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Expert Speak

Can Diabetes be prevented?

Dr. V. Mohan

By Dr. V. Mohan

DR. V. Mohan, M.D., Ph.D., D.Sc who has founded the M.V.Diabetes Specialities Centre and Madras Diabetes Research Foundation, Gopalapuram, Chennai speaks on the risk factors and advantages of early detection of this widely prevalent condition.

What is the magnitude and seriousness of the problem in India?

The prevalence of diabetes mellitus in India has been growing by leaps and bounds. In the last 20 years there has been a 3 fold increase in the prevalence of diabetes and today it is estimated that there are over 20 million diabetic patients in India. In fact India's diabetic population now ranks first in the world, even ahead of China because although China's total population is higher, the prevalence of diabetes (percentage of patients) is far higher in India. It is estimated that by the year 2010 India will have nearly 20% of the world's diabetic population! This explosion of diabetes in India and other developing countries has been viewed with serious concern by the World Health Organization (WHO) and the International Diabetes federation (IDF). The problem with diabetes is that very often it is silent. The classical symptoms of the disease such as increased thirst and urination, non-healing of wounds etc., occur only when the diabetes is severe. In early stages, the disease can remain totally asymptomatic. Moreover, after 10 to 15 years duration of diabetes, the prevalence of all diabetes related complications increase markedly. These include Retinopathy leading to blindness, Nephropathy leading to kidney failure, Heart attacks, Gangrene of the feet, Strokes and even less known or spoken of complications like Impotency and sexual weakness. It is obvious that in a country like India, the rising prevalence of diabetes with its attendant complications is likely to produce severe constraints on health care budgets in the future.

What can be done to prevent diabetes?

Early detection is the key to prevention and effective control of diabetes. As diabetes is largely asymptomatic, regular screening for diabetes is of utmost importance.

Who should be screened ?

It is well known that diabetes is mostly a hereditary disease. Hence it is logical that screening of diabetic families would be the first priority.

The table below shows the risk of developing diabetes according to the family history of diabetes.

Risk of diabetes based on family history

Family history Risk of Diabetes
If both parents are diabetic 99%
One parent diabetic and any other relative of non-diabetic parent is also diabetic 75%
If one parent is diabetic 50%
Any other close relative 25%

It is thus clear that any one who has a family history of diabetes should be screened for diabetes.

At what age should testing for diabetes start ?

When compared to western countries, in India the onset of diabetes occurs a solid two decades earlier and it is not unusual for diabetes to set in by 20 or 30 years of age. If the family history is very strong eg. more than two generations of diabetes in the family, the first screening test could be done even by 20-25 years of age and thereafter on a yearly or two yearly basis.

Which test is best ?

The Glucose Tolerance Test (GTT) still remains the gold standard particularly as it helps to diagnose early stages of diabetes since the sensitivity of the test is very good. The next best test would be a postprandial blood sugar i.e. 1 1/2 hours after a heavy meal.

How to monitor diabetes control ?

Thanks to development in technology, diabetes control has now become easy and very effective. One now has methods to assess blood sugar control on an hourly basis, daily basis, weekly basis and even on a 2-3 monthly basis. For quick determination of blood sugars, small portable blood sugar meters are available that are very reliable and easy to use by patients themselves at home. By doing a new test called Glycosylated Haemoglobin (HbA1c), one can accurately assess blood sugar control over a period of 2-3 months. This test, the results of which can be made available in just 3 minutes using the latest sophisticated instruments, will help to assess long term diabetes control very accurately.

What is the advantage of assessing long term diabetes control?

We now know that blood sugars tend to fluctuate quite a lot day to day and even from hour to hour. For example, imagine a patient who has come to Madras for a check-up by train from a far off place. Even one cup of coffee with sugar taken during the journey or missing of one dose of an antidiabetic drug could immediately raise the blood sugar and give a false impression about the diabetic control. However the HbA1c test which is not influenced by one or two days control, will give a good idea about the overall control for the past 2-3 months.

Is there treatment available once diabetic complications set in ?

Certainly yes. For example for diabetic retinopathy, the technique of laser photocoagulation will help to prevent or reduce the incidence of blindness. Laser photocoagulation helps to seal leaking blood vessels in the retina which could otherwise threaten vision. Similarly effective treatment is now available for almost all diabetic complications including problems like diabetic impotency which till recently was a neglected issue.

It is recommended that atleast once a year every diabetic should do a complete check-up of all complications especially the eyes, kidneys, heart and feet in order to reduce the morbidity due to diabetes.

There are different levels of prevention that one could aim for in the management of diabetes (Figure 1).

Primary prevention refers to the prevention or the postponement of diabetes itself in those who are susceptible to diabetes (eg. those from diabetic families). Secondary prevention refers to the prevention of complications once diabetes sets in. This can be achieved by good diabetes control, diet, exercise and the judicious use of anti-diabetic medications. Finally Tertiary prevention refers to the limitation of disability or the rehabilitative measures once the complications have set in.

At the M.V.Diabetes Specialities Centre at Gopalapuram, Chennai, we take up a three pronged attack on diabetes aimed at these three levels of prevention which we call as `Total Diabetes Care'. Such a programme should be taken up by the youth of this country on a war-footing, in order to prevent or postpone diabetes in those at risk and to help those already having diabetes lead a full and healthy life, despite diabetes.

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