Health: Diabetes -How to prevent and control diabetes, highest amongst indian etc

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How to prevent and control diabetesJanuary 31, 2006 http://us.rediff.com/news/2006/jan/31spec1.htm The Rediff Special/ Shobha Warrier in Chennai A study has been conducted on the causes and prevention of diabetes among the Indian population for the first time. Until now, such studies were conducted only on Western populations and the results of the study were not applicable to residents of South Asia. The results of the study, conducted by the Chennai-based M V Hospital for Diabetes and Diabetes Research Centre (a World Health Organisation Collaborating Centre for Diabetes in India) under the guidance of scientist Dr A Ramachandran, were published in Diabetologia, the

International Journal of Diabetes. The study discovered that India has an estimated 35 million diabetics and worse, that nearly 13.3 million cases remain undiagnosed. Various studies reveal that the high incidence of diabetes is mainly because of rapid urbanisation, decreased physical activity, obesity, stress and above all, the low threshold level among Indians to environmental risk factors. Only 6 percent of the urban population in the West have diabetes. In contrast, the number is between 12 and 15 percent in the case of urban South Asians. The incidence of diabetics in urban India has increased 20 times In the last 20 years! After smoking, diabetes is the major cause of heart disease in urban India. Another startling revelation is that over 50 percent cases of diabetes in rural India and 30 percent in urban areas go undiagnosed. Undiagnosed diabetes can lead to long-term complications. "Early detection and proper treatment are very important," says Dr Ramachandran. A question often asked is whether it is possible to prevent diabetes. Various studies and programmes in the West have shown that a modification in lifestyle and proper medication can delay and prevent diabetes in high-risk groups. Western studies showed reduction diabetes among obese people who reduced their weight. But the results of those studies are not applicable to the Indian population because Indians differ in anthropometric (human body measurement) and biochemical features that increase the risk of diabetes. Indians are also relatively non-obese but highly insulin resistant. The onset of diabetes in Indians is significantly at a young age compared to their Western counterparts. It was important to find out how far a modification in lifestyle

will benefit Indians who are not fat and mostly on vegetarian diets high in carbohydrate and fibre, Dr Ramachandran said. The study, which began in July 2001 and completed recently, screened nearly 11,000 high-risk men and women. It also identified 531 people with Impaired Glucose Tolerance. Their lifestyle was monitored for three years. The subjects were classified into four groups -- a control group who were under observation without any medicine or lifestyle modification; a lifestyle modification group (who walked for 30 minutes daily and followed a recommended diet); a group that was given metformin (a diabetes drug), and the fourth group which was given both medication and asked to follow lifestyle modification. What my heart attack taught me After three years, the study discovered

that 55 percent of the control group had diabetes. 39.3 percent of those who followed a diet and exercise also had diabetes. 40.5 percent of those on medicine had the disease. 39.5 on medicine, diet and exercise were afflicted. A to Z of stress management "Our study clearly shows that lifestyle modification and exercise are as effective as medication in reducing the risk of diabetes. This is a landmark study because it shows the most practical and cost effective way to fight diabetes and its complications especially in a developing country like India," says Dr Ramachandran. How to control anger "Our study shows primary prevention of diabetes is possible in non-obese people with pre-diabetes

without weight reduction, but by dietary modification, enhanced physical activity and also by medication," Dr Ramachandran added. So, if you belong to the high risk group with pre-diabetes with a blood glucose level of between 144 and 199, start walking for 30 minutes daily and follow the prescribed diet, you can reduce the risk of diabetes. Also read: Putting a number on India's diabetics http://www.rediff.com/news/2005/sep/23dia.htm Putting a number on India's diabeticsShobha Warrier in Chennai | September 23, 2005 17:59 ISTLast Updated: September 23, 2005 19:16 IST The facts are startling. Out of the 100 crore people in India, 70 crore are above the age of 20. Out of the 21 crore urban population, 2.52 crore have diabetes but 8.4 million are undiagnosed. About 12 to 15 percent of the urban population above the age of 20 has diabetes but it remains undiagnosed. Out of a population of 49 crore in rural India, 9.8 million have diabetes but 4.9 million are undiagnosed. That is, about 2 to 6 percent of the rural population is diabetic. But 30 percent of the diabetics in urban India and 60 percent of those suffering from diabetes in rural India are undiagnosed. On the whole, out of a total of 3.5 crore diabetics in India, 1.33 crore go undiagnosed. The result is complications at a later stage. Alarmed by these statistics

