According to International Diabetes Federation’s 2013 report, there are 72 million people who suffer from diabetes in the Southeastern Asian region (close to one-fifth of all adult diabetics in the world), of which 65 million people live in India. The age of onset of diabetes is almost two decades younger in India compared to Western population. Therefore diabetes affects people in the prime of their life and not only increases the clinical burden on the healthcare system but is also an economic burden to society at large. The best way to handle this is through early detection and treatment.
The onset of diabetes is often insidious and asymptomatic and hence, diabetes can remain undiagnosed for long periods of time. Often, 10-20 per cent of subjects have one or two complications of diabetes even at diagnosis. It is also well known that the process of atherosclerosis — that causes narrowing of the arteries — starts years before the clinical diagnosis of diabetes. It is, therefore, not surprising that diabetes is often first diagnosed at the time of a heart attack or stroke.
In view of this, the most practical approach would be to detect diabetes early and start control measures so that patients have a healthy life with minimum risk of complications.
Studies have shown that it is not even necessary to wait for clinical diagnosis of florid diabetes to occur and that subjects with high risk can be identified using the diabetes risk score. The risk factors include family history of diabetes, obesity, age, central adiposity (large waist circumference) and sedentary lifestyle habits.
At a diabetes speciality hospital in Chennai, randomised control trials were conducted to find out whether primary prevention of diabetes is possible in the high risk group. The studies employed a number of strategies to motivate people to modify their lifestyle.
One of them was using text messages through mobile phones. It is often felt that changing the behaviour of people with regards to food and physical activity is a challenge. This study proved the effectiveness of mobile technology in getting a favourable clinical outcome. The study, conducted for three years in Chennai and Vishakhapatnam, showed that diabetes could be prevented up to 36 per cent by lifestyle modification.
After clinical diagnosis is made, there is often inertia and lack of motivation to control diabetes. This is understandable because, even if there is no control, the patient often does not experience any discomfort, leading to a complete lack of motivation.
Moreover the benefits of good control on health are not perceivable and obvious in the initial years. The benefits will be seen only after 15-20 years of good treatment, which is called the ‘legacy effect’.
However, clinicians wish to see immediate effects of their treatment, which is not often the case in chronic disorder of diabetes.
A clear message is to identify the risk factors for diabetes and start lifestyle modification early to either prevent the onset itself or achieve good control of diabetes early.
The writers are Chennai-based Diabetologists.
