Times of India
09 July 2011
By, Nilakshi Sharma

The Impaired Glucose Tolerance (IGT) test or in layman's term the pre-diabetic test is an effective early warning
Asilent, sweet epidemic is underway the world around. Diabetes, literally a sweet disease is slowly but surely spreading around the world. From an estimated 30 million diabetics in 1985, there were nearly 135 million diabetics in the world just a decade later. According to the World Health Organisation estimate in 2000 the number was 171 million affected and it is estimated that by 2030 at least 366 million people worldwide will be diabetics.

India today is home to not only one of the world's fastest growing population but is also home to one of world's fastest growing diabetic population. With an identified 50 million Type II diabetics in the country, the country needs to gear itself up for a massive epidemic. It is estimated that by 2030 India will be home to 79.4 million diabetics.

Aretus the Cappadocian physician, named the disease diabetes, Greek for "a siphon," because of one of its most common side effects, very frequent urination. Diabetes is essentially the body's inability to deal with sugar in the bloodstream. Either the pancreas does not produce enough insulin to break down the sugar in the body or the insulin being produced is insufficient.

The former is called Type I diabetes or insulin dependant diabetes whereby the patient has to inject insulin into his body. It is caused by an autoimmune reaction, where the body's defence system attacks the insulin-producing cells. Type II, also known as adultonset diabetes is when the body does not or cannot use the insulin effectively. More common, Type II diabetes is often related to lifestyle and eating patterns.

While technically the result of a single organ's malfunction, diabetes is capable of affecting all of the body's functions and ultimately becoming a cause of death. Hyperglycaemia, or raised blood sugar levels is the common condition of uncontrolled diabetes. As a result of the steady percolation of sugar rich blood the functioning of nearly all the vital organs is impacted and over time, diabetes begins to dramatically impact and invariably damage the heart, blood vessels, kidneys, eyes and the nervous system.

The most common type of the disease, Type II, is more often than not thought to be the result of unwittingly made unhealthy choices. Studies establish an increased prevalence of Type II diabetes in patients whose lifestyle choices are sedentary, leaning towards obesity and more heavily dependant upon processed foods.

Concerned not only with the looming epidemic that seems poised to strike India but also about the alarming lack of knowledge about diabetes, on June 30th, The Times of India and Britannia Nutri Choice organized "India Diabetes Summit - 2011", in association with N-DOC as the knowledge partner.

Discussing Diabetes:Mr. Azad, in his inaugural address pointed out the scope and magnitude of the problem of NCDs or the Non-Communicable Diseases, of which diabetes is one. He pointed out that "in India the prevalence rate is estimated to be about 10% in urban adults and 3.5% in rural adults. India has the second highest number of diabetics in the world following China."

H oweve r, given the scope of the looming problem government intervention may not be enough when it comes to dealing with a population of a billion plus. And as Dr. Naresh Trehan, CMD and Chief Cardiac Surgeon, Medanta, The Medicity, pointed out, “Considering that every 2 out of 10 people in India are at risk for one or the other NCD, that is a huge number.” Shivinder Mohan Singh, MD, Fortis Healthcare (India) Limited, reiterated the need for public and private sector cooperation. And it requires the participation and medical supervision from bodies such as Medical Council of India (MCI), whose governing board member, Dr. Rajiv Yeravdekar made a strong appeal for conscious lifestyle modification.

To start with it is essential to understand diabetes. "It is no longer the disease of the affluent sections of society," emphasized Professor Anoop Misra, Chairman, National Diabetes Obesity and Cholestrol Foundation (N-DOC).

According to the WHO research that Prof. Misra quoted, Indians are getting diabetes younger and dying sooner. Part of it is sheer genetics; Indians have low muscle mass and increased fat all over the abdomen area puts them at increased risk of developing diabetes.

Keeping this in mind, the importance of lifestyle choices becomes even more important. At the same time it is important "to talk of the people as consumers and not patients," pointed out Anuradha Narasimhan, Category Director, Health & Wellness, Britannia Industries Ltd.

Diabetes & You: The good news, as pointed out by Dr. Rajeev Chawla, RSSDI Delhi Chapter Chairman & Joint Secretary in National RSSDI and Senior Consultant Physician Diabetologist, is that we have a huge window of opportunity if we care to take it. Diabetes, especially Type II can be as long as ten years in the making, so if we take the symptoms seriously and get regularly tested we can avoid it.

But the real foundation of developing diabetes is often laid long before, according to Dr. Anupam Sibal, Senior Consultant Pediatric Hepatology, Group Medical Director, Apollo Hospital. But we are, as pointed out by Dr. Damodar Bachani, DDG, Non-Communicable Diseases, Department of Health, Ministry of Health & Family Welfare, "Almost two decades late in programs when competing with communicable diseases such as Malaria, Tuberclosis, HIVAIDS and infant and maternal mortality rates. Clearly the NCDs were the sufferers." And covering the lost ground is not an easy task. As Dr. J.S. Thakur, a National Professional Officer with the WHO pointed out that "if we have to start and sustain a truly s u c c e s s f u l p reve n t ive program we have to focus on three important atmospheres - community, schools and workplace in order to make it comprehensively inclusive."

That is a mammoth undertaking which may best be accomplished by "thinking out of the box" as suggested by Dr. C.S. Pandav, Professor & Head, Centre for Community Medicine, AIIMS. Using the Thailand model, Dr. Pandav suggests "the triangle which will move the mountain of diabetes is information and knowledge; social movement and polity decisions backed by political will." It is here that a partnership between the public and private sector becomes crucial. A.K. Khanna, Chief Operating Officer and Executive Director, Member of Boards Emcure, believes that a successful corporation must also give back to society. Covering other areas of concern in healthcare, such as anemia, the prevalence of eclampsia, he is now also focusing on DISHA which is focused on spreading awareness of diabetes.

Diabetes & A Cure: The history of diabetes detection and management begins with primitive methods of testing the urine for the presence of sugar and has today culminated in cutting edge technology such as a complete implantable artificial pancreas and partially implantable glucose sensors with automatic insulin infusions. But Dr. S.K. Wangnoo, Senior Consultant Diabetologist & Endocrinologist, Apollo Hospital, was at pains to contrast these cutting edge methods with the persistent faith that most Indian diabetics place in alternate treatment methods over allopathic medication. He blames this on a lack of awareness of the dangers of doing this.

The trigger for this belief in alternate medication is the fact that as yet there is no cure for diabetes in allopathy. There is only medicated management of the disease. When talking of the possibility of a cure, Professor Abhay Ahluwalia, Senior Advisor Medicine & Endocrinology, Base Hospital, Delhi Cantt., cautioned that "we should understand that in dealing with diabetes we have two separate groups; Type I, which is characterised by a rapid and fast decline of insulin producing cells and Type II, which is characterised by a slow decline of insulin producing cells.

We can only talk of a cure where we are talking of a total loss of beta cells i.e. insulin producing cells. And the cure lies in stem cells…but we are five to ten years away from the technologies needed." Diabetes & Diet: The last session dealt with the role of nutrition in both, leading a healthy lifestyle and managing diabetes. Rekha Sharma, Shikha Sharma and Neelanjana Singh provided a host of wholesome eating solutions.