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Arantxa Bujanda, Public University of Navarra
If I asked him to think about someone with diabetes, he is likely to know a person in his near circle. It is no accident, since one in each eleven people suffers. At the moment, We talk about 589 million cases in the worldand the figure continues to increase. The International Diabetes Federation estimates that in 2050 those affected could reach 852 million.
We are facing one of the great epidemics of the 21st century. But the most alarming thing is that, according to experts, Type 2 diabetes could be prevented. So why still increase without control?
A silent process
To understand type 2 diabetes, first you have to talk about a key hormone: Insulin. Its function is to allow glucose to enter the cells and transform into energy. In people with this disease, cells become insulin resistant. At first, the pancreas increases its production to compensate for it, but over time it runs out. As a result, glucose accumulates in the blood, giving rise to type 2 diabetes.
This process occurs progressively and silently. The first signs do not generate obvious symptoms, which makes many people be aware that they suffer until they come to a medical review or complications appear.
Thus influence us what surrounds us
When we think of type 2 diabetes, we usually imagine an older person, overweight, sitting on a sofa and with a junk food bag in the hands. And, although lifestyle influences, this image is only part of the story.
A key concept to understand the origin of type 2 diabetes is Exhibition. With this name we refer to the set of environmental factors to which we are exposed throughout life and that influence our health. It is not only about what we eat or the exercise we do, but about everything that surrounds us and how it interacts with our body.
One of the most determining factors is The so -called external exhibitionthat alludes to the environment in which we live. Imagine a person who lives in a large city, in a neighborhood with high levels of pollution, low income and a job with a large stress load. Well, just because they live there, it has an increased risk of developing type 2 diabetes. The investigations have demonstrated That prolonged exposure to air pollution can alter metabolism and increase insulin resistance.
Within this context, there is a more specific level known as Modifiable external exposomethat covers those habits that we can change. It is here where food and physical activity come into play, the factors that have traditionally been associated with type 2 diabetes. Excessive sugar consumption raises blood glucose levels, and lack of exercise contributes to insulin resistance. However, these individual elections are also conditioned by the environment, the social norms and the opportunities that each person has at their disposal.
Looking inside
And finally, the internal exposome, what happens within our body, also plays a fundamental role. A key example is the intestinal microbiota, the set of bacteria that inhabit our digestive system and that influence how we process food. It has been demonstrated that an altered microbiota can affect the regulation of blood sugar and increase the risk of insulin resistance.
Also, certain drugs, such as antibiotics and CorticosteroidsThey can modify glucose metabolism and contribute to the development of the disease.
The environment favors the appearance of diabetes
Therefore, type 2 diabetes is not simply the result of bad personal decisions, but of a complex interaction between biological, environmental and social factors. Understanding this reality is essential to design effective prevention strategies and address the disease from a broader perspective.
So far, we have put the focus on food and physical exercise because they are modifiable variables and depend on individual decisions. However, is it enough to focus only on personal responsibility? The reality is that we live in an environment that favors the appearance of type 2 diabetes.
First, unhealthy food is more accessible and cheap than fresh foods. Second, cars, elevators, long working days and digital leisure have drastically reduced physical activity. And, as if that were not enough, Chronic stress elevates cortisol, favoring insulin resistance. Therefore, the solution cannot only fall on the individual.
Policies that save lives
We need large -scale strategies that address the problem from the root. It is essential to implement policies that limit advertising and access to ultraprocessed products, reduce the use of added sugars and promote affordable healthy options.
In addition, urban design must facilitate active mobility: cities with more pedestrian spaces, safe cycle and access to recreational areas can make a difference in daily physical activity. Education also plays a fundamental role if knowledge about healthy habits and prevention are included.
We are still on time
If we do not act now, the impact on public health and health systems will be devastating. But we are still in time to change the history of type 2 diabetes.
Because it’s not just about surviving, but intelligently adapting to an environment that is playing against us. As Darwin said: “Not surviving the strongest or most intelligent species, but the one that best responds to change.” The time has come to change the rules of the game.
Arantxa BujandaNurse specialized in diabetes, Public University of Navarra
This article was originally published in The conversation. Read the original.