12/27/13

For A Healthy YOU

Publication: The Times Of India Kolkata;Date: Dec 27, 2013;Section: Spl Report;Page: 13

For A Healthy YOU TO TACKLE DIABETES, PEOPLE FROM VARIOUS STREAMS OF LIFE NEED TO BE MOTIVATED TO SPREAD THE AWARENESS THROUGH INTERPERSONAL INTERACTIONS, SAYS DR DEBASIS BASU In 1863, two years after Robert Knight, the reforming founder editor of the newspaper of Victorian India, changed the name from erstwhile Bombay Times and Standard to The Times of India, an Indian patriotic saint and a passionate reformer was born. Swami Vivekananda. He became diabetic at an early age, increasingly becoming disabled due to aggravated complications and finally in 1902, succumbed before he could reach even 40. His protracted poor health was partly a genetic endowment and definitely a result of his personal habits and lifestyle. From early childhood, he was fond of food, meat (including beef) and milk products (ice-creams). He was a chain smoker too. Even as a devoted sanyasi, he loved attending parties for long hours in hotels in the US. Twenty years after his untimely demise, on January 23, 1922 (25 years after Netaji was born) using an improved insulin extract, Leonard Thompson’s (the first recipient of insulin injection) blood glucose fell successfully and safely for the first time. It was a scientific marvel for that once imagined medical condition with no known cause (perhaps referring to Type 1 diabetes where insulin secretion is the primary defect) which affected children and young adults (only treatment being starvation diet), eventually killed everyone it touched, often within weeks or months of diagnosis. Insulin discovery became one of the major humanitarian and scientific milestones of the 20th century. Seventy-five years ago, Prof H Himsworth in the Goulstonian Lecture in London laid the foundation for the concept of impaired insulin action, which gives a clear insight into the pathogenesis of Type 2 diabetes (T2D). Today T2D comprises more than 95% of the existing population of more than 65 million Indian people with diabetes (382 million globally). We now understand that miserable lifestyle changes trigger fat to accumulate in the wrong places causing insulin resistance and realise that kicking junk foods, ditching laziness, curbing environmental pollution and reducing mental stress can make good fat and muscles for insulin to behave well. As a lifestyle disorder, T2D is a progressive disease and those affected will end up on insulin, if they live long enough. Insulin could have indeed helped the world to continue basking in a longer lasting and enduring epoch of Swamiji’s glorious radiance. We were miserably inert at early insulin initiation, incapable of proper dose optimisation and intensification only to observe a dismally grievous state of all pervasive diabetes inviting the dubious distinction of being the “Diabetes Headquarter” of the world. Gestational diabetes (GDM) affects many women and infants – with an estimated 21.4 million live births globally in 2013. India has around 15% prevalence of GDM. Not only does diabetes pose a grave threat to the health of a mother and her child but evidence shows high blood glucose levels during pregnancy can lead to an increased risk of T2D and obesity earlier in life for the child, further contributing to the already devastating pandemic. Compelling clinical proof exists now that T2D (and GDM too) can be prevented through regular screening and spreading awareness. In reality, the major causes of chronic diseases are now known, and if these risk factors are eliminated by effective intervention, at least 80% of all heart disease, stroke and T2D and over 40% of cancer could not only be prevented but the protection could also be sustained beyond 10 years. This forms the holy grail of tackling the modern curse of erroneous living and for the best outcome it needs to be implemented at the school level. Rapid transitions through globalisation have ushered in unprecedented rates of obesity and diabetes. India is a hotspot of ill health with inadequate resources to protect her population. It is predicted that one in two Indians aged 20-79 will have developed diabetes and the prevalence will cross the 100 million mark by 2030. India looks geared to fulfill a two-fold mission to fight diabetes: 1) Galvanise (global) action to address non-communicable diseases (NCDs) where diabetes is a priority agenda, leveraging UN NCD Summit 2011 (as adopted by the 66th World Health Assembly in May 2013)

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12/27/13

For A Healthy YOU

2) Implement diabetes prevention through lifestyle changes in India. Traditional mass awareness programs rely on newspapers, television, or radio programmes. Advances in nanotechnology and biomedical engineering will transform cell phones into an integrated point-of-care solution. Cell phones are an alternate medium for propagating simple messages on understanding of the signs and symptoms, risk factors, longterm complications, and ways to live with diabetes. For illiterate groups, voice and picture messaging are alternate options. Mobile phones with integrated glucometers can interpret and facilitate targeted screening (check blood sugar) approach, which can cut costs tremendously. Submitting to Netaji’s seminal salutation, Diabetes Awareness and YOU (DAY) hails: “Give a drop of blood and DAY promises you freedom from diabetes.” Based on the belief that early regular screening and awareness building are the two pivotal pillars forming the gateway to a positive change, DAY is all for: “Bayas hole tiris bachhor, blood sugar test protibachhor”. People from various streams of life such as teachers, students, IT professionals, industrial workers, police personnel, bank officials, members of social organisation and service clubs and the general population are motivated to spread the learning through interpersonal interactions. Nearly 100 years ago, visionary father of diabetes Dr EP Joslin remarked that ‘the number of cases of diabetes is so great that it at once becomes evident that their care must rest in the hands of the general practitioner. It is ridiculous to expect that the treatment of diabetics should all be under the supervision of a specialist’. Therefore an ideal situation when diabetes is the dis‘order’ of the day is to identify the traditional primary care physician who has an interest in diabetes, train well with adequate available practical inputs so that he or she knows his or her limitations and will refer the ailing for additional care when needed to a specialist. Public Health of India already operates two such excellent courses on diabetes with concise curricula for general physician and gynaecologist empowerment and accreditation. The author is president, Diabetes Awareness and YOU

(From left) Miss MacLeod, Mrs Ole Bull, Swami Vivekananda and Sister Nivedita in Kashmir

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