LARGE FORMAT. Diabetes: Reunion still on the front line in the face of a silent epidemic

By the end of 2022, Emmanuelle Fontaine is exhausted. She is worried about some symptoms, such as blurred vision. She consults with her doctor, who orders a blood test. Not even a few hours have passed when his phone rings: “At 18:00 I get a call from the laboratory. 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 had type 2 diabetes: she was amazed. “I was very shocked, I couldn’t imagine eating sweets all the time.“, she admits.

Like her, one in ten people on the island suffers from diabetes. This is the region most affected by this chronic disease. According to the Regional Health Observatory (ORS), these figures have increased by 3% each year over the past decade. Among the reasons: excess weight, which affects almost half of the population (46%).

At a consultation, diabetes specialist Fatima Kharcha is observing a 60-year-old patient suffering from excess abdominal weight. This fat accumulated around the belly caused inflammation in the body to the point that it caused resistance to insulin, the hormone that regulates blood sugar levels.

“The more fat you have, the harder it is for insulin to work. So, we will have to produce more insulin to maintain our sugar levels. But it’s also the hormone that makes you gain weight. It’s a vicious cycle in which insulin resistance causes diabetes.“says the nurse in her office at Caz Diabète in Saint-Denis.

In Reunion, this excess weight is explained by a lifestyle that is far from recommended: only 21% of the population eats at least 5 fruits and vegetables a day, and 22% drink sugary drinks daily.

Weight gain caused by, among other things, fast food. The family from Saint-Benoit says they eat there about once a week. Causes ? The offered prices, according to the father: “The menu costs ten euros. In the restaurant you get it for 25 euros.” Availability, according to the mother: “Open late, you can easily come after work“

But faced with these numerous changes in eating behavior observed over the past 50 years, organisms have not had time to adapt: ​​“We have very quickly moved from a society of scarcity to a society of abundance. We eat a lot more and walk less. This explains why the ability to metabolize or transform food is not optimal.“explains Laurence Tieber, a food sociologist and spokesman for the Institute for Research for Development (IRD).

“Who doesn’t have a diabetic relative in their family in Reunion?”

Emmanuel Seraphin, Mayor of Saint-Paul

To combat lifestyles that promote diabetes, the mayor of Saint-Paul has abandoned two fast food projects. “We saw the abundance of fast food restaurants in Reunion and decided to avoid them in the future. It is a belief that as a politician, we must care about health issues and take action to protect the public.“, supports Emmanuel Serafina, head of the municipality with the inscription “Ville Sante”.

Le Grand Format: Diabetes, the state of affairs in the department

Because the burden of diabetes is growing on the island today. Kidney failure, stroke… Here, according to the Ministry of Health, severe complications of the disease occur almost twice as often as in the country as a whole.

“When the doctors told me that I was at risk of losing my leg, I had a seizure and had to call a psychologist. We say to ourselves: how will we live or move?”

Ulrik Techer, diabetic, toe amputated.

A phenomenon that can be explained by the age of the patients, according to Anna Flaus-Furmanyuk, diabetologist at the University Hospital of Saint-Denis: “More and more we are seeing young patients between 25 and 40 years old. This rarely happens in mainland France. Therefore, if they live longer with the condition, they are more likely to develop complications.“

In Réunion, 52% of diabetics are under 65, compared with 37% nationally, according to ORS. So how can we explain this early onset? Among the factors, genetic inheritance may predispose residents of Reunion Island to this pathology: this is the “genotype rescue” hypothesis.

To understand this theory, we must go back in time to the time of colonization of the island. Between major transitions and periods of famine, History could have consequences for the populations of yesterday and today.

“According to this hypothesis, the surviving people had a lighter metabolism. However, this is an advantage in times of famine and a disadvantage when we have access to food as we do now: it can contribute to obesity and therefore insulin resistance.“, supports Simon Auvray, junior physician in diabetology at the University Hospital of Saint-Denis.

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©First reunion

To better manage patients’ daily lives and reduce the risk of complications, therapeutic education plays a key role in diabetes care. Every week the Groupe Hospitalier Est Réunion (GHER) in Saint-Benoit hosts a group of diabetics. Several times a day, they attend workshops such as music therapy or discussion sessions between patients and caregivers to better understand the disease.

“It gives the body a shock. We want to move, to react: this helps us forget about the disease.”

Judith, a diabetic, after a music therapy workshop.

But in order to limit diabetes or even avoid it, Reunion is the first since 2023 to act on warning signs: the “prediabetes” stage. Muriel Dombe is in this situation, she learned about it last year during the show: “I realized that I needed to do something before I got diabetes. I was careful with my diet and exercise, but I needed help.“, she says.

“Are you worried about the prospect, like the sword of Damocles, of the risk of treatment?” “Yes, it is quite”

An exchange between Muriel Dombe, a prediabetic patient, and Cécile Beton, coordinator of the Run Prédiabète program

That day she attended her first evaluation of the Run Prédiabète program, developed by ETP Réunion and funded by the Regional Health Agency (ARS). Throughout the session, the facilitator asks him questions to determine his future path to health, which will allow him to limit his risk factors for diabetes.

A research program led by the Faculty of Health and the University Hospital of Reunion wants to go even further with SMS. Of the two groups of people with prediabetes, only one will receive coaching messages three times a week for six months.

These words can lead to 3% more weight loss. “This is an operation that complements therapeutic educational sessions: the idea is that participants continue to follow the recommendations daily to complete the program.“explains Catherine Marimuthu, assistant professor of public health and head of the clinical research center at CHU Reunion.

“What we are also interested in in this study is to find out why and who goes to the end.”

Catherine Marimuthu, Associate Professor of Public Health

The purpose of this five-year study? Maximize your chances of losing weight to prevent disease. “These rewards, these basic reminders about diet or physical activity, have already been tried, for example, in the United States. The result: Beneficiaries lost more weight and adhered better to the program. This is what we want to evaluate here with a different population and environment.“, she finishes.

Le Grand Format: Diabetes, therapeutic education for better management of daily life

They embody hope: expanding diving options 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, which can cause discomfort underwater.”

Anna Flaus-Furmanyuk, diabetes specialist

Emeric Vogt managed to obtain his first three diving certificates thanks to the lifting of bans on diabetics over the past twenty years. But today it is impossible to become a diving guide, for example, due to the risk of discomfort underwater. With the data collected by his artificial pancreas, he and his diabetologist Anna Flaus-Furmanyuk hope to change the rules.

“Everyone is afraid, I’m afraid too. But you must be stronger”

Jean-Christian Robert, diabetic runner

“I fight to show people that diabetes doesn’t end there.“: this is the motivation of Jean Christian Robert. The will of this 62-year-old runner? Go beyond yourself to pave the way for diabetics. He had his breakthrough in hospital in 2010 after a heart attack. “My friends asked me if I was okay. I told them: yes, but I’m going to 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: crossing the finish line of the fool’s diagonal with an artificial pancreas. It is the only one to date. This year he puts on the bib again, and time does not matter, as long as it gives hope to all diabetics.

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