markers as there are types of cancers. Some of the tumor markers include PSA(Prostate-Specific Antigen), CEA (Carcinoembryonic Antigen), CA19–9, CA125, CA 15–3, AFP (Alpha-fetoprotein), BHCG (Human chorionic gonadotropin) and many more.
PSA is associated with prostate cancer, CEA is associated with colorectal/ lung/ thyroid/ pancreas/stomach cancers and CA 19–9 is associated with pancreatic cancers. BHCG is the hormone produced by the placenta during pregnancy but if it is high when a woman is not pregnant, it is associated with cancer in the uterus (womb).
Although tumor markers help detect the presence of cancer, they are no definitive diagnostic tests. The diagnosis of cancer must be confirmed by other specific tests.
Cancer Screening tests:
The goal of a screening test is to find cancer early when it is the most treatable and before it has had a chance to grow and spread. Screening tests detect potential health disorders in large numbers of apparently healthy people who do not have any symptoms of the disease. It begins with an invitation to participate and ends with the treatment of individuals with confirmed illness or follow up for high-risk individuals. The ideal screening test is a delicate balance of specificity& sensitivity of the tests, accessibility (availability & cost), acceptability (most people would feel comfortable doing it) and the local context (WHO).
In 2018 there were 48,000 new cases of cancer reported in Kenya and 33,000 deaths (Globocan 2018). Women accounted for nearly 60% of the new cases and close to 60% of the deaths. 60–80% of cases in Kenya are detected late; the burden of cancer in Kenya is heavy.
Healthcare professionals recommend regular screening for cancer to detect cancer early. Although the cancer screening tests are few and there are different approaches to screening, the currently available tests are a starting point. The good news is that the future is promising. More precise cancer screening tests are under development and screening and cancer prevention regimens will soon be matched to the individualized risk of cancer due to known genetic and environmental factors.
A Case Against Malaria
“An Italian walk’s into a country……” sounds like the start of a bad joke. When the ancient Romans named the disease plaguing their mighty army malaria (‘bad air’ in Medieval Italian), they definitely did not know that it would one day have an annual economic impact to Africa of $12 billion every year. The name was derived from the association of the disease with swampy, marshy areas where the air smelled bad. Malaria occupies a unique place in the annals of history.
Over millennia, its victims have included Neolithic dwellers, early Chinese and Greeks, princes and paupers. In the 20th century alone, this weapon of mass destruction claimed between 150 million and 300 million lives, accounting for 2 to 5 per cent of all deaths.
Malaria is a serious and sometimes life-threatening tropical disease that spreads through parasites. A mosquito’s bite transmits a parasite into a person’s blood, where it infects red blood cells. Periodically, the red blood cells rupture, causing fever, chills, flu-like symptoms and organ damage that can prove fatal if not treated quickly. The disease is caused by Plasmodium parasites, which are carried by Anopheles mosquitoes.
Only female mosquitoes spread malaria parasites. When a mosquito bites a person who already has malaria, it sucks up the person’s blood, which contains the parasites. When the mosquito bites its next victim, it injects the parasites into that person thus spreading the disease.
Once the parasites enter the body, they travel to the liver where they multiply. They then invade red blood cells, which are important cells in the blood that carries oxygen. The parasites get inside them, lay their eggs, and multiply until the red blood cell bursts.
This releases more parasites into the bloodstream. As they attack healthier red blood cells, this infection can make one feel very sick.
Symptoms for malaria usually start about 10 to 15 days after the infected mosquito bite. There are some things to keep in mind, though:
- Because the signs are so similar to cold or flu symptoms, it might be hard to tell what a client is suffering from at first.
- Malaria symptoms don’t always show up within 2 weeks, especially if it’s a P. vivax infection.
- People who live in areas with lots of malaria cases may become partially immune after being exposed to it throughout their lives.
A blood test can confirm whether you have malaria. Along with high fever, shaking chills and sweating, symptoms can include:
- Nausea and Vomiting
- Body aches
- Yellow skin (jaundice) from losing red blood cells
- Kidney failure
A person with severe malaria may get anaemia, a condition that happens when one loses too many red blood cells. They may also have trouble breathing. In rare cases, they can get cerebral malaria, which causes brain damage from swelling.
