Fighting rural India's diabetes spurt

Fighting rural India's diabetes spurt

When the fifth edition of the International Diabetes Federation Atlas came out in 2011, it had significant data and one fact stood out in particular. One person died of diabetes-related complications every seven seconds. The sixth edition which followed in 2013 showed that one person died of diabetes-related complications every six seconds!

While this was alarming in itself, subsequent data continued to report an increase in these numbers. Recent studies and surveys have revealed that, in India the numbers have been grossly underreported, especially when it comes to rural India, since 67.63% of our people live in villages.

The number of people in the country with diabetes is 72 million and about half of these do not know they have diabetes. Although most of these cases come from urban areas, the rural population has been found to make up 13% of this number. This translates to some 54 million people in rural India who suffer from diabetes!

Moreover, we have found that more than 50% of the rural population remains undetected and unaware of their condition. They have no means to determine if their blood sugar levels fall within the normal range or if they are at a high risk of being diabetic.

Urban residents have comparably higher awareness about the disease (58.4%) than rural residents (36.8%). A general lack of awareness about diabetes and its complications prevents a large section of the rural population from going for health check-ups.

While access to screening and diagnostic amenities are slowly increasing in rural areas, facilities still remain significantly low when compared to urban areas. This acts as an impediment to catching diabetes early, when treatment interventions are most effective.  
When it comes to rural settings, it has been seen that maternal and pregnancy care is not very accessible or of the best quality. This may explain the birth of underweight babies, which predisposes them to insulin resistance and thereby increases the risk of diabetes in rural spaces.

Gestational diabetes – diabetes which develops during pregnancy – is also a big cause for concern, both for the mother and baby. Thankfully, we have tests to detect it early between 24 and 28 weeks of pregnancy.

Early detection, regular check-ups and maintaining a healthy diet and lifestyle can control and even reverse gestational diabetes, and facilities for the same should be made available to the farthest rural pockets in our country.

Weapon of education
It is abundantly clear that if we are to win the fight against diabetes, creating higher awareness and empowering the rural population with more knowledge about the disease must become our number one priority.

Diabetes education is our we-apon and must become a central theme in this fight. We have to spread knowledge to the medical care givers, especially the primary care physicians, diab-etes educators and to the people with diabetes in the rural areas.

The International Diabetes Federation has been working with the WHO, the UN and the Government in India to make diabetes a priority on the global political and development agenda and to develop actionable programmes to reach remote areas across the country.

The treatment paradigms that we have developed for the management of diabetes in urban India need to be made available to the rural population. Collaborative initiatives and public-private partnerships appear to be viable routes to make this happen.

Research and medical advances have given us a wide range of choices from oral drugs which stimulate insulin production to oral drugs that fight insulin resistance to injectable insulin which manages the more advanced stages of diabetes.

Additionally, newer therapies are available today which can be used as and when required. Weight gain and hypoglycaemia are the two most frequently seen side effects of anti-diabetes medication which has made adherence difficult. With newer therapies, these become less of a concern.

I am convinced that we will continue to make stellar pro-gress and, in time, may even find a cure for diabetes. However, none of this will matter if we cannot take such discoveries and make them available and accessible to patients in the remotest corners of our country. It is my hope that time will change this for the better and we will be able to collaboratively reach out to every single diabetic in India.

(The writer is President Elect of the International Diabetes Federation-IDF)

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