Urgent Action Needed!
At the dawn of the 21st century, India is belatedly staking its claim to be counted as one of the emerging powers on the world scene. Major advances in all fields of human endeavour promise to make the present century the most fruitful one yet for our nation. Yet as a byproduct of our successes, has arisen a deadly and sinister foe, which if not controlled in time, threatens to derail the whole success story of our country.
According to International Diabetes Federation, 40 million Indians have diabetes as of 2006. This number is expected to rise to 70 million by the year 2025. Not only will India have the largest number of diabetic subjects, but the gap between India and the second-placed China is also expected to widen in the next 20 years.
This might come as a surprise to most people who tend to associate India with famines and epidemics. Twenty-first century India is passing through a phase of epidemiologic transition. The old killers such as infections and undernutrition are declining rapidly. Simultaneously, there has been an explosion in the “diseases of prosperity”- Type 2 diabetes, high blood pressure and heart disease.
Why has India become the “Diabetic Capital” of the world? Genetic factors definitely play a role. Not only are Indians more prone to diabetes, they also tend to get it at a much earlier age than White Caucasians. Moreover, while Whites who develop Type 2 diabetes tend to be overweight or frankly obese, Indians can get this disorder even if they are lean. However, genes do not change in 30 years; it is within this span of time that the prevalence of diabetes has exploded in India. Hence, there must be other factors at work.
India has changed beyond recognition in the last 30 years. Most of these changes have been for the good. Indians today, especially in the urban areas, are better fed, clothed and entertained than at any other point in recorded history. But these changes have not been without their drawbacks.
One major casualty of development has been diet. Most city-dwellers today have forsaken the traditional Indian diet, which has been developed and refined by our ancestors over thousands of years and is hence ideally suited to Indian bodies and climatic conditions. In its place, we now have calorie-rich “fast foods”, which deserve the tag of “junk foods” and which have been recognized as harmful, even in the western world. Another major casualty of modernization has been physical activity. Very few city dwellers undertake regular exercise any more. They drive or are driven to and from work, and any leisure time is spent in front of the TV. Even kids have become victims of sedentarinism, leading to the emergence of a generation of obese children.
The situation is somewhat better in the villages. It is interesting to note that the prevalence of diabetes is much lower in the rural areas, even though villagers have essentially the same genes as city-dwellers! However, this difference is fast disappearing as urbanization takes hold.
What implications does the epidemic of diabetes have for India? Diabetes takes its toll on every organ of the body. Heart attacks, kidney failure, blindness and foot amputations are some of the consequences of uncontrolled diabetes. The treatment of diabetes and its complications entail a huge drain on the finances of the individual and the nation, not to mention the mental and psychological stress. Moreover, since Indians develop diabetes early in life, diabetic complications tend to set in during middle age, which is the prime of productive life in most professions. The loss to the individual and the nation is incalculable.
At present, there is little we can do to tackle the problem of genetic susceptibility to diabetes. What we can do is to inculcate healthy lifestyle patterns in our population so that they can either prevent or delay the onset of diabetes.
There needs to be a nation-wide movement towards encouraging physical activity among individuals in all walks of life. This is especially relevant in the urban areas where sedentarinism is increasing by the day. Increasing physical activity takes only a little goodwill and effort from our part; there is no need to join a gym or purchase expensive equipment. Simple steps like using the stairs instead of the elevator, parking the car a little further away from your destination and walking the rest of the way, and getting down at the previous or next stop to your destination while traveling by bus- such small steps can be taken by anyone with little effort and no expense. Done over a long period of time, the benefits are considerable.
Governments and local bodies can promote physical activity by educating the public regarding its benefits and providing and maintaining facilities like parks and walking tracks for the public to utilize. Our roads need to be made more pedestrian-friendly in order to encourage more people to travel on foot. Dedicated bicycle tracks will encourage more people to take to bicycling, a fuel-efficient and healthy alternative to motor vehicles.
No less important is raising awareness among the public regarding healthy food choices. A return to our traditional diet-insofar as the circumstances allow- would be ideal. At the very least, information needs to be disseminated on the beneficial effects of dietary fibre, fruits and vegetables and the deleterious effects of “junk foods” and soft drinks. Several developed countries have legal restraints on the marketing of these junk foods, and it would not be a bad idea for India to follow their example.
All these measures need to be targeted preferentially at the younger generation. Spreading the mantra of physical activity and healthy eating among schoolchildren will yield the most benefit as far as changing people’s attitudes is concerned. “Catch ‘em young” should be the motto. A child in whom a healthy lifestyle has been inculcated will grow up to be a healthy adult. Moreover, a generation of aware and motivated children can also act as a catalyst to change adult behaviour. India is facing a major threat to the health of its future generations in the form of the epidemic of diabetes and other non-communicable diseases. Preventive steps should start now so that we can abort this epidemic at its nascent stage. After all, “Diabetic Capital” is a distinction we can well do without!
Even among Indians, not everyone develops diabetes. So what decides a person’s risk of developing diabetes? The author and his colleagues, after studies on more than 25,000 subjects, have developed an Indian Diabetes Risk Score (IDRS) which calculates an individual’s risk of developing diabetes based on four simple questions and a waist measurement. An IDRS of 60 or above is associated with a high risk of getting diabetes. IDRS is useful in that it tells us in whom preventive measures for diabetes will yield the maximum benefit.
Dr. Ranjit Unnikrishnan I, MD
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Dr.V.Mohan, M.D., F.R.C.P [London, Edinburgh & Glasgow], Ph.D., D.Sc., FNASc., |
