Diabetes And TB : Do Not Neglect One At Cost Of Other

The discussions at the recently concluded 41st Union World Conference on Lung Health,  in Berlin, brought forth several connections between diabetes and tuberculosis, clearly showing a link between non communicable and communicable diseases. According to Professor Anthony Harries, a seasoned physician and Director, Department of Research, at the International Union Against Tuberculosis and Lung Disease (The Union), "There is very good evidence which suggests that if you have diabetes, the risk of TB is twice than if you do not have it. In terms of diagnosis and treatment also, there is similarity of obstacles. We do not have simple diagnostic tests available for both these diseases." Read more


"To get a blood sugar count done for diabetes is as cumbersome a process as sputum microscopy test for pulmonary TB. There is a more advanced test - glycoselated haemoglobin test - which looks at the blood sugar profile of the last 3 months to test for diabetes. But it is an expensive test and not available everywhere, in the same sense as LED Microscopy and other advanced tests for TB are not there for the common person. Also, monitoring diabetes is perhaps equally difficult. We do not have very good data about what happens to patients of diabetes—how many develop complications, how many actually die at global level. It would be nice to have something like DOTS strategy here also to provide data on the outcome. An electronic monitoring system, very much on the same lines as in HIV/AIDS is needed for people living with diabetes. So, in terms of innovation, we need a point of care test s for both the diseases, which can revolutionize diagnosis and monitoring in resource poor countries. Diabetes, like TB, not only impacts the health of a person, but also the wealth of the affected households, in terms of  the number of productive years lost /compromised upon, and the heavy, prolonged cost of treatment" further said Prof Anthony Harries.

Dr Anil Kapur, President of World Diabetes Foundation (WDF) echoes similar sentiments. According to him, "People with diabetes are in a way immune compromised. So the risk of getting TB becomes greater for them, as in the case of HIV/AIDS patients. Hence from the population point of view, diabetes is as relevant in the control of TB as HIV/AIDS. Unfortunately, due to lack of knowledge and information, many people all over the world continue to wrongly perceive diabetes as a disease of affluence. We should not give diabetes the short shrift in TB control programmes. Else we will jeopardise the gains of active case findings and appropriate treatment. If we are not able to control people with TB having diabetes in the background, we will land up with more cases of MDR-TB, and with people remaining infected over a longer period of time, thus causing a reversal of the gains we might have achieved."

The problem of funding is there in both cases, but perhaps more in diabetes. Organizations need to give a fillip to research in this field too. Moreover, while the governments pay for the medicines of a TB/ HIV patient, diabetes treatment costs are not supported by the state. This becomes all the more critical as, contrary to popular belief, diabetes is not a disease of rich people alone. In fact, 70% of the burden of the disease globally exists in poor countries. Let us hope for a change in the general mindset of people. Health professionals should be updated and be aware of the link between diabetes, TB and other co infections. Funding agencies and governments should allocate funds to both in a realistically appropriate manner and not at the cost of each other.

Let one not become the driver of the other.


Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. She is supported by the Stop TB Partnership to write from the 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010). Email: shobha@citizen-news.org, website: www.citizen-news.org)  

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The Union advocates for integrated response to diabetes on World Diabetes Day (14 November)

World Diabetes Day is on 14th November
Diabetes is a leading threat to public health and, along with other non-communicable diseases (NCDs), is a major contributor to morbidity and mortality globally. The largest burden -- 80% (28 million) -- occurs in low- and middle- income countries, making NCDs a major cause of poverty and an urgent development issue. Building awareness of this issue is the main focus of World Diabetes Day, which will be on Sunday, 14 November 2010.

"You can not talk about public health today without addressing the rise of non-communicable diseases, especially in low- and middle-income countries", said Dr Nils E Billo, Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union), which is one of the key partners of the NCD Alliance. Read more


"Many of these diseases are linked, such as diabetes and tuberculosis, so when you have a rapidly increasing burden of diabetes, you will also see an impact on TB control. Studies have shown that people with diabetes have a two-three times greater risk of developing tuberculosis."

According to the International Diabetes Federation (IDF), the disease now affects over 300 million people worldwide and will cost the global economy at least USD 376 billion in 2010, or 11.6% of total world healthcare expenditure. A further 344 million people are at risk of developing type II diabetes -- the most common form of the disease. If nothing is done to reverse the epidemic, IDF predicts that by 2030, 438 million people will live with diabetes at a cost projected to exceed USD 490 billion.

"For patients, the danger is that the mortality risk attributed to diabetes is much higher for people with active TB disease. Communities will see the impact in reduced quality of life and productivity and increased poverty. For health systems, the impact will be a greatly increased case load of patients needing chronic care", said Dr Billo.

According to a research study done by the University of Texas School of Public Health Brownsville Regional Campus, people with type-II diabetes are not only at greater risk of developing active TB, their chronic high blood sugar is associated with an altered immune response to TB. In addition, patients with diabetes and TB take longer to respond to anti-TB treatment and are more likely to have multidrug-resistant TB.

The Union hopes to see health responses to diabetes that are integrated with programmes addressing risk factors like those of TB. The linkages of diabetes with poverty also need further attention from the governments and other stakeholders.

