First, the economics. The current expenditure on diabetes treatment in India is approximately 95 USD (Rs. 6,000) person/annum as per IDF atlas, 2014, whereas the cost of treatment of one complication of diabetes, e.g. treating the diabetic foot is around Rs. 10-30,000 per treatment. With the huge numbers of diabetes patients and complications we are dealing with, overall health expenditure per person is much lesser as compared to the developed countries.
Besides expenditure, there is a huge requirement for trained workforce at all levels; paramedical workers, doctors, podiatrists and more. While the National Diabetes Control Program is well on its way, lack of specialized human resources is making it lag behind.
Why is diabetes a morbid disease?
Lack of awareness about diabetes and its complications, delayed diagnosis, myths surrounding diabetes management and dependence on quacks for treatment makes diabetes detection and management difficult. Uncontrolled levels of blood sugar can lead to tissue damage throughout the body, from eyes to toes.
What makes it particularly dangerous is the surreptitious nature of complications; they tend to remain hidden for long time. During this time, since the patient does not feel it or suffer from it, grip on diabetes control becomes poor because of wayward diet and exercise. By the time clear symptoms emerge, it is too late for treatment to reverse them.
Is diabetes now attacking people from low socio-economic stratum?
The incidence of diabetes is increasing in urban as well as rural areas. Most of the recent studies show equal increase in prevalence of diabetes (about 30-50%) in urban and rural areas. According to our studies/ underprivileged populations living in urban areas are particularly affected, especially those who have recently migrated from rural areas.
This could be due to increasing mechanization, leading sedentary lives and shift of eating habits from traditional frugal foods to energy dense foods which are easily available. This is coupled with lower levels of awareness in rural population as compared to urban population.
Recently we launched “prevention and treatment of diabetes at doorsteps” with mobile vans (“Diabetes Rath”) in collaboration with World Diabetes Federation for underprivileged people in urban areas
Healthy alternatives to fast food should be opted for. Healthy eating habits should be inculcated right from early childhood. Complete abstinence from fast food may not be a good strategy, instead children should be guided to consume these foods in moderation by cutting down on frequency and portion size.
What is the biggest challenge to a person with diabetes in India?
The biggest challenge for patient is access to reliable information regarding diabetes management and appropriate medical advice. As a doctor, the biggest challenge is to make the patients understand nature of the disease, dispel myths surrounding the diet and medication and ensuring compliance to the medical regime.
5 tips to prevent diabetes
One should adhere to the following to beat the risk of developing diabetes -
1) A well balanced diet including whole grains, pulses, fruits and vegetables, low fat dairy and avoiding saturated and trans-fats
2) Regular physical activity for 60 minutes everyday
3) Maintaining healthy weight
4) Disciplined lifestyle
5) Regular check ups
In conclusion there are three rules that you should always keep in mind. Firstly, diabetes should be seriously managed throughout the lifetime. Secondly, for prevention the focus should be on a healthy diet and regular exercise. And lastly, early diagnosis is the key to effective management and prevention of complications.