The Hindu : Tamil Nadu / Chennai News : The challenge of the HOLD syndrome

Online edition of India's National Newspaper
Wednesday, Mar 30, 2005

Tamil Nadu

Tamil Nadu - Chennai

The challenge of the HOLD syndrome

By R. Sujatha

CHENNAI, MARCH 29 . One in three visitors to the outpatient wards today suffers from obesity, a survey in the Kilpauk Medical College's diabetology ward here shows.

Ten years ago, only 13 per cent of the visitors screened were obese. Now 33 per cent are so, says Anand Moses, the department head.

The finding reflects a critical gap in diabetes education both among medical and paramedical personnel and the way the patients manage the condition.

Though several organisations, including Dr. Ambedkar's Institute of Diabetes of KMC, conduct educational programmes, it will be a long time before hospital wards get trained nurses to treat diabetics before the problem turns severe, say diabetologists.

Worrying sign

A one-year diploma in diabetology offered in the Madras Medical College was scrapped recently because only a few could be admitted to the course. The public believe that only specialists can treat them and this is not a good sign, says Dr. Moses.

The KMC has trained 60 nurses, who are posted in state-run hospitals. "In each ward, we may have 20-30 diabetics who need monitoring. If every ward has a trained nurse, diabetics need not be referred to specialists for preliminary treatment."

A. Sundaram, former head of the department, says doctors should be willing to depend on nurses, dieticians, pharmacists and psychologists to tackle the diabetic population. Specialised diabetic clinics will be necessary all over the country until the people learn to take care of themselves.

"You must teach the patient to safeguard himself. Diabetes and hypertension coexist, and the patient remains asymptomatic till the advanced stage," says Dr. Sundaram. In KMC, the curriculum for training is based on the International Diabetes Federation's syllabus.

"Nursing care is an important component of diabetes management. It is important for nurses to work in tandem with the doctor," says Dr. Sundaram.

In KMC, nurse trainees get to interact with patients, and in some cases in the podiatry ward, juvenile diabetics have been trained as nurse educators. The minimum requirements in a specialised clinic are a trained doctor, a nurse specialist and a podiatrist. More youngsters in their 20s suffer from type 2 (non insulin-dependent) diabetes. Till some years ago, only people above 50 suffered from this syndrome. Even genetic changes may be rooted in lifestyle alterations among people who moved to cities from villages, says Dr. Sundaram.

Several doctors feel that the Government must set apart more money for management of non-communicable diseases. "Diabetes education should be made an on-going process. Even after retirement, I am learning about the disease," he says. "We have a long way to go in tackling people with the HOLD syndrome — hypertension, obesity, lipidity, diabetes."

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