Malaria is treated with prescription drugs to kill the parasite. The types of drugs and the length of varies, depending on:
- Type of malaria parasite you have
- The severity of your symptoms
- Pregnancy state
The most common antimalarial drugs include:
- Artemisinin-based combination therapies (ACTs). ACTs are, in many cases, the first line treatment for malaria. There are several different types of ACTs. Examples include artemether-lumefantrine (Coartem) and artesunate-amodiaquine. Each ACT is a combination of two or more drugs that work against the malaria parasite in different ways.
Other common antimalarial drugs include:
- Combination of atovaquone and proguanil (Malarone)
- Quinine sulfate (Qualaquin) with doxycycline (Vibramycin, Monodox, others)
- Primaquine phosphate
The World Health Organization (WHO) estimates that 3.2 billion people are at risk of malaria worldwide. Sub-Saharan Africa is disproportionally affected; in 2015, the region had 88 per cent of malaria cases and 90 per cent of malaria deaths (WHO 2016).
In Kenya, malaria remains a major cause of morbidity and mortality with more than 70 per cent of the population at risk of the disease with roughly 34,000 young children dying of malaria-related causes annually. High transmission cases usually coincide with the rainy season. Indeed, the current delays in rains have seen a sharp decline in clients diagnosed with Malaria. According to 2009 statistics, malaria constituted approximately 32% of the total outpatient cases in Nyanza and Western provinces in Kenya.
Malaria is also terrible for business: this ‘bad air’ can strain national economies, impacting some nations’ gross domestic product at an estimated 5–6%. It is responsible for employee absenteeism, increased health care spending, and decreased productivity, all of which can negatively impact a company’s reputation. In some areas, malaria accounts for 15% of health-related absenteeism from school. It is estimated that in endemic areas, malaria may impair as much as 60% of the school children’s learning ability.
A 2011 Roll Back Malaria report found that in sub-Saharan Africa, 72% of companies reported a negative malaria impact, with 39% perceiving these impacts to be serious. Leading economists estimate that malaria causes an “economic growth penalty” of up to 1.3% per year in malaria-endemic African countries. Malaria discourages investments and tourism, affects land use patterns and crop selection resulting in sub-optimal agricultural production, reduces labour productivity, and impairs learning.
In a 2004 survey, nearly three-quarters of companies in the Africa region reported that malaria was negatively affecting their business. Poor women and children in rural areas are at the greatest risk of death or severe debility from malaria, which drains the resources of families. Overall, households in Africa lose up to 25% of income to the disease.
The impact of this annihilator is huge. It’s time we end Malaria for good.
MAKING WELLNESS A LIFESTYLE NOT A FAD
Health has come into strong focus in the country with Universal Health Coverage (UHC) being declared one of the big 4 agenda for the President of Kenya in his current term. Globally, apart from UHC, the discussion is around the rise in Non-Communicable Diseases (NCDs) and interventions to lower the impact of NCDs. The WHO 2018 report on NCDs reiterates that NCDs are the leading cause of death worldwide, carrying a huge cost that goes beyond health to trap people in poverty, deny them a life of dignity, undermine workforce productivity and threaten economic prosperity. The report indicated that NCDs and mental illness accounted for 71% of global deaths, mostly occurring in low and middle-income countries like Kenya. Suicide was also reported to be on the rise with at least 800,000 lives lost to suicide each year; and for every person who died by suicide, there are 20 others who have attempted suicide. A prior suicide attempt is an important risk factor for suicide.
Recently, the Cabinet Secretary, Ministry of Health, Kenya Ms Sicily Kariuki reported that NCDs account for 50% of deaths in Kenya and 50% of hospital admissions. These indicators have led to the scaling up of the UHC mandate to include NCDs. The ministry of health also reports that 25% of Kenyans are unknowingly living with high blood pressure and other heart diseases. Therefore, wellness programs are currently relevant in corporate employee welfare strategies to optimize productivity and retain talent.
AAR Healthcare has been at the forefront in wellness programs conducting over 700 health talks to raise awareness on NCDs with the main point of discussion being around lifestyle changes and regular checkups to detect NCDs early. The highest demand for the talks has been from the white-collar workforce driven by concerns over premature deaths and the ever-rising cost of healthcare and medical insurance. The old adage, prevention is better than cure, is still true today. For example, approximately 25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischemic heart disease are linked with physical inactivity. This means that at least a quarter of the commonly occurring NCDs could be prevented if we became more physically active.