Bobby Ramakant - CNS

Walk Your Way To Health And Happiness

Today is World Diabetes Day  and also Children’s Day in India. We are also in the middle of an international conference on Lung Health  in Berlin ( 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010). There can be better way to meaningfully link all these events together than by taking part in the Global Walk which is being promoted by the World Diabetes Foundation. Read more

Walking is the easiest and cheapest way to a healthy life. By walking, we exercise and feed our lungs with oxygen, and make them healthier. We also reduce the risk of getting diabetes and other diseases. Moreover, this simple pleasure transports us to the good old days of childhood when we hopped, skipped and danced (all these are various forms of walking) our way to a healthy and joyous world. The first Prime Minister of free India, Pandit Jawaharlal Nehru, loved children; and the Father of our nation, Mahatma Gandhi, amongst other things, loved to walk his way through difficult situations. As a tribute to both, (as well as to the cause of diabetes) thousands of children and adults in India, and all over the world, will be part of the Global Diabetes Walk Campaign at the behest of World Diabetes Foundation (WDF). This walkathon is part of the efforts of WDD to remind one and all about the importance of physical activity in our lives for, not only preventing diabetes, but other chronic diseases as well. Physical activity combined with good nutrition is the perfect recipe for a disease free and healthy world. 

One project partner of WDF, has initiated a ‘walk activity’ in schools of two or three districts of Kerala, a southern state of India. The project aims at promoting healthy life styles in children and adults. It was launched on 2nd October (the birthday of the Mahatma) this year, and would culminate today on 14th November. School children have taken it upon themselves to spread the message that health and physical activity go hand in hand. They have recruited their parents, friends, and family members, to be part of this gala and socially relevant affair. It is hoped that more than 400,000 people would have walked (at least part of their way), during this period.

Dr Anil Kapur, president of the World Diabetes Foundation, rues that “the focus on academic learning is so high that we have relegated the importance of physical activity, which used to be a part of the natural growth of the child. As a child, I used to walk from my house to the bus stand, and then again from the bus stand to the school. But my children have been driven to school in cars. Very often the environment outside is so unsafe that we do not allow them to go cycling or playing outdoors. This is very sad indeed, and hence it becomes all the more important to have enough sports facilities in schools. I appeal to educationists to sacrifice at least three academic lectures/teaching periods a week and devote that time to meaningful physical activity for students.”

Parents will also have to be mobilized and educated to demand compulsory sports/ yoga facilities in schools, and not just computer labs. The process has already begun in many schools of North India, where a mass movement against sedentary lifestyle and junk-food/improper diet is building up under the aegis of project Marg, which has been initiated by Diabetes Federation of India, with support from World Diabetes Foundation. This project targets school children to make them discover the joy and benefits of healthy diet and physical exercise.
 
The World Health Organization (WHO) has issued the following statement to mark World Diabetes Day 2010 on 14 November: World Diabetes Day: A reminder of health, developmental impacts of chronic diseases.

In the words of Dr Ala Alwan, WHO's Assistant Director-General for Non communicable Diseases and Mental Health, “World Diabetes Day, held on 14 November, comes at a critical moment in the global fight against this deadly disease and a host of other chronic illnesses that are causing both untold, needless suffering and holding back the development of many of the world's poorest countries.”

Let us join hands in this noble cause and walk at least a mile today, and then every day, for our own good.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. She is supported by the Stop TB Partnership to write from the 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010). Email: shobha@citizen-news.org, website: www.citizen-news.org) 


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Call To Unite for Diabetes Awareness on World Diabetes Day (14 Nov)

World Diabetes Day is on 14 November 2010
Starting from 12th November, people from all corners of the world are uniting together for three days of celebration to put diabetes firmly in the public spotlight. World Diabetes Day is the best opportunity there is to draw attention to the silent killer that is diabetes. Read more

Celebrated every year on 14 November, World Diabetes Day was initiated in 1991 by the International Diabetes Federation (IDF) and the World Health Organization in response to growing concerns about the escalating health threat that diabetes poses to the global community. World Diabetes Day draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. It is represented by the blue circle – the global symbol of diabetes.

Diabetes is a leading threat to global health and development. According to IDF, the disease now affects over 300 million people worldwide and will cost the global economy at least US$376 billion in 2010, or 11.6% of total world healthcare expenditure. A further 344 million people are at risk of developing type2 diabetes -- the most common form of the disease. If nothing is done to reverse the epidemic, IDF predicts that by 2030, 438 million people will live with diabetes at a cost projected to exceed US$490 billion.

Faced with these alarming numbers, World Diabetes Day aims to establish access to diabetes education as a right for all people with diabetes, to promote greater awareness of the risk factors and warning signs of diabetes, and encourage best-practice sharing in diabetes prevention.

This year sees the second of a five-year campaign (2009-2013) that addresses the growing need for diabetes education and prevention programmes throughout the world. The theme for World Diabetes Day 2010 is "Let's take control of diabetes. Now." In keeping with this theme, IDF has developed a special web application – the Blue Circle Test—to showcase the risk factors for type 2 diabetes and highlight the positive actions that individuals can take to help prevent the disease.

