Venmony, a small village in Chengannur taluk, sinks the belief that diabetes is something that only people in cities have to worry about.
The overall crude prevalence of diabetes at 14.6 per cent of the population above the age of 18 in the village, lying on the border of Alappuzha and Pathanamthitta districts, is the highest reported among any rural population in the country.
An internationally accepted situational analysis of the burden of diabetes and its determinants, carried out by the Medical Trust Hospital and Diabetes Care Centre, Kulanada, near Pandalam, has made the alarming finding.
India, with 40 million people with type-2 diabetes in 2007 or 20 per cent of the global population with the disorder, is considered the diabetes capital of the world. Kerala has been identified as the State with the highest diabetic prevalence in India, and data show that the rural belt in the central Travancore region has the population with the highest prevalence of the silent killer in Kerala, says G. Vijayakumar, diabetologist and former president of the Association of Physicians in India State unit.
High blood sugar build-up can damage vital organs such as heart, kidneys, eyes and nerves, causing heart attack, stroke, renal problems and so on over a period of time. Most of these complications are preventable, if the blood sugar level is controlled.
Survey findings
The cross-sectional survey in two wards of the Venmony panchayat in Chengannur taluk found that 5.1 per cent of the population is in a pre-diabetes stage, which is one of the highest reported from any State, Dr. Vijayakumar says.
The survey team found that that the prevalence of diabetes increases with economic status (8 per cent among the very poor and 25 per cent among the rich).
The crude prevalence rate of hypertension was 36.1 per cent, high cholesterol, 37 per cent and obesity, 85.6 per cent, he says.
G. Dileepan, project manager, says the glucose tolerance rate was not estimated. Had it been done, the prevalence rate of diabetes would have been much higher.
The chief physicians G. Ganapati Rao of the Amrita Institute of Medical Sciences and G. Sukumaran of Pushpagiri Medical College believe that if Indians do not change their lifestyle, the country will become the nerve centre of diabetes and cardiovascular diseases in a decade.
Changed eating habits and stress have been leading to several lifestyle-related diseases among the urban class. Chronic non-communicable diseases such as diabetes, hypertension, central obesity, heart disease, high cholesterol, cancer and mental illness have been on the rise in the past two decades. Overeating, junk foods, lack of exercise and a sedentary lifestyle, change in job patterns, stress and consumption of alcohol and tobacco have been identified as the key causative factors for these alarming health problems.
Dr. Vijayakumar, project director of a health intervention programme sponsored by the World Diabetes Foundation in Pathanamthitta and Alappuzha districts, says lifestyle changes have been implicated as the major contributing factor for the epidemiological transition from communicable to non-communicable diseases. In 2000, India had 31.7 million people with diabetes. The figure will reach an alarming 80 million by 2030.
Dr. Vijayakumar says the age of onset of type-2 diabetes is coming down. The onset before the age of 45 is an aggressive phenotype of the disorder, and 42 per cent of type-2 diabetes patients attending the hospital at Kulanada fall into that group.
The hospital, he says, has opened a free community health centre in the areas where the survey was conducted. The participants were given health cards, and free medical camps are being organised every month for them.
Symbiosis
Dr. Vijayakumar says obesity and diabetes have a symbiotic relationship, together leading to high blood pressure and heart diseases. In a dangerous trend, obesity is becoming a problem in rural Kerala, where the per capita income has gone up, leading to significant changes in the rural lifestyle in the past two decades.
Children are becoming obese by having junk food. Consumption of left-over food is identified as a major causative factor for obesity among women.
Physicians say early to bed and early to rise helps reduce chances of becoming obese. Do not have breakfast before sunrise. Try to finish supper early as late eating leads to accumulation of fat. A balanced diet is a must for reducing obesity, and the calorie intake must correspond with your physical labour, says Kurien Oommen, chest specialist and former District TB Officer, who has been an active supporter of the diabetes control programme in central Travancore for a decade.
Dr. Vijayakumar and Dr. Sukumaran say it is time the governments changed their approach towards diabetes. As such, they neither have any detailed plan nor a policy to address this silent killer.
Dr. Vijayakumar says the State has 7,000 people with type-1 diabetes. To them, insulin is like oxygen, and many such patients belong to poor families. The State should provide them free insulin, which would cost hardly Rs. 1.5 crore a year to the exchequer.
Dr. Sukumaran suggests that the government supply insulin free to all diabetic patients in the State as they have to use this life-saving drug all through their life. The government should promote Indian companies that come forward to produce superior quality insulin at a far lower cost than that of multinational groups, taking it as a social responsibility.
Dr. Vijayakumar has undertaken a mission to provide free insulin for all type-1 diabetic patients (nearly 100) identified in the district, with the support of the district panchayat, from 2009.
He has provided glucometers to such patients at the Kulanada hospital.
The future is not so rosy for the young unless they change their lifestyle, striking a balance between the modern and the traditional, he says.
