{ Dr. H. R. Keshavamurthy*} November 14th, birthday of Frederick Banting, who, along with Charles Best, discovered insulin, is celebrated as World Diabetes Day. 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.
As diabetes is a chronic disease and needs lifelong treatment, it 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%.
Diabetes is part of a larger global epidemic of non- communicable diseases. This disease affects 6.6% (285 million people) of the world’s population in the 20-79 years age group. According to the International Diabetic Federation (IDF), this number is expected to grow to 380 million by 2025. The IDF findings reveal that in 2007, countries with the largest numbers of people with diabetes are India (40.9 million), followed by China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany (7.4 million).
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. Type-2 diabetes is more common 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. 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. The Government of India launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010 by merging the National Cancer Control Programme and the National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke. The programme is under implementation in 100 districts and will be expanded to cover all districts of the country in a phased manner during 12th Five Year Plan. The integration of services at district level and beyond, equitable with universal coverage under the umbrella of National Health Mission is envisaged under the programme.
In the 12th five year plan, NPCDCs is being implemented in the 35 States/UTs from 2013-14. NPCDCs has now been brought under the umbrella of NHM in PIP mode. Interventions upto District level and below have been integrated under the Mission and funds provided through NCD Flexi pool. While State NCD Cells are functional in 21 states, District NCD Cells are functional in 96 districts. An average of 6.15% was found suspected to be Diabetic (above 140mg/dl, random) and an average of 5.12% was found to be either pre hypertensive or hypertensive. 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).As on 31st March 2014 5,5,39,571 persons have been screened for Diabetes and Hypertension under various health facilities,schools,urban slums and work places..
The commitment to strengthen health system stewardship for improved monitoring of NCDs, related risk factors and comorbidities in India was reiterated during GoI-WHO ‘Call for Action on NCD’s at New Delhi in 2011.The development of the National NCD Monitoring Framework and targets was based on consultative process with the relevant stakeholders.
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.
To conclude, considering the ever-increasing burden of diabetes, health system has to be strengthened with standard care at all levels. The Government has taken certain initiatives at national level which is appreciable but there is a need to implement them at grass route level in focussed manner before it takes the shape of pandemic in India. Awareness about the causes and easy way of preventions are the key to success.
—————–
* Dr. H. R. Keshavamurthy is Director (M&C), Government Of India