To mark World Diabetes Day this year, IDF is coordinating a programme of work – called the Diabetes Roadmap - that will produce and package arguments, evidence and solutions to ensure the UN Summit translates into real change for the millions of people with diabetes worldwide.

As part of World Diabetes Day 2010, the International Diabetes Federation (IDF) will be focussing on a major diabetes epicenter: China. IDF plans to unveil a major global diabetes plan, A Call to Action on Diabetes on November 14, as part of World Diabetes Day festivities at the iconic Great Hall of the People at Tiananmen Square in Beijing. Economic progress in China is coming at the cost of public health: China has 92.4 million adults with diabetes (1 in every 10 adults). A Call to Action is the central advocacy tool for the global diabetes community in the lead up to the UN Summit, bringing the global diabetes epidemic to the attention of world leaders, and guide and secure action, commitment, support and resources for diabetes. New data on how much diabetes is costing the Chinese economy and society will also be announced, followed by an expert panel session featuring Madame Kong Lingzhi, Deputy Director-General, Chinese Ministry of Health, and Professor Jean Claude Mbanya, IDF President. 

"Ninety years after the discovery of insulin and four years after UN Resolution 61/225, the number of people with diabetes continues to grow at a staggering rate. In every country and in every community worldwide, we are losing the battle against this cruel and deadly disease," said IDF President Jean Claude Mbanya.

Celebrations will extend from China to various countries in the world, with famous landmarks and monuments once again lighting up in blue for diabetes awareness. More than 500 iconic buildings in over 60 countries will be illuminated, including Table Mountain in South Africa, Christ the Redeemer in Brazil, the Brandenburger Tor in Germany, and Niagara Falls in Canada. Activities such as mass walks for diabetes and aerobics will be held in conjunction with these lightings, to demonstrate the importance of a healthy lifestyle to help take control of this epidemic.

"Our global diabetes champions will literally bring diabetes to light on World Diabetes Day. No matter where we are, it's our efforts that will make World Diabetes Day a truly global success," said Prof Mbanya.

"The time to act for diabetes is now." (CNS)

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People with diabetes at 2-3 fold higher risk of tuberculosis (TB)

[To listen to audio podcast of CNS Exclusive interview with Dr Anil Kapur on TB-diabetes, click here]
People with diabetes are at a high risk of tuberculosis (TB). According to several studies and systematic reviews, people with diabetes might have 2 to 3 fold higher risk of getting tuberculosis (TB). In the lead up to the World Diabetes Day (14 November), and 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010), it might be wise to see one of the key outcomes of a TB and poverty meeting that brought deadly synergy between diabetes and TB to the fore. The linkage of TB and diabetes came out very prominently when different TB programme managers from Nepal, Thailand, India and those from different Indian states shared their experience at the recently concluded consultative workshop of the TB and poverty sub-working group of the Stop TB Partnership (29-30 October 2010). Read more


The secretariat of TB and poverty sub-working group is housed in the South-East Asia office of the International Union Against Tuberculosis and Lung Disease (The Union) in New Delhi, India.

"The other important non-communicable disease (NCD) that will impact TB control in India and countries in the region is diabetes - the prevalence of this in the general population is high and early studies already suggest that about a fifth of incident sputum positive TB are co-morbid with diabetes. This will require coordinated and urgent measures. There is already a rural predominance in the distribution of diabetes in India, and of course the poor are disproportionately affected. Together with TB, this combination will impoverish already poor people and push them into greater poverty. The upcoming UN NCD summit (September 2011) is an opportunity to focus government attention to the magnitude of this problem and attract donor funding. TB programmes must engage with their counterparts in NCD and specifically diabetes control and management and urgently review mechanisms to identify and manage co-morbidity through coordinated programming" commented Dr Nevin Wilson, Regional Director of The Union's South East Asia office in response to a post "Poor people are most hard hit by TB, COPD and tobacco."

"The risk of mortality is much higher in TB patients who have co-existing diabetes. There are also evidences to suggest that when there is co-existing diabetes it takes longer for the sputum to become negative (for TB) with anti-tubercular treatment" said Dr Anil Kapur, President of the World Diabetes Foundation (WDF).

"There are also suggestions that there are interactions between drugs that are used for treating tuberculosis and managing diabetes, which would affect both the treatment of TB and diabetes. Also there is an issue that because of TB, people who are at risk of diabetes and are not at this stage dealing with diabetes (although they may be having pre-diabetes), so when there is a serious infection like TB, this temporarily leads to a phase where blood sugar levels are up, of course blood sugar levels come down when TB is brought under control. But none-the-less these people (with TB) remain at high risk of getting diabetes in the future" further explained Dr Anil Kapur.

According to a research study done by the University of Texas School of Public Health Brownsville Regional Campus, people with type-II diabetes might be at greater risk for contracting TB. This study also further suggested that:
- Type-II diabetes, especially type-II diabetes involving chronic high blood sugar, is associated with altered immune response to TB, and this was particularly marked in patients with chronically high blood sugar
- Patients with diabetes and TB take longer to respond to anti-TB treatment
- Patients with active TB and type-II diabetes are more likely to have multi-drug resistant TB.

