DIABETES: Managing the Pandemic through Prevention-the only solution

Sri Lanka is one of the few countries who are studying the under 20 age group through its ongoing research “Diabrisk-sl” – a collaborative study with Kings College London. Approximately 23,298 urban young between the age of 5-40 yrs were screened for 4 risk factor namely increased BMI, increased waist, low physical activity and first degree family history of which 23 % were found to have 2 or more risk factors. “In this clinical trial, 4683 persons at high risk volunteered to be followed up with life style modification advice to normalize their risk as 70.6% were centrally obese, 51.1% had increased BMI, and 60% had abnormal lipids. 8.2% of this group under 20 years and 22.1% between 20-40 years had diabetes and prediabetes which does not auger well for the country and reflects the global pattern especially in the developing world as it affects our school children and work force. “said Dr Mahen Wijesuriya, the primary investigator of this study and Secretary of the DASL.

Is there a cure for diabetes? NO

There is no cure and only prevention is possible.

What can you do about it?

Prevention: Primary prevention is the only way to stem the tide.

Secondary Prevention is too little too late.

How do you primarily prevent T2DM?

• Identification of risk factors

• Physical - increased BMI/ increased waist/ reduced exercise/ first degree family history

• Biochemical - dysglycaemia (abnormal glucose tolerance - IFG/ IGT/DM)

• Lifestyle modification (LSM)

Adequate and correct nutrition to maintain ideal body weight, adequate exercise, and reduced stress constitutes LSM. The biggest benefit in LSM is that it is simple, low cost and no medication is required.

What is correct nutrition in LSM?

What is good for a diabetic is good for all.

The golden rule in nutrition is quality, quantity and timing.

Quality should ensure a healthy, balanced diet which contains high fiber natural foods that are low in calorie content.

Quantity consumed should ensure ideal body weight. It should be in proportion to growth, pregnancy and exercise.

Timing is paramount as delayed or skipped meals will augment hunger leading to increase consumption. 3 modest meals evenly spread throughout the day is ideal. If a meal is delayed, a small healthy snack should be consumed to keep hunger at bay. School children should eat 4 small meals per day at regular intervals.

What is a balanced diet?

A diet that contains adequate amount of all the necessary nutrients in right proportions required for healthy growth and activity. It is important that your diet is varied. Choose food from all the food groups and balance your diet.

Healthy/ Natural foods to be eaten

• Vegetables and fruits

• Fish and chicken

• Starch products in the way of cereals and pulses minimally milled – high fibre such as Green gram, Gram, Cowpea, Red rice, Whole wheat flour (ata), Red rice flour, Soya, Uludu, kurakkan etc.

• Home cooked meals

Foods to be avoided

• Sugar, jaggery, honey and treacle

• Polished wheat flour and product thereof

• Polished rice flour and products thereof • Oils and fats

• Beef, Mutton, Pork

• Fried and tempered food • Processed food such as sausages, bacon and products thereof

• Fast foods are fast to prepare, fast to absorb and fast to produce illness

Alcohol and cigarettes should be avoided Adequate Exercise

Exercise is essential for all persons of all ages on a regular basis

• The golden rule in exercise is that it should be continuous and regular

• Regular exercise of your choice.

• Try to do your exercise with family and friends.

Recommended exercise regime should be;

• 30 min x 5 times per week or more - Good

• 30 min x 3 times per week - Adequate

• Less than 30 min and or less than 3 times per week – Inadequate

• Children need to play for at least 1 hour per day

• If you need to burn fat, you should engage in continuous exercise 45-60 min x 3-5 times per week

Sedentary activities such as sleeping, reading, computer activities and watching TV to be engaged upon as necessary for short periods.

Stress Reduction

Stress results from an unhappy state of mind

• If you are faced with any stressful problems, discuss your problems with a parent, friend, religious leader or a teacher who may be able to help.

• Meditation, yoga and other relaxation methods can reduce stress.

• Being happy with your lot in life helps to minimize stress.

What is the best method to achieve primary prevention?

It is through the “Life Circle” approach which includes Preconception, Pregnancy, Infancy and Childhood and Adult life as set out in the Kathmandu Declaration formulated by the DASL on behalf of the International Diabetes Federation (IDF) South East Asia Region.