2024-04-26 17:02:28
With 1 in 10 inhabitants affected, twice as many patients treated compared to the national level and a 3% increase in cases every year since 2015, Réunion is the French region most affected by diabetes. Decryption in the week’s large format.
At the end of 2022, Emmanuelle Fontaine is exhausted. Several symptoms worry her, such as her failing eyesight. She visits her doctor, who orders a blood test. Barely a few hours later, his phone rings: “At 6 pm the laboratory calls me. They tell me my sugar level is over 3 grams. Normally it should not exceed one gram”she remembers.
The next day, Emmanuelle Fontaine learned that she was a type 2 diabetic: she was surprised. “I was really shocked, I couldn’t see myself eating sweet things all the time“, she confides.
Like her, 1 in 10 residents on the island are diabetic. It is the region most affected by this chronic disease. Figures that have increased by 3% each year for the past decade, according to the Regional Health Observatory (ORS). Among the reasons: obesity, which affects almost half of the population (46%).
During a consultation, diabetologist Fatima Kharcha sees a 60-year-old patient suffering from abdominal obesity. This fat accumulated around the abdomen has caused inflammation in the body to the point of causing resistance to insulin, the hormone that regulates blood sugar levels.
“The more fat there is, the harder it is for insulin to work. So we have to make more insulin to maintain our sugar levels. But, it is also a hormone that makes you gain weight. It is a vicious cycle where insulin resistance breeds diabetes.”, develops this caregiver in her office at Caz Diabète, in Saint-Denis.
In Reunion, this predominance is explained by lifestyles that are far from recommendations: only 21% of the population eat at least 5 fruits and vegetables per day, while 22% drink sugary drinks daily.
Weight gain driven by, among other things, fast food. In Saint-Benoît, one family says they eat there about once a week. The reasons? The prices offered, according to the father: “A menu costs ten euros. At the restaurant you can get it for 25 euros“. Availability, according to the mother: “It is open until late, you can easily come after work“.
But faced with these numerous changes in eating behavior observed in the last 50 years, the body has not had time to adapt: ”We went very quickly from a society of scarcity to a society of abundance. We eat much more while walking less. This explains why the ability to metabolize or transform food is not optimal.”, explains Laurence Tibère, sociologist specializing in food and representative of the Institute of Research for Development (IRD).
“Who in the family doesn’t have a diabetic in Reunion?”
Emmanuel Seraphin, Mayor of Saint-Paul
To counter these lifestyles that contribute to diabetes, the mayor of Saint-Paul denied the implementation of 2 fast food projects. “We saw the abundance of fast food restaurants in Reunion and we decided to refuse them from now on. It is a conviction: As politicians, we must be concerned about health issues and take measures that protect the population.”, supports Emmanuel Seraphin, head of the municipality labeled “Ville Santé”.
Le Grand Format: Diabetes, the condition in the ward
Because today the burden of diabetes is increasing on the island. Kidney failure, stroke… Here, serious complications of the disease are almost twice as common as nationally, according to Public Health.
“When the doctors told me I was at risk of losing my foot, I had a seizure, we had to call a psychologist. We say to ourselves: how are we going to live or get around?”
Ulrick Techer, diabetic, amputated toe
A phenomenon that can be explained by the age of the patients, according to Anna Flaus-Furmaniuk, diabetologist at Saint-Denis University Hospital: “More and more, we see young patients who are between 25 and 40 years old. This is rarely the case in mainland France. So if they live longer with the disease, they are more likely to develop a complication“.
In Reunion, 52% of diabetics are under the age of 65, compared to 37% nationally, according to the ORS. So how can we explain this early start? Among the factors, genetic inheritance may predispose Reunion Islanders to this pathology: this is the “saving genotype” hypothesis.
To understand this theory we have to go back in time to the colonization of the island. Between major crossings and periods of famine, history could have had repercussions on the population yesterday and today.