"The other problem is that if in a family if somebody has diabetes, and another person in same family has TB, then the chance of the person with diabetes acquiring TB becomes high" said Dr Kapur.

"As with TB, which often occurs in social-economically less well-off people, people living in crowded places, in urban environments where they don’t have access to care, and are often smoking and they also consume alcohol, many of these same risks apply to diabetes" said Dr Kapur. "So what is starting to happen is that diabetes is much more often seen in people who are poor in the developing countries and also in countries where there is a high burden of TB" further added Dr Kapur.

Also the environment in which TB happens is the one where diabetes is occurring. "This has very dangerous portents especially for countries like India where we have a very high level of diabetes and a very high level of TB" said Dr Kapur. In fact there have been studies that have been published which estimate that the level of tuberculosis caused by diabetes might be quite substantial in India.

"Similarly people with diabetes who complain of persistent cough for more than two weeks, the doctors should be aware of the double risk (for TB and diabetes) and therefore should investigate these people for potential risk for TB. So this is something we are working with the International Union Against Tuberculosis and Lung Disease (The Union) and also with Stop TB programme of WHO. In addition to that we have funded programmes where we are doing this kind of screening and training of community healthcare workers who are working in areas with TB to look for diabetes. One such programme is right now ongoing in Tamil Nadu, India, with diabetes research centre and National TB Research Institute in Chennai. There is another one being undertaken in China" said Dr Kapur.

Such collaborative public health approach will yield positive public health outcomes, keeping fingers crossed for a healthy future.

Bobby Ramakant – CNS 

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From Fit To Fat

World Diabetes Day is on 14th November
Diabetes, one the four priority non-communicable diseases (NCDs) identified by the World Health Organization (WHO), remains a misunderstood and neglected epidemic with numbers increasing alarmingly in every region of the world. According to the International Diabetes Federation (IDF), there are over 300 million people with diabetes worldwide with low- and middle- income countries account for 4 out of 5 cases of diabetes. There are 50.8 million people with diabetes in India and 92.4 million in China. To add fuel to fire, India seems to be at a threshold of an 'outbreak' of obesity, more so in urban Indian cities. Read more

Obese children and adolescents are at an increased risk for the development of early-onset type-2 diabetes mellitus (T2DM) and coronary heart disease (CHD). This phenomenon is accelerated by nutritional westernization and sedentary lifestyle. There is a near global consensus amongst doctors and scientists that healthy dietary and lifestyle practices should be inculcated in children to prevent future development of T2DM and CHD.

Unless preventive measures are taken, obese and insulin resistant children will get affected with T2DM and CHD in young adulthood.

According to Prof (Dr) G Choudhuri, Professor and Head, Department of Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, "The age of onset of diabetes is decreasing, and it is occurring at a younger age these days. Diabetes has a strong genetic component but gets unmasked with disorganized lifestyle and eating habits. The 2 important lifestyle issues of concern are increased body weight and lack of exercise. Indians, especially urban ones, are particularly predisposed to exercise deficient lifestyle. These changes are being increasingly observed now in urban children, and nearly 20% or more school kids are overweight or obese, and are potentially at risk of developing diabetes."

Prof Barry M Popkin, a professor of nutrition at the University of North Carolina rues that, "some children, including very young children, snack almost throughout the day. Such findings raise concerns that more children in the world are moving toward a dysfunctional eating pattern-one that can lead to unhealthy weight gain and obesity."

According to Prof (Dr) Anoop Misra, former Professor, Department of Medicine, All India Institute of Medical Sciences (AIIMS) and Director and Head, Department of Diabetes and Metabolic Diseases, Fortis Hospitals (New Delhi and Noida), who is also the Director, Diabetes Foundation (India): "Trans fatty acids are one of the strongest poisons affecting human metabolism today." Trans Fats are found in fast food products made with hydrogenated oil in an unregulated market, a time bomb waiting to explode, even as the Indian Union Health Ministry is contemplating for processed food manufacturers to list the Trans-fat content on nutrition basis.

Diabetes Foundation (India), with help from other global agencies, is striving to create awareness about lifestyle related diseases in children and adolescents through three major community centric health initiatives involving the education of schoolchildren, teachers and parents regarding diabetes and obesity. These are:-


Project MARG (Medical education for Children / Adolescents for Realistic Prevention of Obesity and Diabetes and for a Healthy Aging), which focuses on primary prevention of not only obesity and diabetes, but also of non-communicable diseases in general, by targeting school children in several cities of India.

Project CHETNA (Children's Health Education Through Nutrition and Health Awareness), which aims at prevention of obesity, diabetes, and heart disease, in order to inculcate healthy lifestyle and nutrition habits in school children.

Project TEACHER (Trends in childhood nutrition and lifestyle factors in India) which covers 4 major cities of India to obtain in- depth understanding of nutrition and lifestyle behaviours that affect the health and well being of urban Indians , particularly children, through detailed knowledge attitude and practice survey questionnaires, group discussions and anthropometric measurements of children and their mothers.

