Says diabetes guru and activist Dr Anoop Misra. “A healthy lifestyle can alter genetic expression”. Plus, his advice on how to keep this silent predator at bay, fast food for kids, the ‘Diabetes Rath’, busting diabetes myths, and more.
Q1. India is home to 17% of the world's diabetics. Are we prepared to deal with the ever-growing numbers?
First, the economics. The current expenditure on diabetes treatment in India is approximately 95 USD (Rs. 6000)/person/annum as per IDF atlas, 2014, whereas the cost of treatment of one complication of diabetes , e.g. treating the diabetic foot is around Rs 10,000-30,000 per treatment. With the huge numbers of diabetes patients and complications we are dealing with, overall health expenditure per person is much less as compared to the developed countries.
Besides expenditure, there is huge requirement for trained workforce at all levels; paramedical workers, doctors, podiatrists etc.. While National Diabetes Control Program is well on its way, lack of specialized human resources is making it lag behind.
Q2. Is the population (and the government) still in denial about the diabetic epidemic that India is caught up in? What is the message that needs to hit home? What is the message that needs to reach the population on a national level?
The government is coming to terms with the magnitude of this epidemic but is unable to deal with it effectively because of lack of intensively focused approach. There is no one person who is consistently incharge of the National programme, and it changes hands with change in official guards from time to time. This dilutes efforts and dissipates the gains.
The take-home messages are:
- Diabetes should be seriously managed throughout the lifetime
- Prevention of diabetes is through healthy diet and regular exercise
- Early diagnosis is the key to effective management and prevention of complications.
Q3. What makes diabetes particularly dangerous?
Lack of awareness about diabetes and its complications, delayed diagnosis, myths surrounding diabetes management, dependence on quacks for treatment makes diabetes detection and management difficult and messy. Uncontrolled levels of blood sugar can lead to tissue damage throughout the body, from eyes to toes.
What makes it particularly dangerous is the surreptitious nature of the complications; they tend to remain hidden for a long time. During this time, since the patient does not feel it or suffers from it, grip on diabetes control becomes poor because of wayward diet and exercise. By the time complications emerge, it is too late for treatment to reverse them.
Q4. Diabetes is a threat not only to the affluent and the urban but also to the underprivileged. Can you elaborate on this and its remedies.
The incidence of diabetes is increasing in urban as well as rural areas. Most of the recent studies show equal increase in prevalence of diabetes (about 30-50%) in urban and rural areas. According to our studies, underprivileged populations living in urban areas are particularly affected, especially those who have recently migrated from rural areas.
This could be due increasing mechanization, leading sedentary lifestyle and shift of eating habits from traditional frugal foods to energy-dense foods which are easily available coupled with even lower levels of awareness in rural population as compared to urban populations.
Q5. You have said that diabetes is 80 percent dependent on lifestyle and 20 per cent on genes. Can you share your top five tips to keep diabetes at bay.
Genes need to interact with the environment for expression. Even if a gene for diabetes is present in an individual, healthy lifestyle can alter gene expression in a favourable manner.
Tips to avoid diabetes:
- Well balanced diet including whole grains, pulses, fruits and vegetables, low fat dairy and avoiding saturated and trans fats
- Regular physical activity for 60 min everyday
- Maintaining healthy weight
- Disciplined lifestyle
- Regular check ups
Q6. Kids nowadays love fast food. As a parent, how do you control their intake of fast food? How often can one indulge in fast food without risk? Is abstinence the only answer?
Healthy alternatives to fast food should be opted for. Healthy eating habits should be inculcated right from early childhood. Complete abstinence from fast food may not be a good strategy, instead children should be guided to consume these foods in moderation by cutting down on frequency and portion size.
Q7. What is the biggest challenge to a person with diabetes in India? As a doctor who sees people with diabetes everyday, what is your biggest challenge?
The biggest challenge for the patient is access to reliable information regarding management and appropriate medical advice. As a doctor, the biggest challenge is to make the patients understand the nature of the disease, dispel myths surrounding diet and medication and ensuring compliance to the medical regimen.
Q8. What needs to be done to control this epidemic?
There is a strong need to spread awareness about the disease. Concerted efforts from government, medical practitioners, school authorities, non-governmental organisations and media are required to spread awareness regarding healthy lifestyle to control this epidemic. However, government’s role in spreading awareness, early detection, provision of standard treatment and rehabilitation and innovative research is of paramount importance.
Q9. What is N-DOC (National Diabetes, Obesity and Cholesterol Foundation) looking to achieve and how?
N-DOC is committed to fight against diabetes, obesity and cholesterol related disorders and raising awareness of these diseases. At N-DOC we are conducting awareness programmes in schools and corporates regarding healthy lifestyle. We are holding health camps where free, dietary and medical advice is given to masses with free blood sugar and blood pressure check-ups. We are also conducting dietary intervention programmes to see the best suited diets for diabetes control and weight loss.
Recently we have launched “prevention and treatment of diabetes at doorsteps” with mobile vans (“Diabetes Rath”) in collaboration with World Diabetes Federation for underprivileged people in urban areas.
Q10. An example of a project/initiative in India or abroad that has had a positive impact on diabetes figures - something we in India can emulate.
There have been a number of initiatives from government, private sector and NGOs in India and in other countries. No single initiative is overwhelmingly effective, but collectively these make a difference. Awareness initiative from International Diabetes Federation has been particularly effective in about 80 countries. Our own initiative, MARG, in schools and colleges of north India, has been a spearhead of prevention of obesity and diabetes at young age.
About Dr Anoop Misra
Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology
Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC)
Director, Diabetes and Metabolic Diseases, Diabetes Foundation (India) (DFI)
Awarded Padma Shree and BC Roy Award
