The Hindu : `The challenge of diabetes'

Online edition of India's National Newspaper
Thursday, Aug 21, 2003

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National

`The challenge of diabetes'

Dr. C.V. Krishnaswami, Head of the Diabetes Department, Voluntary Health Services Hospital, Chennai, writes:

I am unable to understand the reasons prompting the Editorial in The Hindu ( Aug. 19 ) "The challenge of diabetes", which strikes a note of panic describing diabetes as a "major public health concern" in India! Environmental pollution, woeful sanitary conditions, awful drinking water situations, mosquitoe menace, etc., are the real public health concerns. The complex genes of this age-old and ubiquitous disorder called Type 2 Diabetes (adult-onset diabetes) are acquired at birth and the clinical disease usually manifests at around 40 years of age and above; sometimes, it occurs in younger people and more infrequently in children below 15 years of age. The latter situation is increasing with increasing Westernisation in food habits, lifestyle and obesity; so much so, the occurrence of Type 2 Diabetes in children below 15 years is reportedly on the rise in countries like the U.S., the U.K., Japan, Hong Kong and Singapore.

For a country as large and populous as India the database for diabetes is woefully poor, confined to small studies from the corporate and NGO sectors. The WHO (which has a regional presence in New Delhi) in its wisdom does not even mention India in its technical report on Type 1 Diabetes (insulin dependent diabetes mellitus, or juvenile diabetes), but has released predictions and estimate of Type 2 Diabetes, three decades hence when India is projected as the diabetes capital of the world! Sir, I may be wrong, but I would like media leaders like The Hindu and other enlightened press, not to fall into this trap of "Epidemiologists causing epidemics" - the title for an Editorial in the Lancet (April 17, 1993).

From the VHS Diabetes Department we have collaborated with the National Institute of Epidemiology, Chennai and carried out a detailed, and statistically significant survey of 1,56,258 persons from 30 randomly selected Corporation divisions in Chennai in 1998. According to the study, the prevalence of diabetes was three per cent for all age groups from 5 to 70 years, 4.9 per cent for above 20 years and 10.5 per cent for above 40 years. The detailed study and results were published in national medical journals. For reasons best known to it, the WHO has not taken cognisance of these reports and had its estimates drawn from other sources whose validity in giving the true projection in terms of futuristic numbers of the condition for the country as a whole needs to be questioned critically. The Government of India should coordinate studies from the different regions of the country and maintain a central database. But alas, they seem to have abdicated their responsibilities to private bodies with conflict of interests other than public welfare!

As a practising diabetologist of nearly four decades in Chennai, I am both amused and alarmed at the proliferation of the ad blitz on diabetes (centres and cures) which makes very good business sense, but poor public health sense!

Change in lifestyle depends on several factors — personal and environmental. It is easily spoken about but difficult to implement in long term practice. Again, this is an area where a lot of business in generated, with very little tangible long-term benefits. A lot of brouhaha was created about prophylactic medicating trials for diabetes, which were both unethical and medically unsound as was proven by the study conducted by the National Institute of Health (NIH), in 2001.

Type 2 Diabetes is a personal heredo-familial disorder with a complex inherited genetic predisposition upon which many environmental factors such as obesity, stress, sedentary habits, multiple pregnancies, drugs, toxins, etc., act to precipitate the condition which may manifest any time from childhood to old age. Education about diabetes and its management are not achieved through advertisement causing panic in the minds of the public. It should be done by neutral organisations with no ulterior motive or vested interests, giving facts and encouragement through information for positive living with diabetes. In that sense your Editorial `Eat and exercise sensibly' (The Hindu, Sept. 4, 2002) was most appropriate and timely for the generation next.

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