Project HOPE (Health Oriented Programmes and Education) with Prof (Dr) G Choudhuri as its founder member - has been concentrating on lifestyle as one of its thrust areas and targeting diabetes prevention as one of its goals. Its mission is to promote health awareness in schools throughout the city of Lucknow. It recognizes that healthy children learn better and that school based programmes can help to influence the health of students.

More such initiatives are needed to encourage our children/adolescents to eat a nutritious diet and increase physical activity. Schools can be targeted to become harbingers of this change by increasing sports activities in their premises and by monitoring the food/snacks preferences of the students. Some schools have indeed changed the school canteen menu to a tasty health menu and have stopped the sale of cola drinks on the campus. It is worth mentioning here that a single serving of soda or other sweetened soft drink contains between 120 and 200 calories of sugar, equivalent to a man's recommended intake for a full day and exceeding the recommended daily intake for a woman.

According to a study conducted by researchers from the University of California, the booming popularity of sugary soft drinks has led to 6,000 more deaths, 14,000 more cases of heart disease and 130,000 new cases of diabetes in the past 10 years. "We can demonstrate an association between daily consumption of sugared beverages and diabetes risk," researcher Litsa Lambrakos said. "We can then translate this information into estimates of the current diabetes and cardiovascular disease that can be attributed to the rise in consumption of these drinks."

What better way to celebrate India's Children's Day this year on 14th November (which coincides with the World Diabetes Day, 14th November), than us parents, teachers, school authorities and youngsters to join hands in this noble endeavour of going from fat to fit, by saying no to colas/ junk food and yes to healthy snacks, and hop/skip /jump/ swim/ cycle/ dance to a diabetes free world.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: www.citizen-news.org)

Alarm on diabetic foot: "People with diabetes take care of feet"

Prof (Dr) Rama Kant awarded Jharkhand Presidential Oration on diabetic foot
Professor (Dr) Rama Kant was awarded the prestigious Presidential Oration by Association of Surgeons of India (ASI) Jharkhand in Hazaribagh on 24th October. Prof (Dr) Rama Kant is currently the Managing Director of Piles to Smiles Clinic at Rama Consultations and Training Centre (RCTC), C-block crossing, Indira Nagar and also the Professor-Director at SIPS Hospital, Shahmina Road. He is the former Head of Surgery Dept, CSMMU (erst KGMC) and former Chief Medical Superintendent of Gandhi Memorial and Associated Hospitals, CSMMU. Read more


Prof (Dr) Rama Kant was awarded the Jharkhand Presidential Oration at the JASICON 2010 in Hazaribagh on diabetic foot. “People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness - loss of feeling - in the hands, arms, feet, and legs” informed Professor (Dr) Rama Kant, who is the current President of Association of Surgeons of India, UP Chapter (2009-2010) and is the ASI governing council member (2010-2012).

“The foot of the patient with long-standing diabetes is often the site of neuropathic and vascular growth which poses a considerable threat, not only to the lower limb but also to the life of the patient” warns Prof Rama Kant, who is also the recipient of the coveted World Health Organization (WHO) Director-General’s Award for the year 2005.

Relatively diabetic foot is one of the leading causes resulting in long hospital stays for people with diabetes. It demands much care and attention by both the patient and healthcare personnel. Two major problems which predispose the patients with diabetes to amputation are the development of neuropathy due to uncontrolled diabetes over several years while result in damage to the nerves in the feet leading to the loss of sensation. They also develop certain high pressure points under the feet which result in the formation of callus which later turns in to an ulcer. In addition cigarette smoking will lead to nerve damage and reduced blood flow in the feet.

With increasing age, people with diabetes may develop diminished sensation and decreased peripheral circulation in the feet, and thus are at a heightened risk of developing foot infections.

Prof Rama Kant lists some ways people with diabetes can take care of their feet:
1. Keep feet clean – wash them regularly.
2. Use only lukewarm water – no hot water, heating pads, hot water bottles, iodine or alcohol.
3. Keep the feet dry – especially between toes-use unscented lotion or cream to keep skin soft.
4. Use only medicines recommended by your doctor
5. Cut toe nails straight across, not deep into the corners to help avoid ingrown toe nails.
6. Never use razors, knives or corn caps to remove corns.
7. Wear shoes or slippers at all times -never walk bare foot even at home.
8. Wear good fitting shoes/slippers - not tight or worn-out ones. Boots should be used only for short periods.
9. Check your feet daily and see your doctor immediately about foot problems.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: www.citizen-news.org) 


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Not Screening For Diabetes During Pregnancy Is Dangerous And Costly

The theme for the World Diabetes Day 2009-2013 campaigns is: "Diabetes Education and Prevention"; with a view to "Understand Diabetes and Take Control". Diabetes, mainly type-2 diabetes is very common in India and there are 50.8 million people living with diabetes currently in the country. The International Diabetes Federation (IDF) estimates this number to rise to 70 million by the year 2025. So there is an urgent need for a national diabetes control programme. Read more


Women are as equally affected by diabetes as men. When compared with men, women have a 50 percent greater risk of diabetic coma, a condition brought on by poorly controlled diabetes and lack of insulin. Diabetes also poses special challenges during pregnancy. Diabetes during pregnancy (gestational and type-1 diabetes) results in an increased risk for problems such as high birth weight, birth defects, and other complications for the mother. It also puts the woman and her child to an increased risk for developing type-2 diabetes later.

