Why in News:

• Only half the Indian adults in the most productive age group (15-49 years) are aware that they ail from diabetes and only one-fourth of those diagnosed and treated have their blood sugar under control – says a study carried out by the Public Health Foundation of India (PHFI), Harvard T.H. Chan School of Public Health, Madras Diabetes Research Foundation, Heidelberg Institute of Global Health, University of Birmingham and University of Gottingen.

Background:

• Diabetes was defined as blood glucose (BG) ≥ 200 mg/dL if not fasted and ≥ 126 mg/dL
  if fasted or reporting to have diabetes.

Diabetes

• Diabetes mellitus (DM) – Commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.
• Most common types of Diabetes Mellitus are as follows
• Type 2 diabetes – A chronic condition that affects the way the body processes blood sugar (glucose)
• Type 1 diabetes – A chronic condition in which the pancreas produces little or no insulin.
• Prediabetes – A condition in which blood sugar is high, but not high enough to be type 2 diabetes.
• Gestational diabetes – A form of high blood sugar affecting pregnant women. Diabetes insipidus – It occurs when the body can’t regulate how it handles fluids. The condition is caused by a hormonal abnormality and isn’t related to diabetes.
• In addition to extreme thirst and heavy urination, other symptoms may include getting up at night to urinate, or bed-wetting.
• Depending on the form of the disorder, treatments might include hormone therapy, a low- salt diet and drinking more water.

Cause of concern:

• Diabetes is a “high maintenance” disease that leads to severe damage to the heart, kidneys and eyes apart from risk of gangrene if mismanaged. Given the state of the public health system in the country, and the fact that the poor have to pay for healthcare, the findings must be treated as a distress signal on an urgent basis.
• Given that people in rural areas and poorer communities in cities are unable to access care earlier, they would be more prone to advanced complications such as renal failure and blindness due to retinopathy. Since 70% of the population lives in rural areas, even a small increase in percentage of people suffering from diabetes adds up to a large number of people who need sustained medical attention but have access to poor health services.

Underlying causes:

• For many poorer people in cities, nutritionally well-balanced food may not be within their
  means. Eating “junk food” is thus not a matter of choice or taste as much as affordability.
• Higher income levels, less physically demanding occupations and increased availability of mechanised transport and household appliances among urban dwellers to possibly explain the higher incidence of the disease in urban areas.
• The pressure of commuting long distances to work and the need to use the public transport system is also not a matter of choice for urban poor. These issues lead to the build-up of stress—another factor that is among the causes of the disease.
• Asian Indians progress faster through the pre-diabetes stage than those of other ethnic groups. Also, as in other countries where diabetes is spreading rapidly, in India too, recreational physical activity is very low, more so, among women from all sections.
• People living in urban areas have access to diabetes care services and can afford the associated out-of-pocket expenditure. However, people living in semi-urban and rural areas do not have access to diabetes centres or clinics that provide comprehensive care.
• The other reasons for this shift could be the increased awareness of healthy practices among affluent sections, which means they are engaging in physical activity and making necessary dietary changes to keep non communicable diseases at bay.

Way Forward:

The ICMR findings call for urgent short- and long-term interventions.

The government, non-governmental organisations (NGOs), the medical community and diabetics will have to join hands to ensure that community involvement is encouraged.

Starting with the availability of nutritious food and facilities for physical recreational activities, a sustained campaign to spread awareness of the disease is needed.

The situation calls for more long-term policy interventions that go beyond packaging and advertising of fast food.

Stress and strain have become important factors in the increase of incidence of diabetes in mostly middle and lower middle classes and rural poor. Thus, besides change of lifestyles, peaceful atmosphere is also very crucial in reducing diabetes. Health care policies along with peaceful life approach would help in containing the spread of diabetes in the country at an alarming rate in the country

Ensuring the supply of nutritious food and creating public spaces for people to exercise is required. The National Program for Control of Diabetes, Cardiovascular Disease and Stroke, which has been rolled out across the country, could also help improve diabetes awareness levels at a national level.

Conclusion:

• Infectious diseases remain the largest concern in developing countries. However, non- communicable diseases like diabetes (known appropriately as the silent killer) are spreading at a frightening rate. In the 21st century, if we are not to sentence large sections of the population to a half-life, we must act quickly and in concert