Tame Diabetes Before It Gets You

The Union Health minister Ghulam Nabi Azad  recently announced a nationwide screening campaign under which every person above 30 years of age and all pregnant women will be tested for diabetes in a phased manner. In his inaugural address at the India Diabetes Summit, which was jointly organized by The Times of India, Britannia Industries, and National Diabetes, Obesity and Cholesterol Foundation, New Delhi, he informed that, “Under the first phase, around 10 crore people in 100 districts of 21 states, and urban slums in 33 cities will be screened. This pilot project will cover more people than the population of many countries."

The screening has already been completed in Bangalore and Chennai, and is expected to begin in Delhi in July. In Bangalore, 14% of the people tested were found to be suffering from diabetes, 21% had high blood pressure and 13% persons were having both diabetes and hypertension. The situation was no better in Chennai where the corresponding figures were 17%, 20% and 13%. Around 3% of pregnant women were also found to be diabetic. These figures come as a shock since they would seem to indicate that the prevalence of diabetes is even higher than the current estimates. Another significant point is that most of the affected persons were unaware of their condition of their affliction with diabetes or hypertension.

Once the screening programme ends, the government will reportedly run awareness campaigns through regional media and with the help of health workers.

This indeed is a very positive step, keeping in mind that one person dies due to diabetes every 10 seconds in India and two new persons get the disease in the same time. The number of diabetes patients in the country is estimated to have risen to around 51 million. Worse, many remain untreated due to lack of awareness and die due to complications like heart disease and kidney problems caused by the disease.

A major international study has revealed that the number of adults with diabetes has increased by more than double in the last three decades. The study, the largest of its kind for diabetes, was carried out by an international collaboration of researchers, led by Professor Majid Ezzati from Imperial College London and co-led by Goodarz Danaei from the Harvard School of Public Health, in collaboration with The World Health Organization and a number of other institutions.

The study has found that the number of adults with the disease reached 347 million in 2008, from 153 million in 1980. Of the 347 million people with diabetes, 138 million live in China and India. The proportion of adults with diabetes rose to 9.8 per cent of men and 9.2 per cent of women in 2008, compared with 8.3 per cent of men and 7.5 per cent of women in 1980.

"Diabetes is one of the biggest causes of morbidity and mortality worldwide. Our study has shown that diabetes is becoming more common almost everywhere in the world," said Ezzati.

Another reason for concern is the rise of obesity and diabetes amongst teenagers, chiefly due to life style related problems, especially in urban areas. All work and no play is making city students not only dull but fat. City teenagers going on 17 are carrying not only the heavy burden of parental expectations but extra kilos that they gain in their classrooms. Doctors in Hyderabad, and elsewhere too, report that students are becoming more prone to lifestyle health problems. Chasing better grades, they spend long hours in cramped classrooms during and after school hours. The absence of playgrounds and large campuses, or even the scope to indulge in any extracurricular activity is only fuelling the obesity trend amongst students.  

"Adolescent diabetes is on the rise. But what is alarming is the increase in the number of Poly-Cystic Ovarian Disease (PCOD) cases in young girls because of obesity. I see at least five to seven cases of PCOD among girls in their late teens, every month," said Dr Lalitha K, uro-gynaecologist, Yashoda Hospitals, Hyderabad, adding that this trend has been on the rise in the last six to seven years.

Unhealthy food habits are also another contributory factor. "These students may carry their lunch from home, but they binge on junk during their breaks. The high sodium, carbohydrates and cholesterol in this usually greasy fare adds to their weight gain, as it is coupled with a sedentary lifestyle without exercise," said Dr VSV Prasad, chief consultant paediatrician, Krishna Institute of Medical Sciences (KIMS).

