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Awareness against diabetes

In India, type 2 diabetes is hitting people in their productive years


Ahead of World Diabetes Day on November 14, Jean Claude Mbanya, president of the International Diabetes Federation, is in India for a campaign to create awareness about the disease. A series of screening drives, awareness walks, lectures and flash mobs are being organised as part of the campaign, titled the Sanofi Diabetes Blue Fortnight. In an interview with TOI-Crest, Mbanya talks about why diabetes is a 'health time bomb'.

How bad are the diabetes numbers in India?

The numbers are getting worse. In 2011 there were already 61 million diabetes cases. We predict this will rise to 101 million by 2030. Type 2 diabetes makes up about 85 to 95% of all diabetes in high-income countries and may account for an even higher percentage in low- and middleincome countries such as India. Type 2 diabetes is now a common and serious global health problem. The reasons for the rise are rapid cultural and social changes, ageing populations, increasing urbanisation, dietary changes, reduced physical activity, and other unhealthy behaviours.

Why are Indians so prone to diabetes?

India is second only to China in terms of numbers of diabetes cases. There is a high prevalence of impaired blood glucose level which could be a precursor to diabetes. South Asians also display a distinctive pattern of impaired blood cholesterol in the population, with low levels of HDL (good cholesterol) and high levels of LDL and triglycerides (bad cholesterol). In addition, a large number of people have abdominal obesity (which is considered an important risk factor for diabetes ) even though their body mass index (BMI) may be normal. Impaired foetal nutrition and low birth weight have been associated with the development of cardiovascular diseases and diabetes in general. In India the prevalence of low birth weight babies (less than 2. 5 kg) is high and this could be a contributory factor for the burden of diabetes as well.

Should India start testing every adult for blood sugar levels?

To prevent type 2 diabetes, IDF promotes regular screening of people who are overweight, have a first degree relative with this disease, are part of ethnic high-risk groups as well as everyone over 65 years. IDF also advocates taking the following steps to prevent the development of diabetes and obesity: Creation of footpaths, walking tracks and road schemes that allow safe walking, cycling and the use of play areas around the home and school Changes in school curriculum to encourage children to be sporty and active Implementation of policies to control access to energy-dense food and drinks A ban on all forms of marketing of foods and drinks directed at children Simple and understandable displays of the composition and energy density of food items in all eating establishments Monitoring food consumption patterns and the prevalence of diabetes

What is the biggest threat India faces through diabetes?

Undiagnosed and poorly managed diabetes can create costly and debilitating complications that include nerve and kidney disease leading to limb amputation and loss of vision. As the number of diabetes cases increases, even in the younger generation, India will begin to feel the economic impact of this epidemic as their workforce becomes unhealthy. Communities, societies and families will also suffer.

What is the future of diabetes care in the world? Are new drugs in the pipeline?

There are new drugs in the pipeline but we must make sure that the basics ie Insulin and Metformin are accessible to those who need it. We face many challenges in bringing the diabetes epidemic under control. To prevent diabetes where possible, to improve diabetes-care and to look for a cure we would recommend the following: Government should give due priority to diabetes and other non-communicable diseases Public-private partnerships with clearly defined roles and responsibilities for each sector could be considered in the future Primary health care systems need to be strengthened including screening for diabetes;early detection (to prevent complications ) and increased capacity of health professionals through diabetes education Healthy dietary patterns need to be encouraged at an early age Physical activity should form a central part of both childhood and adult lifestyles Clear food labelling and a reduction in portion size are crucial factors in encouraging a healthy diet Children should be protected from advertising, which promotes inappropriate (and unnecessary) consumption of energy dense (high calorie) food and drink

More and more Indians are becoming
obese and, hence, suffering from sleep apnea. How do bad sleep habits affect diabetes?

Obstructive Sleep Apnea (OSA) is the most common form of sleep-disordered breathing, accounting for over 80% of cases. Estimates suggest that up to 40% of people with OSA will have diabetes, but the incidence of new diabetes in people with OSA is not known. In people who have diabetes, the prevalence of OSA may be up to 23%. Obesity may play a role, but some recent studies show an association between the two conditions that is independent of obesity.
OSA may have effects on glycemic control in people with type 2 diabetes and it is also associated with a range of cardiovascular complications such as hypertension, stroke and heart failure.

Should India push bariatric surgery as a treatment for high blood sugar?

Bariatric surgery should be considered on an individual basis and if there are sufficient resources. There is increasing evidence that the health of obese people with type 2 diabetes can benefit substantially from bariatric surgery under certain circumstances. However, there are other extremely effective and cost-efficient methods for controlling blood sugar, like daily physical activity, losing weight and eating healthy.

How much does India stand to lose financially because of diabetes?

In spite of the large number of people with diabetes in the South East Asia region, healthcare expenditure due to diabetes are (IS) estimated to be only USD ($) 4. 5 billion in 2011, accounting for less than 1% of the global total. Most of this estimated spending occurs in India. The low total expenditure comes from the inadequacies of the health system. Eighty per cent of the investment in health sector comes from private funds (94% of these funds come from individual pockets), only 20% investment comes from public sector. Given the lifelong costs associated with diabetes, many people in the lower income segment are unable to cope with the economic and disease burden.

Is the age of onset of diabetes dipping in India?

Worryingly in India type 2 diabetes is hitting people in their productive years. Referred to as India's "health time bomb" people as young as 25 are now being diagnosed with the disease. This is mostly due to a shift toward low-quality, high-calorie diets, decreased physical activity and urbanisation.

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