AAR Healthcare carries out >3,000 wellness checks every year. The wellness checks include screening for NCDs including diabetes, high blood pressure and several cancers (breast, cervical, pancreas, colon, ovarian). We find that being overweight is the most common health risk among Kenyans with the >35% of us being overweight. Following closely is high cholesterol, which increases the risk for the blockage of veins and arteries resulting in strokes and heart attacks. High blood pressure is increasingly prevalent with the age of first diagnosis coming lower to late twenties. Cancer risk is significant with the risk of cervical cancer in women being highest. It is unfortunate to note that whilst the prevalence of cancer of the cervix is highest, only about a quarter of women would do the test when presented with the opportunity. Whilst health involves many personal choices, studies have shown that group interventions have a higher success rate in terms of enrolment and persistence. Starting a health program is commendable, but the greatest impact is in maintaining the lifestyle change.
As part of the wellness program, AAR Healthcare prepares corporate reports that help the organization determine the key needs of their staff and therefore plan corporate interventions. We have seen organizations opt to set space for group exercise as a result of the corporate wellness checks every year. Others have opted to provide subsidized food and refreshments increasing staff access to healthy foods that would otherwise not be available. The uptake of the flu and cholera vaccines have reduced absenteeism and potentially catastrophic illnesses respectively during outbreaks.
The increase in NCDs coupled with lifestyle changes that inevitably occur with advancement necessitates a more deliberate approach towards health. The ever-increasing demand on the employee’s time means that they need support to make that tough choice to invest in healthy habits. Therefore, healthcare organizations like AAR Healthcare that are easily accessible and have the appropriate expertise in the management of NCDs including emergencies like heart attacks, preventive programs and screening programs, are strategic partnerships to sustain a healthy productive workforce.
Mental Health and Mental Disorders
Doctor: Good morning Mr. C, how is the going? How have you been feeling since we last saw you?
Mr. C: I could be better
Doctor: What’s going on? How are you feeling today?
Mr. C: Doc, I feel tired all the time, I am not sleeping well and sometimes sleep during the day, I have a headache that won’t go, and I am not eating well. I think my blood pressure is very high and feel like I am about to die
Doctor: How long have you been having the symptoms?
Mr. C: For about two months now. I have been seen severally in different facilities for the same, very many tests done and nothing found, but I still feel the same way. I am getting frustrated and I just need it to stop
Doctor: Do you have any stressing factors?
Mr. C: Is this life without its stresses Doc?
Doctor: I see, tell me about it. We shall also go through a Patient’s Health Questionnaire together…….
I am sure we all feel this way some times and some stress is important in our lives. When we are not able to cope with the daily stresses of life then we may not be mentally healthy. WHO defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect our mood, thinking and behaviour. They may also impair our cognition, perceptions of the world, physical health and bodily functioning. Examples of mental illness include depression, anxiety disorders, schizophrenia, stress, eating disorders and addictive behaviours. They are very common and many people have had one or know someone who has.
Mental illness can make us miserable and can cause problems in our daily life, such as at school or work or in relationships. In most cases, symptoms can be managed with a combination of medications and talk therapy (psychotherapy).
Signs and symptoms
They may include;
· low self-esteem, feeling overwhelmed, difficulty in making decisions,
· Being irritable or ‘touchy’, excessive fearfulness or worry, being paranoid, racing thoughts,
· Difficulty concentrating and suicidal thinking.
Sometimes, symptoms of a mental health disorder appear as physical problems, such as back pain, stiff neck, constipation, diarrhoea, acidity, recurrent infections, headaches, weight gain or loss, high blood pressure and persistent fatigue.
Causes and Risk factors
The exact cause of most mental illnesses is not known. It is thought to be a combination of several factors including our genes, biology, and life experiences are definitely involved.
Many mental illnesses run in families, but that doesn’t mean we will have one if a family member did. Some conditions involve circuits in our brain that are used in thinking, mood, and behaviour. For instance, we may have too much, or not enough, the activity of certain brain chemicals called “neurotransmitters” within those circuits. Brain injuries are also linked to some mental conditions.
