The recent ICMR INDIAB study on diabetes conducted in association with the Madras Diabetes Research Foundation (MDRF), revealed that Goa had the highest prevalence of diabetes in the whole country. It's time to contemplate and not celebrate, says DR AMIT DIAS, MD, co-Principal Investigator of the ICMR INDIAB study, as he throws light on the results concerning Goa on World Diabetes Day.
November 14 is observed as World Diabetes Day in honour of Sir Frederick Banting, who celebrated his birthday on November 14. Together with Charles Best, he isolated insulin, the hormone necessary for controlling blood sugar levels. The discovery revolutionised our understanding and management of diabetes and continues to save lives.
The theme for World Diabetes Day this year is ‘Know your Risk, Know your Response’ and focuses on risk reduction and prevention of diabetes.
Given the results of the ICMR INDIAB study that was published in the Lancet Endocrinology, the theme is very relevant to the people of Goa. We need to understand our risk and take active measures to reverse the chances of developing diabetes.
STUDY IN GOA
The ICMR INDIAB is a landmark study conducted all throughout the country which revealed that Goa has the highest prevalence of diabetes in India. It was found to be prevalent in 26.4% in those above 20 years. It also revealed that the proportion of pre-diabetes was seen in 20.3% of the participants.
Prediabetes is a state where the person has high blood sugar levels, but not high enough to be labeled as diabetes. Many of them can progress to full-blown diabetes if they do not change their lifestyle and address their risks. Close behind Goa, was the UT of Puducherry (26.3%) followed by Kerala (25.5%).
The study was conducted on 1,13,043 individuals from all over India (79,506 from rural areas and 33,537 from urban areas). The prevalence of diabetes and pre-diabetes for the whole country was 11.4% and 15.3% which is much lower than the findings in Goa. Urban areas showed a higher prevalence of diabetes compared to rural areas. The prevalence was 16.4% in the urban areas and 8.9% in the rural areas. Goa showed an overall urbanised pattern of diabetes which is reflected in the higher prevalence.
This is the trend all through the country. While the diabetes epidemic is stabilising in more developed states of the country, it is still increasing in most other states.
Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic Non Communicable Diseases (NCD) in India.
The study in Goa also revealed that 45.6% of participants had high cholesterol levels. This is the second highest in the country as Kerala had a prevalence of 50.3%.
The triglycerides were high in 31.6% of the Goans. Low HDL (the good cholesterol) was seen in 69.2%. High LDL (bad cholesterol) was seen in 46.8% which again was the second highest behind Kerala with 52.1%.
High blood pressure was seen in 45.8% of the participants. Obesity was seen in 44.4% of which abdominal obesity was seen in 51.8%. It is a major risk factor for diabetes. Abdominal obesity is said to exist if the waist–hip ratio is >0.90 in males and >0.85 in females. Obesity leads to insulin resistance and as a result of this sugar levels starts to rise despite having insulin. Reducing obesity can increase the sensitivity of the cells to insulin and can help the person achieve normal glucose levels.
One in 10 people have diabetes. The global estimate is that around 537 million have diabetes. Almost 1 in 2 adults with diabetes (44%) remain undiagnosed. More than 1.2 million children and adolescents in the world have been diagnosed with Type 1 diabetes. Over 90% of diabetics are type 2 diabetics, making it the most common presentation.
People are often under the misconception that Type 2 diabetes is mild and nothing to worry about. But that is not true, one needs to take care to keep type 2 diabetes under control. The rising sugar levels are only the tip of the iceberg. There is a lot more going on inside the body of a person with type 2 diabetes, which affects several vital organs and needs to be prevented to prevent complications, disability, and death.
FACILITIES IN GOA
We need to ensure that people in Goa get access to appropriate diabetes care through our primary health centres and the Health and Wellness Centres. The Goa government has taken several steps and has been leading the way in this direction with the launch of the diabetes barometer programme and several such initiatives.
Medications, including insulin, are available free of cost. Besides ensuring good diabetic care and monitoring, we also need to concentrate on detecting pre-diabetes and preventing their conversion to diabetes. At the National level the government has launched a special programme for the control of NCDs.
The study is a wake-up call for the people of Goa, they need to address the rising trend in obesity, especially abdominal obesity. Diet, medication, monitoring, meditation, and exercise play an important role in the management of diabetes.
The writer, an Assistant Professor at the Department of Preventive and Social Medicine, GMC, has been involved in several epidemiological studies on non-communicable diseases in Goa. He was co-Principal Investigator on the ICMR INDIAB study in collaboration with the MDRF and led by Dr Ankush Desai, Professor, Department of Endocrinology, GMC for Goa.