world-renowned diabetic specialist Dr A Ramachandran of the MV Diabetic Centre and his team did a study on diabetes in India and identified the undiagnosed diabetics without unnecessarily testing all the people concerned. The Diabetes Risk Score That is where the Diabetes Risk Score plays a role. It is based on simple measurements to identify people with undiagnosed diabetes. These risk scores have been developed in Cambridge University, UK and Denmark, and are used only in the white (Caucasian) European populations. "It was believed that this may not be suitable for Indians. Therefore, we decided to undertake a study to develop and validate a simple diabetes risk score in an urban Indian population. We also tested whether this score was applicable to South Asian migrants living in a different cultural context," said Dr Ramachandran. Indian Diabetes Risk Score

The Diabetes Research Centre of the MV Diabetic Centre, Royapuram, Chennai, in collaboration with Cambridge and the University of Sydney, Australia, developed an Indian Diabetes Risk Score. Dr Ramachandran and his team took data from a national survey sample of approximately 10,000 subjects, which included people from Chennai, Bangalore, New Delhi, Mumbai, Kolakata and Hyderabad. The sample was divided into two parts of 5,000 each. They applied the Diabetes Risk Score on them, and found that age, body mass index, waist size, family history of diabetes and sedentary lifestyle, or no physical activity are significant risk factors. The score was validated by applying to a population sample of 5,000 where the survey was conducted. The score was applied to a second sample of 5,000 in the same national sample and again found to be valid. It was then validated for

a separate Chennai sample from a previous survey done in 1995. The score developed in India has low sensitivity for Indians in the UK, and is also not applicable to the white population in the UK. The use of risk score and advantages The advantages of using Diabetic Risk Score to identify diabetes is that it saves costs to apply the score and simple measurements are used. Second, unnecessary testing of people who do not have the risk of diabetes can be avoided. "Therefore this can be used on a national scale in clinics all over India." Needless to say, it will be a boon to the millions of people in India who are under risk. Diet do's and don'ts for diabetics http://in.rediff.com/getahead/2005/mar/15diab.htm - this is really good link Diabetics: Heed these diet tips! http://www.rediff.com/getahead/2005/mar/14diab.htm 'Diabetes risk highest for Indians' http://www.rediff.com/news/2005/apr/19inter1.htm The Rediff Interview/Dr A RamachandranApril 19, 2005 The 4th World Congress on Prevention of

Diabetes and its Complications, organised by the World Health Organisation, the Diabetes Research Centre and the M V Hospital for Diabetes in Chennai, the International Diabetes Federation, Belgium and the Centre for Disease control, Atlanta, concluded in Chennai. The decision to have the World Congress in India was taken by WHO mainly because every fourth diabetic in the world is an Indian. According to WHO projections, the 30 million to 33 million diabetics in India will go up to 40 million by 2010 and 74 million by 2025. WHO has issued a warning that India will be the Diabetes capital of the world. Professor A Ramachandran, Head of the Diabetes Research Centre, was chairman of the organising committee of the World Diabetic Congress. In an interview to rediff.com Special Contributing Correspondent Shobha Warrier, he says Indians, irrespective of

where they live, fall under the high risk group, hence they have to try to prevent getting diabetes. People were made to understand that diabetes was genetically transmitted, and there was no cure for it. Doctors were talking only about management of the disease. Suddenly, you have shifted the mode to prevention. The theme of the World Diabetic Congress was prevention. Once diabetes occurs, a person's metabolism changes so much that you cannot cure diabetes. Even before you are diagnosed as having diabetes, you have started having the risk of the complications of diabetes. Treating diabetes is a lifelong affair. We have limitations of controlling diabetes to the levels we want because bringing down the blood sugar value to normal is a challenge. When did the shift from cure to prevention take place? What was the reason behind the change in

