The influence of social mores and sedentary
life styles on health is well established. Health
behaviours of people especially related to eating, types
of food, exercises etc. are, to a considerable extend,
driven not by rational, scientific principles, but by
commercial advertisement blitzkriegs and clever product
promotion devices. This leads to a host of avoidable,
man-made health problems ranging from diabetes to heart
diseases. Good health habits lead to better health and
they help prolong the life of even the people with
diabetes. In this special issue of HFM on Diabetes, we
are trying to look at the corelation between these
influences and the ways to cope with them. Diabetes is a
metabolic disorder, which is not contagious, has no cure,
but can be effectively controlled.
A major challenge for the future in diabetes research and
practice is that most people with diabetes (more than
90%) have the non-insulin dependent form (type 2) and the
number is expected to rise from approximately 100 million
today (in the world) to more than twice this figure in 20
years. The problem is reaching epidemic proportions.
Results from a Diabetes Control and Complications Trial
(DCCT) carried out in the USA indicate that the same
importance should be placed on good blood glucose control
in people with type 2 as in people with type I. In
addition, there are good evidences from research that
"traditional" treatment regimens (including
diet, physical exercise and various blood glucose
lowering tablets) fail in most patients within 3 to 5
years.
In our country this experience and intensive treatment
may not come for many decades. We still do not know for
sure as to what kind of treatment is necessary to reduce
or avoid the increased risk of premature cardio-vascular
disease and death among people with non-insulin dependent
diabetes. Non-insulin dependent diabetes appears to be a
modern, urban life style disease in genetically
susceptible individuals. A lot of people don’t have
the genes to survive disease in an environment where the
demand for physical activity has dramatically been
reduced and the availability for cheap energy (fat and
refined sugar), responsible for premature and severe
obesity and the onset of diabetes, has increased
enormously.
Now the question arises whether this trend can be
reversed. This means research into new methods, focusing
on behavioural changes for prevention of obesity in young
people and its reversal to some degree in the affected
adults. This should be taken seriously by the diabetes
and health decision-makers. Traditional research by drug
companies alone is not likely to solve the problem.
Societies and governments all over the world have to take
this problem for real. Education is vital to the
management of diabetes. It is integral to effective
self-care by the person with diabetes and for control of
short and long-term complications. It remains a concern
that diabetes education is not available to all those who
need it. Educational strategies are also urgently needed
to improve the primary knowledge of health professionals,
policy-makers and the community at large. The people with
diabetes have a right to diabetes education. Diabetes
education should be incorporated into national health
policies.
Public awareness is an essential part of the fight
against diabetes. It is very hard to garner support for a
condition which few people are aware and most do not
understand. Diabetes has been shrouded in secrecy for too
long. A survey in France showed that some people put
diabetes in the same bracket as "socially
unacceptable" conditions like alcoholism or venereal
diseases. Without public awareness, people with diabetes
will continue to be misunderstood and discriminated
against at home at work or at school. Government will
continue to put other matters above diabetes for
investment as has been mostly happening in the third
world countries.
With such a rapid rise in diabetes prevalence there is an
acute need for initiating national diabetes control and
care programmes. An integrated model of diabetes
prevention and control through a primary health care
approach has been in vogue for the last two decades in
India. The information and other technological inputs for
diabetes diagnosis and treatment should be enhanced,
besides using them to generate greater awareness on all
aspects of the disease, especially among the rural
population. A close linkage should be established amongst
indigenous systems, allopathic system, physical sciences
and engineering in the management of diabetes. These
efforts should be funded by Governmental organisations
like Department of Bio-technology and Indian Council of
Medical Research. Experiments like Yoga therapy in
diabetes need to be optimized. Most sensitive monitoring
and analytical methodologies should be applied to
quantification of parameters like trace metal levels,
oxidation effects and role of medicinal plants in
diabetes.
Due to the limitation of space, experiences of several
doctors, researchers and social workers in the field of
diabetes could not be included in this issue of Health
for the Millions. But the contributions of all of them
and especially the family members are very important in
the control and management of this ‘sweet’,
dreaded disease called Diabetes.
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