Diabetes – The Alarming Facts - Interview With Dr. V. Vishwanathan

Medindia spoke to Dr. Vijay Viswanathan, MD, Ph.D, MNAMS, Managing Director of M.V. Hospital for Diabetes and Diabetes Research Center at Chennai, Tamil Nadu, India, a WHO Collaborating Center for Education, Research and Training in Diabetes. M.V. Hospital for Diabetes is one of the largest referrals for diabetic patients requiring super-specialist opinion and management of the disease. The WHO Collaborative Center’s plan of action for the control and prevention of diabetes mellitus includes evolving appropriate programs at country, inter-country, regional, inter-regional and global levels. Medindia heard the doctor’s views on the awareness, prevalence and management of diabetes in this part of the world.

The alarming rise of diabetes around the world is causing great concern and every country across the globe is devising ways and means to explore newer strategies to control the disease.

Alarming Diabetes Facts –

Findings released by the International Diabetes Federation recently are shocking:

• Diabetes affects 240 million people worldwide currently and is expected to affect 380 million by 2025
• In 2007, five countries with the highest numbers of people with diabetes were India (40.9 million), China (38.9 million), US (19.2 million), Russia (9.6 million), Germany (7.4 million)
• In 2007, five countries with the highest diabetes prevalence in the adult population were Nauru (30.7%), United Arab Emirates (19.5%), Saudi Arabia (16.7%), Bahrain (15.2%), and Kuwait (14.4%)
• Every 10 seconds 1 person dies from diabetes-related causes
• Every 10 seconds 2 people develop diabetes
• Cardiovascular disease accounts for 50% of all diabetes fatalities
• 10% to 20% of people with diabetes die of renal failure
• At least 50% of people with diabetes don’t know their diabetic condition. In some countries this may be 80%



Interview

How do Indians compare with others in the world in terms of cardio-vascular risk profile that could be aggravated by the onset of diabetes?

Indians have a higher cardio-vascular risk profile among both diabetics and non-diabetics than the white Caucasians. For instance, even within the UK, it is seen that the Indian population is more prone to diabetes and cardio-vascular diseases. So it is not just food and lifestyle but also genetic factors that are behind the high incidence of diabetes among Indians. India is called the world’s Diabetes capital in terms of numbers. Considering India’s overall population of a billion plus people, the number of diabetics does seem huge. Seen in percentages, India has 16-17% diabetics among the urban adult population, whereas in some places such as in the Gulf countries it is above 20%.

According to recent studies, mortality due to heart disease in diabetics is coming down in the West because of vigorous treatment of high BP, cholesterol and glucose. Is it true of India too? With increasing awareness is the incidence coming down?

Unfortunately, no. It is true diabetic awareness is picking up in India. Some people are switching to healthier lifestyles - exercising their body more and choosing lighter diets. But the prevalence is not coming down as much as it has in the West. Roughly speaking, if 10%-30% of the US population has cardiovascular risk profile, it is 50- 60% in India. Taking statins to control lipid levels and even an aspirin as a preventive measure is not done seriously by most people in India.

What is Diabesity?

The words diabetes and obesity blend to form Diabesity – the word sums up the problem. Health experts in the West and in some developing countries are deeply concerned about the rapid increase in adult-onset or Type 2 diabetes. Previously, this used to be a problem of later years. Now there are more and more obese young people - even children are growing obese and getting diabetes. On top of genetic factors that make Indians prone to diabetes, it is environmental factors such as wrong lifestyles, unhealthy diet, lack of physical exercise, too much TV, computers, sedentary jobs, faulty snacking habits etc, that aggravate the problem.

Please tell us about any recent study that your hospitals undertook to drive home the seriousness of the problem?

In our recently concluded epidemiological study to determine the prevalence of diabetes and cardiovascular risk factors among policemen in Chennai (a leading metro in Southern India), 30% of the policemen studied were diagnosed with Type 2 Diabetes. It has emerged from the study that stress, lifestyle, lack of exercise, food habits, (they skipped breakfast, had meals at odd hours and snacked excessively throughout the day to quell the pangs of hunger) led to diabetes and other metabolic disorders. This study is part of a two year program launched to prevent diabetes among Chennai police personnel.

As you see it, how do people cope with the expenses of treating diabetes? How do you advise patients on the cost factor? Do you encourage health insurance in your clinics? 

Things have improved in the last couple of years in this area. Previously only 2 or 3 companies offered specific health insurance plans to pay for the cost of treating diabetes. Now cashless cards promoted by many companies are covering diabetes costs. This is a healthy trend. We see it happening among our patients. All said and done, diabetes management can become progressively expensive if the patient neglects the condition and allows it to worsen. We are working hard to create awareness among the general public that Prevention is better than Cure.

You’ve said stress - as in workplace stress especially, can lead to diabetes. Do you advise stress management and de-stress techniques?

Compounded with unhealthy diets and wrong lifestyles, stress can surely precipitate diabetes. De-stressing according to each one’s disposition - say...spending quality time with family and friends, Yoga, breathing exercises, walking, meditation, aerobics and other fitness regimen can ward off diabetes.

Child Obesity leading to early onset of diabetes is a growing concern worldwide. How serious is it in India? Among those visiting your hospitals, are you seeing more young people getting diabetic than before?

Definitely yes. Preliminary findings of a recent study among school children in the higher socio-economic group in Chennai show child obesity is indeed growing higher and girls were found to be disproportionately ‘heavier’ than boys. Earlier, there used to be, maybe one case of a young person in a year (aged between 10 and 20 years) who was diagnosed with Type 2 diabetes in our hospitals. Now we are seeing at least 3-4 cases of young persons in a month reporting the onset of diabetes. A multi-pronged approach is needed to tackle this problem of child obesity. At the government level we are urging the ban of aerated drinks and junk food from the vicinity of the school campus. School authorities are asked to take stock of the food served in their canteens and promote awareness on eating food packed with nutrition. Parents need to act responsibly and supervise their children’s snacking habit, especially in the evening as soon as they return from school, because that is when the kids are most hungry.

Previously, diabetes used to be dubbed a "rich man’s disease" in movies and generally in the media. Is there still a divide?

That diabetes is a rich man’s disease, is a myth. The urban -rural divide, as far as diabetes is concerned is very hazy. People in the peri-urban areas are catching up fast in numbers in getting diabetic. Even in rural areas, tractors have replaced ploughs, roads are improved so people don’t trek from one place to another and then, there’s TV to keep people rooted in a place. Diabetes is in such ways, a great leveller.

The doctor signed off saying the prediabetic-stage when blood sugar readings are higher than normal is a wakeup call that the body is becoming resistant to insulin. Cutting calories in diet, snacking on whole grain and high-fiber food items, avoiding smoking and alcohol, exercising regularly and getting stress levels under control are proactive ways in keeping the dreaded diabetes at bay.

Source-Medindia
THILAKA RAVI/L