According to Dr Anoop Misra, Chairman of the National Diabetes, Obesity and Cholesterol Foundation, school children should be disseminated information on good food habits from 10 years of age. There is a need to develop technology for low-cost diagnosis and treatment of diabetes.
Dr Misra has been doing pioneering work in trying to spread awareness about proper diet and physical exercise in school children through numerous projects carried out in several schools of the country. It is important to sustain these and other efforts to keep the public informed about the disastrous effects of junk food, sedentary life style, and alcohol abuse and tobacco usage. The latter is indeed a slow poison which is proving to be one of the main causes of Non Communicable Diseases like cancer, diabetes, heart disease and chronic pulmonary disease.

A recent study carried out by the Preventive Social Medicine department of a Sion hospital in Mumbai, found an uncanny correlation between malnutrition and diabetes. A survey conducted in the tribal village of Themba, found that most of the adults who had diabetes were malnourished as children. Of the 596 persons above the age of 25 years, who were tested, around 5.6% were found to be suffering from diabetes. Another 1.2% had Impaired Fasting Glucose (IFG), meaning they were in a pre-diabetic stage and could become full-blown diabetics. Around 4.4% had a high level of diabetes, with uncontrolled sugar levels.

The study has baffled the doctors as common factors like junk food, lack of physical activity and stress, known to cause diabetes in urban populations, were missing in the village. However, several villagers were found to be addicted to alcohol and tobacco and many of the addicts were diabetes patients. This only reaffirms the correlation between tobacco addiction and NCDs like diabetes.

Endocrinologist Dr Dheeraj Kapoor from Kokilaben Dhirubhai Ambani Hospital feels that diabetes could soon become a bigger health issue than malaria and tuberculosis in rural areas. "At some point, even rural lifestyle and food habits are changing," he added.

Recently a three days road show to create awareness on 'Peripheral Arterial Disease' ( PAD ) was organized by doctors, covering  Chennai, Delhi and Pune. Mathias Ulrich, a specialist in angiology who led the show, elaborates that, “Often symptoms such as severe leg pain and burning sensation in the toes are neglected by people suffering from diabetes. But, these could also be symptoms of 'Leg Attack' or PAD. A sedentary lifestyle and lack of exercise coupled with smoking puts one at a higher risk of lifestyle-related diseases like diabetes and hypertension which consequently advances the risk of a leg attack."

The state of Goa has added another first to its kitty (it is the only Indian state to have banned sale of gutkha - chewing tobacco)  by recently launching India's first diabetes registry that would be maintained by the health department with the help of Novo Nordisk Education Foundation (NNEF). Its aim is to monitor this metabolic disease on a regular basis. 

"At present free treatment (medicines and insulin injections) is given to diabetic patients who seek treatment in government hospitals. Once Goans, who are seeking treatment with the private doctors in the state, are registered with the diabetic registry of the health department, we will consider extending free treatment to these patients suffering from diabetes," said Goa’s Health minister Vishwajit Rane.

"There is a need to create awareness and educate people about diabetes. It is important for all concerned parties to get together in delivering diabetes awareness, screening, education and treatment to the common man. The registry is a crucial step towards bridging this fundamental gap".

This is a unique initiative that could be replicated across India in a country which has the high population of diabetics.

So we need a multi pronged strategy to tackle this growing epidemic. Different segments of society will require different approaches. While government efforts, like the ones announced by The Union Health Minister and the state of Goa, are more than welcome, all state governments and the medical fraternity will also have to join forces, in earnest, to spearhead massive awareness campaigns with the help of media to focus attention of the common public on a tobacco free and healthy life style.

The role of parents and teachers is no less important in grooming youngsters from early childhood in developing a liking for healthy and tasty food, staying away from all tobacco products,( especially the misleadingly glamorous versions of it like hookahs, low tar cigarettes, etc), and striking a proper balance between academic work and physical exercise. Only then will we be able to tackle the problem of the growing incidence of obesity, diabetes and other related diseases.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is also the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: http://www.citizen-news.org

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Citizen News Service (CNS), India/Thailand
CNS Tobacco Control Initiative, India
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Elites TV News, California, USA 
CNS Diabetes Media Initiative, India