Dr Abdul Razak Shaikh
DIABETES is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the bloodstream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells. Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood known as hyper glycemia. Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues. Diabetes is the common name for a range of conditions including diabetes mellitus type one and diabetes mellitus type two, diabetes insipidus and gestational diabetes. These are all conditions, which affect how the pancreas (an organ in the digestive system) secretes insulin or how the body reacts to this hormone. Depending on the type and severity, diabetes is controlled by dietary measures, weight loss, oral medication or injected or inhaled insulin. There is a wide range of short and long-term complications of diabetes including foot and eye problems and vascular diseases. It is estimated that one in three residents of the United States will develop diabetes at some point in their life.
On 20 December 2006, the United Nations (UN) passed a resolution to designate 14 November as World Diabetes Day. The occasion aimed to raise awareness of diabetes, its prevention, and complications and the care that people with the condition need. Governments, non-governmental organizations and private businesses are encouraged to increase awareness of the disease, among the general population. World Diabetes Day was first commemorated on 14 November 2007, and is observed annually. The latest data of 2017 belies the old figures of 6.56% of diabetes prevalence affecting just 7.6 million people in Pakistan, which is mentioned in the International Diabetes Federation 2017 Atlas, as diabetes prevalence also triplicates under the fresh survey conducted by Hayatabad Medical Complex, Peshawar, in collaboration with Pakistan Endocrine Society and Institute of Public Health and Social Sciences, Khyber Medical College University, as well as the University of Manchester and the University of Glasgow.
One in every six persons is a diabetic in Pakistan as a whopping 9.04% of new diabetes mellitus (without knowing about their disease) were added to the fresh findings of the diabetes prevalence in Pakistan. Survey was informed that, based on census results of 2017 for an adult population, approximately 21.9 million were suffering from diabetes mellitus (DM), which suggests the ratio of 1:7 for diabetes prevalence among population aged 20 or above. Out of total prevalence in the latest survey, at least 17.85% of the female population is affected and 16.22 male populations are suffering from the disease. At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation. While there are a number of factors that influence the development of type 2 diabetes, it is evident that the most influential are lifestyle behaviors commonly associated with urbanization. These include the consumption of unhealthy foods and inactive lifestyles with sedentary behavior. Studies from different parts of the world have established that lifestyle modification with physical activity and healthy diet can delay or prevent the onset of type 2 diabetes.
Modern lifestyles are characterized by physical inactivity and long sedentary periods. Community-based interventions can reach individuals and families through campaigns, education, social marketing and encourage physical activity both inside and outside the school and the workplace. IDF recommends physical activity at least between three to five days a week, for a minimum of 30-45 minutes. Taking a life course perspective is essential for preventing type 2 diabetes and its complications. Early in life, when eating and physical activity habits are established and when the long-term regulation of energy balance may be programmed, there is an especially critical window to prevent the development of overweight and reduce the risk of type 2 diabetes. Healthy lifestyles can improve health outcomes at later stages of life as well. Population-based interventions and policies allow healthy choices through policies in trade, agriculture, transport and urban planning to become more accessible and easy. Healthy choices can be promoted in specific settings: schools, workplaces, homes and contribute to better health for everyone. They include exercising regularly and eating wisely which will help to maintain normal levels of blood glucose, blood pressure and lipids.
The prevalence is higher in males than females and more common in urban areas compared to rural areas. Pakistan must include diabetes preventive measures in their national health policy to minimize the burden of the disease. The original action plan for diabetes prevention and control in Pakistan was developed at a meeting in Islamabad in November 1995. The background to the National Diabetes Programme in Pakistan and the analysis of the current situation regarding diabetes prevalence and burden in Pakistan have not changed since the original plan was formulated, and do not need to be restarted. This revision will update objectives and strategies, review progress in terms of activities during 1996-8 and proposed further initiatives for the period 1999-end of 2001. The revision has been prepared on the basis of discussions held in Karachi on 14 March 1999. General objectives were to continue the evaluation of the burden of diabetes and its complications, in terms of prevalence, clinical impact and cost, to strengthen the program for primary prevention of diabetes, further integrated into strategies for the primary prevention of other non-communicable diseases.
— The writer is retired officer of Sindh Govt.