Some mental illnesses may be triggered or worsened by psychological trauma that happened in our childhood or teenage years, including severe emotional, physical or sexual abuse. A major loss, such as the death of a parent, early in life and neglect. Other major sources of stress, such as a death or divorce, problems in family relationships, job loss, school, and substance abuse, can trigger or aggravate some mental disorders in some people. But not everyone who goes through those things develops a mental illness.
It’s normal to have some grief, anger, and other emotions when we have a major setback in life. Mental illness is different from that.
Suicide and Mental Illness
The World Health Organization estimates that 20 Kenyans attempt suicide every single day. Globally, over 800 000 people die due to suicide every year and suicide is the second leading cause of death in 15–29-year-olds. There are indications that for each adult who died of suicide there may have been more than 20 others attempting suicide. 75% of suicides occur in low- and middle-income countries. Mental disorders and harmful use of alcohol contribute to many suicides around the world.
People who attempt suicide are usually ambivalent; that is, part of them wants to die and another part of them wants to live. They are internally divided. In an attempt to mitigate suicide, the best healthcare practitioners try to appeal to the healthy “part” of a person’s mind. Half the time we are left with an intractable enigma that cannot ever be completely unravelled in this life.
How can we help?
“ A lot of people call suicide a coward’s way out, but they don’t realize just how bad you are until they have lost someone close or they are in that position
Not all suicides can be prevented, but a large proportion can. Truth is, most people with mental illness are neglected, looked down upon, rejected and stigmatized against. Think about it, how differently do we treat people suffering from cancer or chronic illness from people suffering from mental illness? Stigmatization starts with us!
There’s no sure way to prevent mental illness. However, if you or a loved one has a mental illness, taking steps to control stress, to increase your resilience and to boost low self-esteem may help keep symptoms under control. It’s also very important to: Recognize the symptoms: lookout for the above symptoms including physical ones that may suggest one could be stressed or depressed, Pay attention to warning signs: Take note if someone makes suicidal comments, all suicide threats and attempts should be taken seriously, Seek medical attention and encourage a loved one to seek help, Take good care of yourself: Sufficient sleep, healthy eating and regular physical activity are important. Try to maintain a regular schedule.
Remember, even the strongest pot does crack at some point. Seek help before you crack, at any of our 21 Out-patient centres countrywide. With early diagnosis and treatment, many people fully recover from mental illness or can manage their symptoms. Although some people become disabled because of chronic or severe mental illness, many others are able to live full and productive lives. The key is to get help as soon as you notice the symptoms then you and the Healthcare provider will continue from there…
What is Chikungunya? This is a viral disease transmitted to humans by mosquitoes. It is a self-limiting disease, meaning there is no specific medicine to treat the virus. There are currently no vaccines to prevent it either. It usually occurs in outbreaks. Currently there is an outbreak in the Coastal region of Kenya.
Is infection by the Chikungunya virus fatal? The disease rarely causes death.
How is the Chikungunya virus transmitted? The Aedes mosquito transmits the virus. It bites during the day and preferably outdoors. The mosquito also facilitates person-to-person transmission of the virus.
What are the symptoms of infection?
Sudden onset of fever Severe joint pain Headache Muscle pain Nausea Fatigue Rash
The symptoms usually start 3–7 days after the mosquito bite and lasts a few days. A few people would have joint pains extending for a few weeks. The symptoms are similar to those of Dengue fever and sometimes the outbreaks can occur at the same time. Symptoms are worst in newborns, in the elderly (>65 years) and in people with chronic illness such as diabetes and heart disease.
How is diagnosis made? Diagnosis is mainly clinical, meaning it would be made based on symptoms of the infection in the context of a known outbreak. A blood test confirms the diagnosis. At the same time, the doctor may want to exclude diseases with similar symptoms like malaria or dengue fever.
Is there treatment for Chikungunya disease? There is no specific treatment for the virus. However, the doctor would focus on treating the symptoms by prescribing pain relievers, fever relievers and medicine to help prevent vomiting. Fluids are given in case of dehydration.
How to prevent infection:
Eliminate mosquito-breeding sites by clearing bushes and draining pools of water around human dwelling. Minimize skin exposure to mosquitoes (long sleeved clothes, trousers) and use mosquito repellent skin products. Sleep under treated nets including during daytime naps. Use window and door screens. People suspected to have Chikungunya should be kept away from mosquitos to prevent infecting others through person-to-person mosquito bites.