Charting a healthy future: Strategies for effective diabetes and NCD management in India

Dr Kishore Kumar, Founder Chairman & Executive Director, Cloudnine Group of Hospitals, Bengaluru stresses on the key aspects of the rising disease burden of diabetes and NCDs in India

India stands at a crossroads where the burden of diabetes and Non-Communicable Diseases (NCDs) demands strategic interventions. As I write today, I would like to ask, are we doing enough to create awareness or are we aware enough about the consequences of diabetes.

Recently in the month of September, ICMR released a study stating Indians are consuming more than the WHO-recommended amount of salt every day, 8 gm instead of five grams across all categories of people. This study itself is alarming stating highlighting the growing shadow of diabetes and NCD in India. A call to action is the need to hour with a collective responsibility to foster awareness, prioritise preventive measures, and build a healthier tomorrow. For instance, South India – is supposed to be the capital of diabetic world – but we are hardly talking about it. [1] Since diabetes is a lifestyle disease – modification of lifestyle and diet – can change the pre-disposition to this disease, which accounts for quite a lot of morbidity, mortality, and poverty too – since the expenditure of caring for a person with a diabetes suddenly increases the cost of living – to the extent that we will have to account for the reduction income levels of the family.

What is causing a rise of NCD’s?

Several factors contribute to this increasing trend, posing challenges for both individuals and the healthcare system. Here are some key aspects of the rising disease burden of diabetes and NCDs in India:

Epidemiological transition: India is undergoing an epidemiological transition characterised by a shift from communicable diseases to NCDs. This transition is largely driven by changes in lifestyle, urbanisation, sedentary behavior, and dietary patterns.

Prevalence of diabetes: The prevalence of diabetes in India has been on the rise, and the country has earned the unfortunate distinction of being the diabetes capital of the world. Both type 1 and type 2 diabetes are prevalent, with type 2 diabetes accounting for the majority of cases.

Risk factors: Unhealthy lifestyle choices such as poor diet, lack of physical activity, and the increasing prevalence of obesity contribute significantly to the risk of diabetes and other NCDs. Genetic predisposition also plays a role.

Urbanisation and sedentary lifestyle: Rapid urbanisation has led to lifestyle changes, including decreased physical activity, increased consumption of processed foods, and a higher prevalence of sedentary jobs. These factors contribute to the rising burden of NCDs.

Lack of awareness: There is often a lack of awareness about diabetes and NCDs, both among the general population and healthcare professionals. Early detection and management are crucial for controlling the impact of these diseases.

Healthcare infrastructure challenges: The healthcare system in India faces challenges in terms of accessibility, affordability, and quality of care. This can impede timely diagnosis and management of diabetes and other NCDs.

Economic impact: The economic burden of managing diabetes and NCDs is substantial, encompassing healthcare costs, loss of productivity, and the impact on the overall economy.

Policy initiatives: While there have been efforts to address the rising burden of NCDs in India, there is a need for comprehensive and sustained public health interventions. These may include awareness campaigns, lifestyle modification programs, and improved healthcare infrastructure.

Integration of healthcare services: A holistic approach that integrates primary healthcare services with a focus on prevention, early detection, and management is essential to tackle the rising burden of diabetes and NCDs.

Addressing the challenges posed by the increasing disease burden requires a multi-sectoral approach involving the government, healthcare professionals, the private sector, and the community. Efforts should be directed towards promoting healthy lifestyles, improving healthcare infrastructure, and enhancing awareness to effectively mitigate the impact of diabetes and NCDs in India.

Besides, diabetes we also see surge of gestational diabetes, Why?

