Diabetes: Care, Risk and Response

World Diabetes Day is observed on November 14th, coinciding with the birth anniversary of Sir Frederick Banting, the co-discoverer of insulin. Established in 1991 by the International Diabetes Federation (IDF) and the WHO, the day aims to address the global health problem of diabetes, affecting at least 1 in 10 people worldwide, with half of them undiagnosed. Despite countries like Benin and Gambia in sub-Saharan

Africa recording the lowest prevalence of diabetes (as low as 2%), numbers are steadily increasing with urbanisation.
The theme for this year, as in the past, is "Access to Diabetes Care." Alarming data from the Indian Council of Medical Research (ICMR) indicates a weighted prevalence of 11.4% for diabetes and an additional 15.4% for pre-diabetes.

Know Your Risk of Getting Diabetes:

Understanding risk factors is crucial for prediction, with algorithms available on apps to assist. Non-modifiable factors include family history, race (South Asians at higher risk), age (above 40), and gestational diabetes history. Modifiable factors involve body weight, physical activity, high blood pressure (BP > 140/90 mm Hg), smoking, alcohol consumption, diet (high carbohydrate intake, low fruits, and vegetables), high blood cholesterol and triglycerides, stress, and insufficient sleep (less than 7 hours).
Know Your Response to Diabetes:

Diabetes is a complex disease involving multiple organs and mechanisms, leading to various complications such as heart attacks, heart failure, leg ulcers, brain strokes, kidney failure, and blindness. Prevention involves meticulous control of sugar levels, maintaining low body weight, controlling blood pressure and cholesterol, monitoring kidney function, and adopting a healthy lifestyle with a diet rich in fruits and vegetables and regular exercise.

Challenges of Access:

While healthcare and drugs are available, the challenge lies in providing medical treatment to millions of diabetics throughout the country. Access can be affected by factors such as location (rural areas face difficulties), income (lower-income groups have a high prevalence), diet (limited access to fresh fruits and vegetables), lack of insurance, and education. Providing equal and good care to as many as possible requires policies of health care, low-cost insurance policies covering health education and preventive care, outreach programs for high-risk populations, addressing environmental issues, ensuring affordable nutritious food, and providing parks and green areas for physical activity.

Gauri Kaul Foundation since its inception has been focusing on diabetes and high blood pressure care. It has a special reach in South Kashmir beyond Pulwama through its centre in Hawal, near Rajpora, Pulwama and catering to Shopian and Kulgam.

Take Home Message:

Access to care or providing healthcare when needed to all those involved can affect the outcomes of those involved with Type 2 diabetes. Barriers to accessing health care which includes a large population because of a number of reasons. These are: Level of health education, low personal income, lack of health insurance and even for those who have it, the management for outpatient care may not be covered. Lack of culture of having yearly check ups and paucity of open green spaces, inclement weather for months in a row all affect the short- and long-term outcomes.

The Government and voluntary organisations need to supplement the provision of holistic care. Organisations like Rotary, Lions’ Club and state chapters of Associations of Physicians of India and the like need to provide resources like health education, moral support and subsidised medical care.

Prof Upendra Kaul, Founder Director Gauri Kaul Foundation, recipient of Padma Shri and Dr B C Roy Award