India is now in the midst of a diabetes epidemic, with an adult prevalence rate of nine per cent and almost 69 million people living with diabetes. In another 15 years, the figure is expected to rise to 101 million. In all this, more than 90 per cent of cases are lifestyle-induced.
Individuals with diabetes do not have any symptoms for long periods of time and may have complications at the time of diagnosis. Common examples such as retinopathy (blindness), nephropathy (kidney disease), neuropathy (nerve damage) and diabetic foot (gangrene and amputations in extreme cases) affect a large proportion of individuals with diabetes. Approximately a third of those with diabetes are known to develop retinopathy. Diabetes is also known to increase the risk of cardiovascular diseases (heart attack and stroke); nearly half of those with diabetes die of heart attack.
A bad lifestyle is what propels this epidemic while an inadequate response from the health system results in debilitating complications. The staggering increase of cases of diabetics and prediabetics has been attributed to lifestyle changes as a result of rapid and unplanned urbanisation, an ageing population, a sedentary lifestyle and increasing consumption of unhealthy food, especially modern processed foods. Lack of opportunistic screening delays diagnosis while poor access to care and medicines, information asymmetry between doctors and patients, and a paucity of well-trained human resource, impede evidence-based management of diabetes.
Health promotion strategies
Prevention remains central in halting the current pace of the diabetes epidemic. Our focus should be on both individual and policy-level interventions. Health promotion strategies should be aimed at maintaining normal body weight by improving physical activity and following a balanced and healthy diet. Evidence from the [international] Diabetes Prevention Program (DPP) shows that small reductions in weight by moderate-intensity activity of at least 150 minutes per week and reduced fat consumption on most days prevented progression to diabetes by 58 per cent among those with prediabetes.
In general, brisk walking for at least 30 minutes a day and following a healthy diet every day which has at least 3-5 servings of locally available and inexpensive fruits and vegetables, and less refined sugar and saturated fat can prevent or postpone the occurrence of diabetes. Doing yoga may also help prevent diabetes; in individuals with diabetes, it may even help them have better control of blood sugar. In addition, every adult above 30 years should be screened for diabetes and hypertension during a planned or unplanned visit to a physician or hospital.
Policy measures also call for reinforcement of health systems. Higher taxation on sugar-sweetened beverages and high fat junk foods and planning urban infrastructure to promote physical activity have become all the more imperative now.
Diabetes is no longer a disease predominantly affecting the rich and is fast spreading to rural communities. The poor are even more vulnerable. Thus India has: a population where the number of people with diabetes has increased substantially over time and is set to continuously grow; a large number of people disabled by complications, and an equivalent number who are unaware of the condition.
Early diagnosis and prevention is the key to control the disease and minimise the risk of disability. In this, we need a multi-pronged approach that involves collaboration among national leaders, clinicians, public health researchers and allied health professionals.
Dr. D. Prabhakaran is an epidemiologist by training and the Vice-President, Research and Policy at the Public Health Foundation of India.
