The Hindu : Kerala News : World Diabetes Day: Lessons to learn

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Friday, Nov 14, 2008
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Kerala

World Diabetes Day: Lessons to learn

After recognition by the United Nations two years back, World Diabetes Day has gained global attention. November 14th is the birthday of Frederick Banting, the scientist who along with Charles Best, Macleod, Collip and others discovered insulin in 1921. India now has 41 million patients with diabetes. Every year World Diabetes Day has got a unique theme and this year the theme is “Diabetes in children and adolescents”

Importance

Diabetes is now the leading cause of death and disability in elderly. It causes one death in every 10 seconds due to heart attacks, strokes, kidney failures, infections, pneumonia and other complications. The age of onset of diabetes has become younger. The treatment is complex and expensive and the huge impact on the health and economics due to diabetes related complications has already started affecting developing nations.

Why treatment is failing?

It is a fact that the treatment of diabetes is largely a failure. The reasons are: Diabetes is asymptomatic in the initial 5-7 years and the patients are reluctant to go for preventive investigations and medications. Diabetes being a life long illness, it is common for patients to stop drugs in between and try unproven therapies. Many a time patients are worried about the side effects of the drugs rather than impact of the disease itself and this precludes them from following the treatment regimen strictly. More important than the drugs will be adherence to dietary instructions and daily exercise which the majority cannot follow.

Diabetes leads to major complications like heart attacks, kidney failures, blindness etc etc. The treatment is usually directed towards the major complications largely neglecting the management of the underlying diabetes status thereby contributing to further serious complications in the subsequent years. A good majority of patients are depressed because of pain and complications of the disease, loss of sexual function and un affordability to purchase the medications. Depression adversely effects control of sugars, blood pressure and cholesterol..

New treatment options

The introduction of real time insulin pumps has revolutionised the treatment of diabetes in children and in T2 diabetics requiring insulin; insulin, delivery mechanism is combined with a glucose sensing automatic technology. Our own studies available at American diabetes Association website

(http://professional.diabetes.org/Abstracts_Display.aspx?TYP=1&CID=54139) strongly supports the fact that if Comprehensive management of diabetes is undertaken and regularly followed from the beginning itself, it largely offsets the further enormous costs of treating complication of diabetes. The common man because of myths associated with diabetes and insulin, delays introduction of insulin and this results in 3-4 times increase in the dosage of medications and also failure of treatment leading to amputations and blindness. Our own research on insulin pump therapy has revealed the fact that continuous subcutaneous insulin infusion will help regain excellent physical quality of life, disappearance of pain of peripheral neuropathy, improvement in the sexual dysfunction etc However insulin pump therapy should be opted not in terms of affordability of patients but more importance should be given for obedience in monitoring the sugar readings, capability of learning technical skills, application of mathematical calculations etc etc

Continuous Glucose Monitoring CGM has evolved as a vital tool to learn in depth on the fluctuations in the blood sugar values which by itself damages the blood vessels.. The devices automatically measure blood sugars once in every 5 minutes and the data can be downloaded at the end of three days.

Future Challenge

Once diabetes sets in it is a continuous story. In the subsequent years, gradually in uncontrolled diabetes the vital organs will get involved. The only solution to this enormous problem is continuous education of the patient and caregivers. Healthy eating habits if followed in a diabetic family will help prevent the onset of diabetes in the offspring.

Dr.Jothydev Kesavadev, MD, CEO & Director

Jothydev’s Diabetes & Research Centre

info@jothydev.net