“According to this hypothesis, people who survived had a metabolism that stores more easily. However, this is an advantage in a famine, but a disadvantage when we have access to food like today: it can promote obesity and thus insulin resistance.”, supports Simon Auvray, assistant doctor in diabetology at Saint-Denis University Hospital.
Le Grand Format: Diabetes, more and more children affected by type 1 • ©Réunion la 1ère
In order to better manage the patients’ everyday life and reduce the risk of complications, therapeutic education plays a key role in the treatment of diabetes. Every week, the Groupe Hospitalier Est Réunion (GHER) in Saint-Benoît receives a group of diabetics. Several times a day, they attend workshops such as music therapy or discussion meetings between patients and carers to gain a better understanding of the disease.
“It gives the body a shock. We want to move, to react: It helps to forget the illness.”
Judith, diabetic after a music therapy workshop
But to limit diabetes or even avoid it, Reunion is the first to act against the warning signs since 2023: at the “pre-diabetes” stage. Murielle Dombé is in this situation, she learned it last year during a screening: “I realized I had to do something before I got diabetes. I was careful with my diet and exercise, but I wanted help“, she says.
“Does the prospect, like the sword of Damocles, of a risk of treatment worry you?” “Yes a lot”
Exchange between Murielle Dombé, prediabetic and Cécile Béton, Run Prédiabète facilitator
That day she attended her first assessment of the Run Prédiabète program developed by ETP Réunion and funded by the Regional Health Agency (ARS). Throughout the session, a facilitator asks him questions to establish his future health path that will allow him to limit his risk factors for diabetes.
A research program led by the Faculty of Health and Reunion University Hospital wants to go even further with sending SMS. Of two groups of pre-diabetics, only one will receive coaching messages three times a week for six months.
These words can lead to 3% more weight loss. “It is an operation that complements the therapeutic training sessions: the idea is that the beneficiaries continue the recommendations on a daily basis to complete the program.”, explains Catherine Marimoutou, associate professor of public health and head of the clinical research center at CHU Réunion.
“What also interests us in this study is knowing why and who goes to the end”
Catherine Marimoutou, associate professor in public health
The goal of this five-year study? Maximize your chances of losing weight to prevent disease. “These encouragements, these basic dietary or physical activity reminders have already been tested in the United States, for example. Result: the recipients lost more weight and followed the program better. This is what we want to evaluate here with a different population and environment.“, she finishes.
Le Grand Format: Diabetes, therapeutic education to better manage daily life
They embody hope: pushing the boundaries of diving for diabetics; the other is the only one to complete the Grand Raid with an artificial pancreas. To achieve their dream, these two athletes with type 1 diabetes had to redouble their efforts.
“We establish a protocol to avoid hypoglycemia that can cause discomfort underwater”
Anna Flaus-Furmaniuk, diabetologist
Aymeric Vogt managed to obtain the first three diving certificates thanks to the lifting of the bans for diabetics in the last twenty years. But today it is impossible to become a diving guide because of the risk of discomfort underwater, for example. Thanks to the data collected by his artificial pancreas, he and his diabetologist, Anna Flaus-Furmaniuk, hope to change the regulations.
“Everyone is scared, I’m scared too. But you have to be stronger”
Jean-Christian Robert, diabetic runner
“I fight to show people that diabetes doesn’t stop there”: this is the motivation of Jean Christian Robert. The will of this 62-year-old runner? Outdo yourself to pave the way for diabetics. A breakthrough he had in hospital in 2010, after a heart attack. “My friends asked me if I was okay. I told them: yes, but I will register for the Grand Raid. But back then I didn’t even know how to run a mile“, he says. In 2022 he achieved this feat: to cross the finish line of the diagonal of the fools, with an artificial pancreas. It is the only one to date. This year again he puts on the bib and time does not matter, as long as gives hope to all diabetics.
Le Grand Format: Diabetes, the achievements of patients living with an artificial pancreas
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