"Women who have uncontrolled or undiagnosed diabetes in pregnancy can have several complications like: infertility, recurrent spontaneous abortions, higher risk of congenital malformations in the developing foetus, cardiac malformations, gastro-intestinal malformations etc. Moreover, they have a higher chance of having a macrosomic baby who can have several complications in the early neonatal period like hypoglycemia, hypocalcemia. A large baby can also create problems during childbirth and lead to increased incidence of operative delivery" said Dr Amita Pandey, a leading gynaecologist and Assistant Professor, Department of Obstetrics and Gynaecology, CSM Medical University (CSMMU, erstwhile King George's Medical College - KGMC).

Yet, diabetes as a maternal health issue is largely unaddressed in developing countries like India. Gender inequality places a higher burden of social and economic consequences of diabetes on women, while at the same time imposing greater barriers to access to care. Diagnosis of gestational diabetes identifies women as well as their children at very high risk of future diabetes. So identifying and providing care for diabetes during pregnancy are crucial.

Dr Pandey rues that "doctors working in the smaller cities and in the peripheral health centres, are not programmed to diagnose and manage diabetes in pregnancy. Most of the times it goes unnoticed, and only when complications, like congenital malformation or abortion, occur and the patient consults a specialist, is it diagnosed. So although the health system is equipped to screen for the disorder and diagnose it early (there are simple screening tests, like the 50g, one hour blood sugar screening test, available to diagnose GDM in all government hospitals), the doctors don't lay enough emphasis on this and often overlook the problem. In fact, it may appear to be shocking, but in the state of Uttar Pradesh at least, very often the doctors do not even get the haemoglobin of the woman estimated during the entire pregnancy. So how can one expect them to think about blood sugar screening to diagnose gestational diabetes? One may justify it by calling it a result of system failure or adverse effect of over-population, but we do fail on this aspect as far as public health services are concerned."

A study carried out in 2004, by Diabetes Care and Research Institute, Chennai, and the Tamil Nadu Health Department, in and around the rural/urban areas of the city found a 13.8% prevalence of gestational diabetes. This prompted the Tamil Nadu state government to make diabetes screening compulsory for all pregnant women, since 2007. This needs to be emulated on a national level.

Dr Pandey agrees that "diabetes is perhaps a complication of the super-mechanised lives we lead these days. We Indians have very poor dietary habits--a high intake of simple carbohydrates and fats with very little physical exercise. This results in fulminant diabetes in those (like Indians), who are genetically predisposed for the same. Moreover, Indian women are more negligent in controlling blood sugar levels and often end up with grave consequences and complications of diabetes. They are also not able to spend sufficient money on getting a proper treatment for themselves as the husband and the sons get a higher priority as far as health and treatment expenditures are concerned."

So while on the one hand, we have an overburdened health system which is ill equipped to conduct basic health checkups, on the other hand we have educated but ignorant expectant mothers, who have been traditionally tutored to neglect their own health. Little do they realize that undetected/untreated gestational diabetes involves a higher risk of maternal and prenatal morbidity and poor pregnancy outcomes.

Hence it is important that women shed their apathetic attitude and pay proper attention to eating a healthy diet and to go for regular walks and other forms of exercise. Merely doing household chores is not enough exercise. Exercise lowers glucose levels, helps weight loss, maintains a healthy heart and helps relieve stress. They also need to demand to have their blood sugar tested in both the first and second trimester, if pregnant. It is to their advantage to discover gestational diabetes early, if it exists.

Also, there is an urgent need for government action, to not only focus on women with diabetes, but have compulsory screening for gestational diabetes in all public/private hospitals. It should also be mandatory for all government/non government enterprises and educational institutions to have annual health tests for diabetes and other non-communicable diseases for their staff.

In the words of Dr Anil Kapur, President of the World Diabetes Foundation (WDF), "focussing on gestational diabetes is a low cost preventive way to improve maternal and child health, and a small investment in providing screening for mothers at risk for gestational diabetes is likely to have an impact on the beneficiaries as well as on health care systems and budgets."

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: www.citizen-news.org) 


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WHO SEARO Flags Self-Discipline As Key To Diabetes Fight

According to the International Diabetes Federation (IDF), the number of people in Thailand living with diabetes, in the age group 20-79 years, has risen from 3,162,400 in 2007 to 3,538,000 in 2010. Thus, during the past three years 375,600 more Thais have joined the band wagon of this non communicable disease, increasing the national incidence of diabetes from 7.2% in 2007 to 7.7% in 2010. This is more than the current prevalence in India (7.1%) and China (4.5%) in the age group of 20-79 years. Thailand urgently needs to increase efforts to raise awareness of diabetes among its population in order to stem the potential of a burden epidemic. Read more



"I don't want to call 'diabetes' as a disease actually it is Hyperglycemia, or it is the level of the high blood sugar that becomes the problem all over the world at this moment. So I think this is the big problem. We already know how to prevent ourselves from diabetes especially through better nutrition, exercise and so on. The problem is how about those who are starting to have risk of Hyperglycemia, what should they do? One thing that needs to be done is blood testing. Since diabetes now affects all ages, at some point when a person reaches age 30 they certainly need to check their blood and continue controlling the glucose level yearly" said Dr Samlee Plianbangchang, Regional Director of World Health Organization South-East Asia Region Office (WHO-SEARO) in an exclusive interview with CNS.

