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Insights into Editorial: Managing a great epidemic + MINDMAPS on Current Issues

Insights into Editorial: Managing a great epidemic + MINDMAPS on Current Issues

30 November 2015

Today, Diabetes has become a major public health concern in India. According to the International Diabetes Federation, over 66 million people in India live with this metabolic disease; an almost equal number has pre-diabetes which is an immediate precursor to diabetes. It is predicted that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India.

  • India has often been referred to as the “diabetes capital of the world” but has now ceded this position to China.
  • Earlier, diabetes was known as a rich man’s disease. But, the latest data have revealed that the annual increase in the numbers of those with diabetes is much higher in the rural areas, poor individuals and those less educated.
  • Chronic conditions or non-communicable diseases like diabetes are virtually lifelong diseases; they can be managed and controlled, but in most cases not cured fully.

What is diabetes?

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both.

Factors currently affecting diabetes in India that are making this problem so extreme:

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, Poor diabetes screening and preventive services, non-adherence to diabetic management guidelines and lack of available counseling.
  • The rapidly changing lifestyle of children is equally important; they are now more sedentary than earlier generations.
  • Most Indians also have abdominal obesity which also has a role in the development of diabetes.
  • The impact of stress, both physical and mental, has also a strong effect of increasing incidence of Diabetes.

Why rural population is more vulnerable?

  • There is a disproportionate allocation of health resources between urban and rural areas.
  • Although the Indian urban population has access to reliable screening methods and anti-diabetic-medications, such health benefits are not often available to the rural patients.
  • Aged care facilities in rural areas report disparity in the diabetes management compared with their urban counterparts, these populations more likely to suffer from diabetic complications compared to their urban counterparts.

What should be done?

  • To reduce the disease burden that diabetes creates in India, appropriate government interventions and combined efforts from all the stakeholders of the society are required.
  • Clinicians may be targeted to facilitate the implementation of screening and early detection programmes, diabetes prevention, self-management counselling, and therapeutic management of diabetes.
  • Aggressive clinical measures in terms of early insulin initiation combined with optimal doses of oral hypoglycaemic agents and appropriate lifestyle modification could also have long-term positive effects in disease management.
  • Government policies may also help in creating guidelines on diabetes management, funding community programmes for public awareness about the diabetes risk reduction, availability of medicines and diagnostic services to all sections of community.
  • Strengthening health systems at the primary care level is also imperative and involves providing low-cost generic drugs, long-term management of the disease and a robust surveillance mechanism to study changing trends and progress.

India currently faces an uncertain future in relation to the potential burden that diabetes may impose upon the country. If this continues unchecked, an already overloaded and inefficient health system will run out of solutions. Many influences affect the prevalence of diabetes throughout a country, and identification of those factors is necessary to facilitate changes in the healthcare system.


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