Chronic conditions or non-communicable diseases are virtually lifelong diseases; they can be managed and controlled, but in most cases not cured fully. Examples are diseases of the heart and blood vessels, diabetes, lungs, chronic kidney disease, cancers and arthritis. Diabetes has now become a major public health concern especially in India because of several reasons. World Diabetes Day is observed on November 14. It was named in 1991 by the International Diabetes Federation and the World Health Organisation in response to growing concern about the threat posed by diabetes.
D. Prabhakaran Risk factors Generally, the rise in numbers has been attributed to chaotic urbanisation, an ageing population, reduced physical activity/deskbound lifestyle and a change in diet patterns which includes consuming junk food. Other factors include genetic susceptibility, under-nutrition during foetal and early life and environmental pollutants. The rapidly changing lifestyle of children is equally important; they are now more sedentary than earlier generations. Most Indians also have abdominal obesity (“pot-belly”) which has a role in the development of diabetes.
If this continues unchecked, an already overloaded and inefficient health system will run out of solutions. What is needed are prevention and management strategies. These must include creating an environment of healthy living. There must be context specific health promotional messages that encourage physical activity and a balanced and healthy diet. For example, in hilly Himachal Pradesh, where physical activity is high, the focus must be on encouraging healthy diets. In Tamil Nadu or Kerala, a healthy diet and increased physical activity must be the aim.
Non-personal policy interventions also play an important role. These include taxation, enabling urban infrastructure development particularly in the new ‘Smart City’ plan, encouraging right agricultural practices and reducing sugar consumption, an increased and daily intake of fruits, vegetables and whole grain-based food and a promotion of physical activity. These are cost-effective and prventive strategies. For example, a 20 per cent increase in taxation on sweetened beverages helped reduce new cases of diabetes by 1.6 per cent over 2014-2023. This means that 400,000 type-2 cases of diabetes can be prevented during the same decade.
Second, strengthening health systems at the primary care level is imperative and involves providing low-cost generic drugs, long-term management of the disease with health counselling and a robust surveillance mechanism to study changing trends and progress. Here, innovations include developing a cadre of physician assistants to schedule and manage diabetes care, yoga as a lifestyle [improvement] package, self-care apps and innovative use of gaming technologies to improve physical activity. Third, partnerships must be built for research and development in preventing and managing the disease.
The medical fraternity needs to gear up to the challenge of preventing, diagnosing and treating diabetes in society and people. Several institutes have initiated in-service programmes to enhance the knowledge, skills and core competencies of primary care physicians to deliver standardised care. Unique initiatives such as (advanced) certificate courses in: evidence-based diabetes management, gestational diabetes management, prevention and management of diabetes and cardiovascular disease, management of thyroid disorders will help fight the rising burden of tackling diabetes in India.
(Prof. D. Prabhakaran is Vice-President, Research, Public Health Foundation of India.)
