sulabh swatchh bharat

Saturday, 17-November-2018

Poor turning diabetic

Mechanised transport has been leading to a sedentary lifestyle among urban poor thereby causing diabetes 

Diabetes, one would presume, is a disease of the affluent. Doctors too tell you that it is caused by a sedentary lifestyle hence labelled a lifestyle disease. Basically, it is related to input and output of calories. If the input calories are consistently higher than the output, the excess calories get deposited as fat. The obesity gradually leads to diabetes. 

That is too simple explanation, it would seem. But, one would get startled to know that the ‘lifestyle disease’ is now spreading like wildfire among the poor as well – though for now only in the cities, who are euphemistically labelled ‘urban poor’. Basis of this sweeping statement is a study published in The Lancet, a British medical journal, on June 7, 2017. The study has been conducted by V Mohan, one of India’s pioneering diabetologists. He was one of the authors of a 15-state study on diabetes in India funded by the Indian Council of Medical Research and India’s health ministry.

At 16.7%, India had the highest share of the world’s diabetics in 2015 after China (26%), according to Diabetes Atlas 2015. This obviously, is the result of sedentary lifestyle and bad food choices. A data-churning site Indiaspend has done a fantastic job of dissecting Mohan’s report.  The standard of living among the urban poor has improved. With this, their lifestyle too has been changing. Their physical activity has gone down. They get mechanised transport, their eating habits change. They start eating unhealthy foods and the brunt of the diabetes epidemic now has shifted to the poor. So, in this sense, behavioural change cuts across all classes, the report has concluded.The 15-state survey showed that 47.3% of the 3,938 respondents identified as having diabetes had not been diagnosed. In 2015, about 52% of India’s 69.2 million diabetics remained undiagnosed, IndiaSpend reported on October 13, 2016. Except Punjab, more respondents reported prediabetes– high blood glucose that hasn’t matured to full-fledged disease – than diabetes. This implied that in the future more Asians are likely to develop the disease, as research shows they have a greater tendency to become diabetic than other populations, the Lancet study said.

 It is important to ensure early detection of diabetes – an impairment that reduces the pancreas’ ability to produce insulin, a hormone that regulates blood glucose levels. Uncontrolled diabetes can lead to complications such as heart disease, stroke, kidney failure and vision loss.Mohan, 63, provides free diabetes care to about 9,000 patients. This includes four Chennai colonies he has adopted. He has also provided free diabetes check-up to about 10,000 autorickshaw drivers in Tamil Nadu’s capital, according to his website.A graduate of Madras Medical College, Mohan is a fellow of all the four Royal College of Physicians in Glasgow, Edinburgh, London and Dublin, the American College of Endocrinology and all the three science academies of India. For his contribution to the field of diabetes, Mohan was awarded the Padma Shri, one of the highest civilian awards in India, in 2012.

In 2002, India contributed only 1% of the world’s diabetes research even as it shared 14% of the global disease burden. The burden increased to 17% in 2015. The study found that mainland states saw more cases of diabetes (8.3%) than the north-east (5.9%). The differences could be due to ethnic differences or even genetic differences. It could be related to lifestyle, for example, the cereal type consumed. Even more importantly, it could be related to physical activity, which is much higher in the north-eastern states that have a hilly terrain. The study says the main factors driving the diabetes epidemic in both urban and rural areas are obesity, age, and family history of diabetes. It also points out that in urban areas less affluent individuals have a higher prevalence of diabetes than their more affluent counterparts. Scientists are still trying to find out the reason for this unusual phenomenon. 

 The diabetes epidemic is now spreading to those individuals who cannot afford to pay for its management. In such a scenario, the government could provide free treatment for those who cannot afford to pay.  Indians thus, remain one of the biggest out-of-pocket health spenders. To ameliorate their problems tax deduction for diabetes expenses could be one solution. The other is to provide widespread insurance which can also pay for out-patient treatment. Better control of diabetes will result in lower rates of complications that are more expensive to treat than diabetes itself.  Diabetes also leads to other major complications such as stroke, kidney failure and vision loss. For that we need massive awareness programmes. We have to teach people about the importance of diabetes and its good control. We should also convey the message that good control of diabetes and related co-morbidities like blood pressure and lipid disorders can prevent diabetic complications. Finally, there should be facilities for screening not only for diabetes but also for its complications.

 Rising diabetes incidence among urban Indians is partly because they are aping the food habits of the West. As the epidemic of diabetes matures, the more affluent and educated classes of society begin to take care of themselves because knowledge and awareness levels are better. They also have the facilities to look after their health. Hence, the diabetes rates begin to level off in the upper classes. It is high time that everyone starts taking care of his health. We cannot leave everything to the government. We need to exercise well – walking at least 3-4 kilometres at a brisk pace. We need to wake up now because as doctors say – diabetes is a silent killer. It leads to hypertension, cardiac problems – because it thickens walls of blood vessels – and also affects kidneys. By the time, one starts treatment it become too late.