Dr Marcus Brauer, a General Practitioner from one of the Club's PEME approved clinics in South Africa, provides valuable medical insight into one of the industry's most concerning medical issues: diabetes.

A recent study in 2015 by Till Seuring of the Norwich Medical School stated: "Diabetes affects 382 million people worldwide, and that number is expected to grow to 592 million by 2035. It is a chronic disease that has spread widely in recent decades - not only in high-income countries, but also in many populous low and

middle-income countries such as India and China.The rising prevalence of diabetes in these countries has been fuelled by rapid urbanisation, changing eating habits, and increasingly sedentary lifestyles."

Diabetes is a progressive, non- communicable disease, which is caused primarily by a sedentary lifestyle and an increasing consumption of sugars and starches in our diets, which lead to obesity and an increasing difficulty in controlling blood sugar levels. Once this control has been lost, blood sugar levels rise above normal levels, and this starts to have a progressively destructive effect on the body's blood vessels, particularly to the body's vital organs such as the kidney, heart and brain, with an increasing risk of the premature development of heart attacks, stroke and kidney failure. Diabetes is one of the most significant underlying risk factors for developing premature cardiovascular complications, followed by smoking and hypertension.

The most common form of diabetes is Type II Diabetes, which usually presents with increasing age and weight.

The PEME examination is the perfect time to screen for the risk factors for diabetes as well as the presence of early signs of diabetes.

This allows for early recognition of seafarers at risk, and then careful monitoring and treatment.The treatment is aimed at correcting lifestyle measures:

• Minimising the intake of sugar in sweetened foods (typically all packaged and processed foods, fruit juices, fizzy drinks and sauces).
• Minimising the intake of starches - the main culprits being bread, potatoes, pasta and rice.
• Exercising at least three times a week for 30 minutes, aiming to achieve an exercise heart rate of 75% of maximum.This can be easily calculated as follows: (220 - age) x 0.75 = recommended heart rate during exercise to derive cardiovascular benefit. For an average 45 year old, this would mean an exercise heart rate of 131 beats per minute.
• Monitoring the blood sugar levels with tests such as urine glucose tests, blood sugar tests and a diabetes control measuring test, an HBA1C, which provides a measure of diabetes control over the last six weeks.The seafarer must also keep a log book of their diabetes control to enable them to understand their health condition, and to take responsibility for its management.
• Using the medication prescribed by their doctor regularly, and notifying their doctor of any change in their diabetes control, so that appropriate adjustments to their treatment regime can be made.

The early detection and effective early management of diabetes is one of the most satisfying parts of our work as PEME doctors, as we are able to not only preserve and maintain the health of the seafarer, but we are also able to assist them understand and manage their condition, allowing them to remain gainfully employed in the careers that they have often devoted their lives to.

Dr Marcus Brauer MBChB (UCT), Dip PEC, DOH
Dr Brauer and Associates,Waterfront, Cape Town, South Africa
Email: marcus@drbrauer.co.za