"Once you know someone is at risk then you have to prevent the complication by keeping the sugar level of blood. In many cases we may have to give them insulin, and try our best to prevent them from the other diseases as much as we can. If we can control the blood sugar in the person well enough and prevent them from the complication diseases, they would be just fine with their life, just only in one condition, don't let there come the complication," added Dr Samlee Plianbangchang.

He said that diabetes is a condition requiring life long treatment, care and management which currently affects a lot of people around the world.

"Diabetes is alarming; it's happening all around the world. For developing countries, there is a need to access medication but people don't even know that they have diabetes, and the access to treatment is limited. So we have to make them aware of their condition and make it possible to access medication. Primary prevention is a very important issue as well," said Dr Samlee Plianbangchang.

He added that Thailand has had so many campaigns during the past few years such as 'Kon Thai Rai Pung' but campaigning is just only a part of it. Success or failure is up to the discipline of individual persons, he said.

"To exercise you need to have discipline, most people don't have discipline. If you're not disciplined then the campaign will not be successful. To make the campaign work out, we have to campaign for people to have discipline. I think this is very big issue" said Dr Samlee Plianbangchang.

Dr Samlee Plianbangchang stressed the need for people to take care of their health in the lead up to the World Diabetes Day, 14 November, and beyond.

"We have to take care of our health, the most important thing that we have to be concerned with is food and nutrition. Along with good exercise and enough rest, these will certainly help to prevent diabetes and other diseases. It is simple saying it but hard in terms of doing, because whoever has no discipline will not be able to work it out, to have discipline in taking care of your health is a very big issue, anyone who has not enough discipline they can never be able to do this" said Dr Samlee Plianbangchang.

The slogan of World Diabetes Day this year is 'Let's take Control of Diabetes Now,' perhaps the best way for us to start with is to have self-discipline.

Jittima Jantanamalaka - CNS

(The author is the Managing Director of Jay Inspire Co. Ltd (JICL), and produces radio programmes in northern Thailand. She is also the Director of CNS Diabetes Media Initiative (CNS-DMI) in Thailand, and a Fellow of CNS Writers' Bureau. Website: www.jay-inspire.com, Email: jittima@citizen-news.org )

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World Diabetes Day: Healthy living prevents diabetes and obesity

World Diabetes Day: Healthy living prevents diabetes and obesity

Today is World Diabetes Day – a day to reflect upon why India has become the diabetes capital of the world with 50.8 million (7.1%) of its people suffering from diabetes. It is high time we prepared to combat this menace and curb its spread. As the new President of IDF has rightly remarked that either we turn off the diabetes tap or else spend our lives mopping the floor.

We Indians are genetically more prone to diabetes. On top of this, a rapid shift in our dietary habits and life styles is resulting in a rapid rise in obesity, diabetes, metabolic syndrome and heart disease. Hence a proper and healthy diet remains the cornerstone of prevention and management of these diseases.

Perhaps the most important reason for increasing prevalence of diabetes, obesity and hypertension is the rapidly changing imbalanced dietary habits, both in rural and urban areas, due to several factors – easy availability of convenience foods, frequent snacking on energy dense fast foods, high consumption of packaged food in place of traditional home made food, etc. This transition has resulted in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and a low fibre intake.

This has necessitated a revision in the existing dietary guidelines prepared 10 years a go by the National Institute of Nutrition, Hyderabad, which was predominantly rural centric. So, more than 100 renowned experts, belonging to varied disciplines of health and nutrition, have got together under the aegis of Science For Equity and Empowerment Division (SEED), Ministry Of Science and Technology, Govt Of India and Diabetes Foundation (India), to formulate a "National Consensus on Dietary Guidelines for Adult Asian Indians for Healthy Living and Prevention of Obesity & Diabetes". They have incorporated worldwide research and opinions in nutrition modulated to India specific data. They are simple, easy to understand by doctors and common public alike, and provision of standard diet charts catering to different regions of India will help people from all parts of India.

According to Mrs. Rekha Sharma, former chief dietician AIIMS, New Delhi, “Researches done on the nutritional health of the Indian Population indicate a rampant increase in obesity and other NCDs, like diabetes, primarily due to faulty eating and sedentary life style. Hence, to keep up with the changing scenario of health, we need new scientific broad based dietary guidelines, tailor made to the eating pattern of the Indian population.”

Dr Anoop Misra, director, Diabetes, Obesity and Metabolism, Diabetes Federation Of India, strongly feels that the application of these guidelines will significantly help in preventing and halting diabetes and obesity epidemic in India.

Countrywide adaptation of these guidelines is likely to have a significant impact on prevalence and management of more than 25 diseases, including diabetes and diabetes related diseases.

