Diabetes is fast gaining the status of a potential epidemic in India with
more than 67 million diabetic patients and another 30 million in pre-diabetes
According to expert doctors, India (31.7 million) topped the world with the
highest number of people with diabetes mellitus in 2000, followed by China
(20.8 million) with the United States (17.7 million) in second and third place
It is predicted that the prevalence of diabetes is predicted to double
globally from 171 million in 2000 to 366 million in 2030 with a maximum
increase in India.
"By 2030, diabetes mellitus may afflict up to 79.4 million individuals in
India, while China (42.3 million) and the United States (30.3 million) will also
see significant increases in those affected by the disease," experts said.
Poor Disease Awareness
Low awareness about the disease in general population has put India on top
of world diabetes sufferers list.
Scientists say that approximately 25% of the population was unaware of
diabetes and only 41% of diabetic patients knew that diabetes could be
Researches indicate that more than 50% of people with diabetes have poor
glycemic control (HbA1c >8%), uncontrolled hypertension and dyslipidemia,
and a large percentage has diabetic vascular complications.
Meanwhile, a population-based study revealed that only 41% of adults (>20
years age) in India were aware of risk associated. Over 92% of the patients
approached general practitioners for treatment instead of an eligible
The awareness of the illness was extremely low in the rural areas and the
ratio of unknown-to-known diabetes is 3:1 as compared to 1:1 in the urban
Also, expert doctors observed a substantial regional variation in diabetes
prevalence and management in India.
The highest prevalence of diabetes was observed in southern region
(Ernakulum, Kerala) and lowest prevalence in North Eastern region (Manipur).
How can We Raise Awareness?
Diabetes mellitus (DM) is due to either the pancreas not producing enough
insulin, or the cells of the body not responding appropriately to the insulin
There are three main types of diabetes mellitus.
Type 1 DM results from the body's failure to produce enough insulin.
This form was previously referred to as 'juvenile diabetes' or
''insulin-dependent diabetes mellitus'.
Type 2 DM begins with insulin resistance, a condition in which cells
fail to respond to insulin appropriately. As the disease progresses a lack of
insulin may also develop. This form was previously referred to as 'adult-onset
diabetes' or 'non insulin-dependent diabetes mellitus'.
Gestational diabetes occurs when pregnant women without a previous
history of diabetes develop a high blood glucose level.
Generally, an inactive life, which involves lack of exercise and poor
calorie management, is one of the biggest contributors to the dreaded disease
All people with Type 1 diabetes (juvenile onset) and those with Type 2
diabetes (adult onset) are at risk.
The rise in diabetes prevalence in India is the outcome of lifestyle changes
in the background of genetic predisposition.
* Various media sources such as print/audio-visual and information
technology (IT) should be efficiently used to spread the awareness about the
* Family members of patients should also be counseled about the significance
of regular monitoring and checkups.
* Children should be made aware about the significance of maintaining
healthy lifestyle and physical activities.
* Healthcare employees, at all levels should be adequately trained to
disseminate information to patients regarding diabetes.
Prevention and Management
* Healthy eating habits and good nutrition can go a long way in preventing and
Healthy food items such as whole grains rich in components like dietary
fiber, starch, fat, antioxidant nutrients, minerals, vitamin, lignans, and
phenolic compounds are recommended.
* Being a chronic disease, patient's compliance is the most important factor
in fight against diabetes. Self-awareness can effectively increase the patient
compliance issues related to adopting healthy diet and lifestyle, regular
checkups of glycemic status, and periodic screening.
Physician Approach to Care
Next to the patient, physician is the important component in the management of
It has been shown that various factors like insufficient knowledge of
guidelines, primary focus on acute management rather than the preventive care,
competing care demands, somewhat late clinical response to poor control, time
constraint, poor resources and attitudinal issues are some of the physician
related problems in diabetes control in India.
To overcome these limitations in the diabetic care specialized CME programs
should be constituted to help the physicians to be updated.
Also, it has been shown that guidelines arising out of evidence-based
medicine (EBM) can efficiently decrease the practice variations thereby
improving the level of care, so it makes lots of clinical sense to implant the
concepts of EBM among general practitioners. To popularize the guidelines
formulated from EBM, physicians must be adequately trained and motivated to use
It has also been shown that physicians are hesitant to prescribe
insulin due to dosage and mode of administration constraints. A conscious
effort has to be made to resolve this significant issue with caregivers.
Healthcare in general and diabetes in particular are very heavily reliant on
adequate infrastructure and funding. India spends only 5% of its GDP on healthcare and DM requires a significant
proportion of that amount for effective control and management.