Prevention of Diabetes

 The prevalence of Diabetes Mellitus in the Indian population now ranks first in the world even ahead of China. In the last twenty years there has been a three fold increase in the prevalence of diabetes and today it is estimated that there are over 20 million people with diabetes in India.

 The problem in diabetes is that very often it is silent. The symptoms of diabetes such as increased thirst and urination, etc., occur only when the diabetes is severe. In early stages it can remain totally asymptomatic. Moreover after 10-15 years duration of diabetes, the prevalence of all diabetes related complications increase markedly. These include Retinopathy leading to blindness, Nephropathy leading to kidney failure, Heart attacks, Gangrene of the feet, Stroke and even less known complications like Impotency, and sexual weakness. Thus diabetes is a serious threat to public health and this shows the need for prevention of diabetes.

Primary Prevention

 Primary prevention refers to the prevention or the postponement of diabetes itself in those who are susceptible to diabetes. Early detection is the key to prevent and control diabetes. As diabetes is largely asymptomatic, regular screening for diabetes is most important.

Why should you be screened for Diabetes?

Positive Family History

 It is a well known fact that diabetes is caused mostly due to hereditary factors. Hence it is clear that screening of diabetic families would be the first priority.

Risk of diabetes based on family history: Risk

• If both parents are diabetic: 99%
• If one parent is diabetic: 50%
• If any other relative is diabetic: 20%
• One parent diabetic and any other relative of the non-diabetic parent is also diabetic: 75%
• Hence it is clear that anyone who has positive family history should be screened for diabetes.

At what age the screening should be started?

 The onset of diabetes is earlier in Indians i.e., around 20-30 years of age. If the family history is strong, e.g., members of more than two generations in the family have diabetes, the first screening could be done even by 20-25 years of age and thereafter on a yearly or two yearly basis.

Obesity

 Obesity causes resistance to Insulin. Your body makes insulin but the extra weight prevents it form using the insulin the way it should be. For this reason, obesity is another risk factor for diabetes.

What test to be done?

 The Glucose Tolerance Test (GTT) is the confirmatory test since it helps to diagnose even the early stage of diabetes. Most people check only Fasting, Postprandial or Random Blood Sugar which may not reveal diabetes until it is at a more advanced stage. Even if the GTT results show normal values at the time of testing, it does not mean that the person will never develop diabetes. Such individuals should have an annual GTT done if the family history of diabetes is very strong.

Secondary Prevention

 Secondary Prevention refers to the prevention of complications once diabetes set in. This can be achieved by good control of diabetes with the help of diet, exercise, medication and regular monitoring of blood sugars. Blood sugars can be checked even on daily basis with help of blood sugar meters which facilitates quick determination of blood sugars. Since blood sugars tend to fluctuate a lot, from day to day or hour to hour, HbA1C (Glycosylated haemoglobin) test should be done to assess the blood sugar for the previous 2-3 months.

Tertiary Prevention

 Tertiary prevention refers to the rehabilitative measures once the complications have set in. For example, for Diabetic Retinopathy, the technique of Laser Photocoagulation will help to prevent or reduce the incidence of blindness. Laser photocoagulation helps to seal leaking blood vessels in the retina and thus prevent visual loss. It is recommended that at least once a year every diabetic individual should do a complete checkup of all complications especially the eyes, kidneys, heart and feet in order to reduce the morbidity due to diabetes.