outlook? There is an increase in the prevalence of diabetes all over the world. At the same time, we find there is an increase in the risk factors associated with diabetes like obesity, sedentary life habits and stress. We realised the factors can be prevented/controlled. The question was asked, if you make people work more, walk more and reduce eating and avoid obesity, can you prevent diabetes? We know there is a way of identifying people with pre-diabetes although the word is not completely agreed upon. The pre-diabetic stage is where the blood sugar is not normal but below the diabetic criteria of diabetes. There are two categories; one is impaired glucose tolerance where the value is between 140 and 199, and the diagnostic value is 200. The other stage is impaired fasting glucose where the fasting value is above 100 and below 126. People who belong to this category have a very

high risk of developing diabetes over the years especially if the family has a history of diabetes. Trials conducted in the US have found that by lifestyle modification and by reducing the weight by seven percent through physical activity, we can reduce the incidence of diabetes by 58 percent. We know that by controlling the risk factors on high risk individuals, you can reduce the prevalence of diabetes. So, the question is, why not prevent diabetes? That is why there is a big push on primary prevention of diabetes. You said obesity is considered one of the major risk factors. Why is it that Indians who are thin and lean are more prone to diabetes than the more obese Westerners? Our genetic susceptibility is more powerful. The propensity to become a diabetic is higher in Indians. We have a low threshold for the risk factors. Americans develop diabetes when the

body mass index is 30 and 35. We develop it when the BMI is only 25. Why do we have a lower threshold? It is the racial difference. Reports say people in Bangladesh, Sri Lanka, Pakistan, Nepal, Mauritius and Mali share the common prevalence rates and seem to share the susceptibility genes, and the same environmental risk factors. We also share the lowered threshold of conventional risk factors, unfortunately. Are the risk factors applicable to Indians living anywhere in the world, or only to those who live in India? It is applicable to all Indians irrespective of the place they live. Some of the worst reports come from South Africa, the United Kingdom and the US. Indians living in South Africa have a higher prevalence of diabetes compared to South Africans and the white population. A report from

London says Indians or South Asians living in London have a higher prevalence of diabetes compared to the white population or the Afro-Caribbean population although they are not more obese than the British. I wrote and published the first paper from India in the British Medical Journal where I compared the prevalence of diabetes in the urban population in India. It is as high as the prevalence of diabetes for Indians living in Southall in London. Some good studies have been done among Indians in the US, and it is found that 18 percent Indians living in Atlanta have a prevalence of diabetes, which is higher than the prevalence of diabetes in Indian cities. The prevalence of diabetes in the immigrant population is high, a little higher than what you see in Chennai and Mumbai. The reasons could be, they are under more mental stress. They must be taking high calorie food and there may be less physical activity.

We have indications that Indian immigrants to the US and UK have a high prevalence of not only diabetes but coronary heart disease too. What precautions should Indians living all over the world take to prevent diabetes? If you have a family history of diabetes, and if you are a girl, you better start thinking about diabetes prevention at 20 to 25 as during pregnancy, you may test positive for diabetes. If you are a man and obese, you should start thinking about diabetes once you cross 25. If you are not obese, the disease may strike you only after 40. Family history of diabetes is a very important risk factor in all of us. We have a big problem in hand. The information technology professionals. They are under tremendous stress at work. We used to see many cases of diabetes among doctors and surgeons. Now we have this new class of very young people. They don't follow any

timing, they have the pressure of deadlines, they have irregular meals, they work at night and they have only time to sit in front of the computer for hours and hours without any physical exercise. Similarly, if you take the case of immigrants, who are uncertain of their jobs, especially in the Persian Gulf region, develop diabetes more often. What we should do to guard is, first, don't gain weight. Be active. More importantly, childhood obesity should be prevented. Obesity in childhood leads to obesity in adulthood. Health education should start from the school level. Children should not be allowed to take junk food, and should be encouraged to indulge in physical activity. WHO has announced an awareness program on diabetes like they did for AIDS, tubercolosis, polio. How effective will this awareness campaign be? It will be very effective. A good example is smoking. Photograph: Sreeram Selvaraj

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