BY IN­VI­TA­TION Di­a­betes con­trol in line with chang­ing dis­ease pat­terns

As World Di­a­betes Day comes up, here’s how In­dia can pro­tect its peo­ple in the time of grow­ing non-com­mu­ni­ca­ble dis­eases

The Hindu Business Line - - PULSE -

Till the 1990s, the ma­jor­ity of deaths in In­dia were due to com­mu­ni­ca­ble dis­eases. Only Ker­ala and Goa showed a dif­fer­ent trend, with more than 50 per cent of the deaths re­sult­ing from non-com­mu­ni­ca­ble dis­eases (NCDs) like di­a­betes, hy­per­ten­sion, coro­nary artery dis­ease or cancer.

But by 2016, all the States of In­dia showed NCDs con­tribut­ing to over 50 per cent and, in some States, up to 75-80 per cent of all deaths. This dra­matic change in dis­ease pat­terns re­sults from a com­bi­na­tion of glob­al­i­sa­tion, ur­ban­i­sa­tion, and an im­proved so­cioe­co­nomic sta­tus in our coun­try. Di­a­betes Mel­li­tus alone con­trib­utes to a good mea­sure of all NCDS, as it is among the eas­i­est to mon­i­tor.

The epi­demi­ol­ogy of di­a­betes has un­der­gone three im­por­tant changes in In­dia, over the last 2-3 decades. Ear­lier, di­a­betes was con­sid­ered a dis­ease of the rich. To­day, it af­fects the mid­dle class and the poor­est of the poor. This has se­ri­ous im­pli­ca­tions be­cause it is es­ti­mated that 25-30 per cent of a poor per­son’s in­come can go to­wards the cost of treat­ing di­a­betes.

Be­sides, di­a­betes, a dis­ease ear­lier as­so­ci­ated with older peo­ple, now af­fects the youth and even ado­les­cents and chil­dren. This is wor­ri­some, be­cause peo­ple run the risk of de­vel­op­ing chronic com­pli­ca­tions of di­a­betes, like blind­ness, re­nal fail­ure, am­pu­ta­tion, heart at­tack and stroke by the age of 40 to 45 years, i.e, at the prime of life. Also, the epi­demic of di­a­betes has now moved to the ru­ral areas, due to im­prove­ment in so­cio-eco­nomic sta­tus, un­healthy diet and de­creased phys­i­cal ac­tiv­ity. In some ru­ral areas of In­dia, even ba­sic health­care may be dif­fi­cult to find.

All th­ese point to an ur­gent need for a di­a­betes pre­ven­tion pro­gramme. The Gov­ern­ment has a Na­tional Pro­gramme for Pre­ven­tion and Con­trol of Cancer, Di­a­betes, Car­dio­vas­cu­lar Dis­eases and Stroke (NPCDCS). Also, Ayush­man Bharat pro­poses to up­grade 150 thou­sand health and well­ness cen­tres to in­clude di­ag­no­sis and treat­ment of NCDs like di­a­betes.

We should en­sure that peo­ple with di­a­betes have proper med­i­cal in­sur­ance. To­day, most poli­cies ex­clude peo­ple with pre-ex­ist­ing ill­nesses like di­a­betes. In­cen­tivis­ing peo­ple with di­a­betes to con­trol it is one way to en­cour­age them. For ex­am­ple, if the gly­cated haemoglobin (HbA1c) is brought agents (es­pe­cially the short act­ing ones), good con­trol of di­a­betes can be main­tained in the ma­jor­ity of pa­tients.

We have shown that pa­tients can live for 50 or more years with type 2 di­a­betes, with­out any com­pli­ca­tions. We also re­cently showed that peo­ple with di­a­betes live be­yond 90 years of age. It would be tempt­ing to sug­gest that, very soon, peo­ple with di­a­betes may ac­tu­ally out­live those with­out, be­cause they look af­ter their health bet­ter, with reg­u­lar check-ups, bet­ter con­trol of sugar, blood pres­sure and lipids, in­creased phys­i­cal ac­tiv­ity and healthy diet.

But to achieve this, we all have to work to­gether: med­i­cal pro­fes­sion­als, the pa­tient and fam­ily, so­ci­ety and the gov­ern­ment and non-gov­ern­men­tal or­gan­i­sa­tions.

Pre­ven­tion, first

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