What are these dietary guidelines for healthy living and prevention of diabetes and obesity?

The energy requirement must be calculated on the basis of height, weight and activity level – a medium frame Indian male of 165cm height should weigh 62 kg, and if sedentary, would require 1850 K cal to maintain healthy weight.

The daily carbohydrate intake, derived from whole wheat, unpolished rice, barley, buckwheat, oats, millet, whole pulses, legumes, and whole fruits like guava/apple etc, should be around 50-60% of total calorie intake, that is 250-300 gm/day.

The total daily dietary fibre should be 25-40 gm. Hence high fibre food items like cereal, pulses, vegetables, salads, guava, amla, apple, pears, peaches etc should be eaten. In fact, 4 to 5 servings of fruits and vegetables per day are recommended.

Visible fat (oil, butter, ghee) and invisible fat (from cereals and pulses), together should be less than 30% of total energy. This can be got by consuming 4 to 5 teaspoonfuls of a combination of two or more vegetable oils. Correct cooking methods like boiling, steaming, roasting, grilling etc, instead of frying can minimize the visible fat intake.

Trans fatty acids should be less than 1% of the total energy. These are found abundantly in bakery products, ready to use soups and gravies and foods prepared in margarine and vanaspati ghee. Hence it is best to avoid these products.

Ideal protein intake is 1gm/day for every one kilo of body weight. Thus for the average Indian male, this could be obtained from two bowls of cooked pulses, or 2 pieces of lean chicken/fish meat, or 500ml of double toned milk, or 9 servings of wheat flour. This much of protein will provide 10-15% of the total calories.

Salt intake should be less than 5gm per day. So, we Indians need to drastically curtail the ever so popular consumption of salted potato chips (a big favourite of children), pickles, and salty fried snacks.

Sugar in very small amounts and water in excess (about 8-10 glasses) every day, should cap it all.

Apart from this, it is important to take small frequent meals at intervals of 3-4 hours. While eating out (which has become increasingly popular, even in small towns in India), one should choose small portion sizes of healthy snacks. Beverages like buttermilk, coconut water, and fresh lime with water are excellent substitutes for aerated and high calorie drinks.

If adopted, these guidelines can, perhaps, have a significant impact on prevalence and management of obesity, diabetes and heart diseases, and save the native Asian Indian race from the ravages of non-communicable diseases (NCDs).

A persistent and prolonged intensive lifestyle intervention could be the most effective tool to combat diabetes. At the same time, more effective drugs (and not glamorous pharmaceutical manipulations) are needed for those who cannot follow intensive life style therapy due to infirmity.

Emergence of obesity, diabetes and metabolic syndrome in developing countries like India, is

basically due to rural-urban migration, mechanization, open market economy, increasing affluence, improved food supply, dietary liberalization and westernization, and physical inactivity due to rapid pace of urban life, resulting in more sedentary work.

Leisure time activities have also shifted from outdoor activities to indoor entertainment, like television viewing and computer usage, both in children and adults. Also, women are generally reported to be physically more inactive than men, perhaps due to cultural influences on outdoor activities.

But what is of major concern is that children and adolescents are showing decreased physical activity which is fuelling obesity and type 2 diabetes at a very young age. There is a general misconception in Indian parents that an obese child is a healthy child and that feeding oils and clarified butter to children is beneficial to their growth and imparts strength. Another important factor is the parental pressure on children to perform well in academics at the cost of sports and other physical activities. Lack of play fields in schools and open spaces around homes, has further aggravated the problem.

Thus health interventions in both children and adults should be aimed at increasing the physical activity, along with healthier eating habits and health education. A carefully followed diet-exercise combination seems to work wonderfully in preventing or delaying the development of diabetes. This has been proved by a 10 year long Diabetes-Prevention-Programme (DPP) study, which has demonstrated the effectiveness of intervention programmes and changes in lifestyle in reducing the cost burden due to diabetes. This cost burden is imposed not only on the patient and her family, but also on society. There is loss in income and productivity. There are intangible costs in terms of pain, anxiety and suffering.

Programmes directed specifically towards children have shown encouraging results. These should be aided with individual and community health initiatives, backed up by government efforts. The government would do well to sell coarse grains like millets through its public distribution systems. Effective strategies for making and marketing healthy food snacks are needed to counteract the increasing sale of junk food. In fact, some kiosks on the Ahmedabad highway sell tribal health foods in attractive packaging. As eating out is becoming fashionable even in small towns, it is necessary for the food and hotel industry to churn out more healthy recipes and popularise them.

Diabetes Federation of India is running some nutritional awareness programmes in schools of

India, aimed at primary prevention of obesity and inculcation of healthy diet and lifestyle practices in children and adolescents who are at an increased risk for early onset of type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD).

Simple measures like regular physical activity, cutting off extra calories, eating more green vegetables and fruits, are likely to be beneficial in preventing diabetes. Eating less and walking more, does not cost anything and the gains are far too many.

So what are we waiting for? Let us make a resolution now to shun unhealthy food, to walk and

exercise a little more, and encourage our children to play outdoors rather than on a computer screen.

Shobha Shukla

(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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