BEHAVIOURAL CHANGE TOWARDS HEALTHY LIFE STYLES IS THE KEY TO CHECK DIABETES UNDER NPCDCS
Diabetes mellitus, or simply diabetes, is a metabolic disorder in which a person has high blood sugar, either because the pancreas gland does not produce enough insulin, or body cells do not respond to the insulin that is produced. Resulting high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (thirst) and polyphagia (increased hunger).
There are three main types of diabetes mellitus (DM):
· Type 1 DM results from the body’s failure to produce insulin and was previously called to as “insulin-dependent diabetes mellitus” (IDDM) or “juvenile diabetes”.
However, noninsulin-dependent diabetes is much more common. This form of diabetes occurs principally in adults and results from the body’s inability to respond properly to the action of insulin. Malnutrition-related diabetes has also been described from some developing countries, like India.
As diabetes is a chronic disease and need lifelong treatment becomes an economic burden on patients and family. The most important aspect of diabetes is occurrence of complications that increases the cost of management. Heart disease in diabetes is 21.4%, neuropathy 17.5%, peripheral vascular disease leading to ulcers 6.3%-30%, Retinopathy (eye) 19.0%, and Micro albumina (kidney)26.3%.
National Diabetes Month, observed each year in November, is a time for communities across the country – and the world – to renew and reinforce their fight against diabetes and encourage action to change the life style to reduce its impact. November 14th which marks the birthday of Frederick Banting, who, along with Charles Best, discovered insulin, is celebrated as World Diabetic Day.
India is home to 40.9 million people with diabetes – nearly 15% of the global diabetes burden and is projected to increase to 70 million by 2025. Impaired Glucose Tolerance (IGT) is also a serious problem in India. It has been noticed that with every diagnosed case of diabetes there is at least one undiagnosed case of glucose intolerance. So the actual population at risk would be much greater than our current estimate.
Type-2 diabetes is far more common than type-1 and results from a genetic predisposition and from lifestyle factors characterised by a high calorie intake and little exercise. The age of onset in India has been shifting towards younger people. Among Indians in their late teens, ‘adult-onset’ diabetes already manifests itself more often than ‘juvenile onset’ diabetes does. The reasons are the same as those behind the diabetes epidemic worldwide. One set of factors is urbanisation, a rise in living standards and the spread of calorie-rich, fatty, fast foods cheaply available in cities to rich and poor alike. Another is the increased sedentariness that has resulted from the replacement of manual labour by service jobs, and from the advent of video games, television and computers that keep people seated lethargically watching screens for hours every day.
Although poor Indians are currently at lower risk than affluent Indians, the rapid spread of fast food exposes even urban Indian slum dwellers to the risk of diabetes. In India, diabetes is no longer a disease of the affluent or a rich man’s disease. It is becoming a problem even among the middle income and poorer sections of the society. Indians have biological susceptibilities to diabetes because of a lower body mass index (BMI); Higher percentage of body fat that is concentrated in the abdominal area; Programmed during pregnancy as Low-birth weight infants are more susceptible than those of normal birth weight to obesity and diabetes and Insulin resistance; Excessive insulin resistance has been observed in Asian Indians as a predominant mechanism leading to Type 2 diabetes.
This alarming scenario led the Government to start the National Diabetes Control Programme on pilot basis during the seventh five year plan in 1987 in some districts of Tamil Nadu, Jammu & Kashmir and Karnataka, but due to paucity of funds in subsequent years this programme could not be expanded further in remaining states. However to contain the increasing burden of Non-Communicable Diseases, Ministry of Health and Family Welfare, launched the National Programme on Prevention and Control of Diabetes, Cardiovascular diseases and Stroke (NPDCS) on 8th January 2008 with the following objectives:
Prevention and control of NCDs.
With the successful implementation of the programme, it is expected to achieve behaviour change in the community to adopt healthy life styles including dietary patterns, enhanced physical activity and reduced intake of tobacco and alcohol resulting in overall reduction in the risk factors of common NCDs in the community. It is envisaged to cover remaining districts during 11th plan period. Till end of 2012, 29000 Glucometers, 5.8 crore Glucostrips and 6.67 Lancets have been supplied to 21 States for Diabetes screening under NPCDCS, Urban Health Check-up (four cities) and Pilot Phase of School Health Programme (four Districts).1,32,59,143 persons have been screened for Diabetes and Hypertension.