The rise in gestational diabetes in India can be attributed to a combination of lifestyle, genetic, and healthcare factors. Rapid urbanisation and modernisation have led to significant changes in lifestyle, including sedentary behavior, unhealthy dietary habits, and increased stress levels. Diets high in refined carbohydrates and sugars, coupled with a lack of physical activity, contribute to an increased risk of gestational diabetes. We are in an era of “Obesity Epidemic” and obesity is often linked to insulin resistance, a key factor in the development of diabetes during pregnancy. Besides this there are many genetic predispositions, delayed childbearing, poor antenatal care. Lack of awareness about gestational diabetes and its risk factors among both healthcare professionals and the general population can contribute to delayed diagnosis and management. Our own Cloudnine data suggests that the incidence of gestational diabetes mellitus (GDM) is around 20 to 22 per cent – whereas the global incidence is around 2 to 8 per cent and incidence in India is thought to be higher at around 15 per cent. Even considering the higher incidence, our incidence appears to be even higher – suggesting that lifestyle and economic status play a much significant role than has been thought. All pregnant women are screened for GDM at around 20 to 24 weeks gestation as per FGOSI guidelines, but there is anecdotal evidence that many women develop GDM sometimes later too – who can be missed because they are not screened routinely after that. GDM not only affects women, but the outcome of babies also born to such mothers get affected too – adversely if unsuspected or undiagnosed antenatally.

It is high time that we address the rising prevalence of gestational diabetes in India which requires a multi-faceted approach, including public health campaigns to raise awareness, education on healthy lifestyle choices during pregnancy, and improvements in antenatal care services. Early detection, proper management, and lifestyle interventions are crucial in mitigating the impact of gestational diabetes on both maternal and fetal health.

Road ahead

There is a need for “Building a Healthier Nation by unmasking new paradigms in diabetes and NCD Management Across India. We need to empower wellness.  Here are some strategies that could be employed:

Health education and promotion:

• • Launch nationwide health education campaigns to increase awareness about the risk factors, prevention, and management of NCDs.
  • Promote healthy lifestyle choices, including regular physical activity, a balanced diet, and avoiding tobacco and excessive alcohol consumption.

Early detection and screening:

• • • Implement widespread screening programs to detect NCDs at an early stage.
    • Strengthen primary healthcare services to facilitate regular health check-ups and screenings.

Primary healthcare strengthening:

• • Invest in strengthening the primary healthcare infrastructure to ensure better access to healthcare services, especially in rural and underserved areas.
  • Train and deploy community health workers for early identification and management of NCDs.

Integration of NCD care:

• • Integrate NCD care into the existing healthcare system to ensure a continuum of care from primary to tertiary levels.
  • Establish NCD clinics and services within primary healthcare centers.

Technology adoption:

• • Leverage technology for remote monitoring, telemedicine, and health information systems to improve the efficiency and reach of healthcare services.
  • Develop mobile applications for health education and self-management of NCDs.

Policy measures:

• • Implement and enforce policies to reduce the consumption of unhealthy products, such as high-sugar and high-salt foods.
  • Introduce and enforce regulations to control tobacco and alcohol use.

Workplace wellness programs:

• • Encourage and incentivise workplaces to implement wellness programs that promote physical activity, healthy eating, and stress management.
  • Provide facilities for physical activity within workplace premises.

School health programs:

• • Introduce comprehensive health education programs in schools, emphasizing the importance of a healthy lifestyle.
  • Promote physical activity and healthy food choices in school settings.

Research and data collection:

• • Support and conduct research on the prevalence, causes, and management of NCDs in the Indian population.
  • Use data to inform evidence-based policies and interventions.

Community engagement:

• • Engage communities in the design and implementation of health programs.
  • Empower communities to take ownership of their health through community-based initiatives.

Public-private partnerships:

• • Foster collaboration between the government, private sector, and non-governmental organizations to pool resources and expertise.
  • Encourage private sector involvement in delivering healthcare services and promoting workplace wellness.

Affordability and accessibility:

• • Ensure that essential medications and treatments for NCDs are affordable and accessible to all segments of the population.
  • Explore innovative financing mechanisms to support individuals in managing their health.

By adopting a holistic and collaborative approach, India can effectively address the rising burden of NCDs and improve the overall health and well-being of its population. The surge in diabetes and non-communicable diseases is a wake-up call for a healthier, more resilient India. It’s not just a health crisis; it’s a collective responsibility to build a nation where wellness is a way of life.

Reference

[1] The latest theory is that EPIGENETICS is the reason why South Asians (Indians) are prone to Diabetes Mellitus – according to this research https://youtu.be/z8Qv7zZBxq8?si=txS2Ui_RZk88I_xm