Dr. P K Sasidharan
Yet another WORLD DIABETES DAY was observed recently with all fanfare. It happens every year for the last several decades but diabetes in India is on the increase only! Undoubtedly India is now the diabetic capital of the world- when we were students, diabetic patients were rarely only seen and there was just one company manufacturing medicines for diabetes- now there are countless companies and countless medications; even traditional unscientific products are now sold in large quantities across India for diabetes.Out of 800 million documented diabetics in the world, 212 million are identified in india alone We are far ahead of China in the numbers of diabetic patients – China has only 148 million cases.But there is one issue the statistics in India is based only on the documented cases and there is no proper comprehensive database on any disease in India What if our statistics is incomplete? It is almost certain that the actual figures could be double this number as we still do not have unified electronic case records for all individuals, which all other countries were maintaining accurately for decades Diabetic patients could definitely be more than 212 million in in India As per the report published in The Hindu attached, we need to do something urgently – but what should we do?Do we need to set up more diabetes centres?Do we need to increase the number of medical colleges and bring out more diabetes specialists and endocrinologists? Mind you, we are talking only about type 2 diabetes and not type 1 diabetes. They are entirely different disorders and there is nothing in common except high blood sugarsI have been taking classes on the issues and solutions for preventing diabetes in doctors’ meetings across india for almost 25 years since there were no takers, except one person who misused those tips to become popular and make money; I gave up going to those meetings and then started doing it on my own at grassroots level with my patients and their relatives.I have the complete action plans on what to do with individuals and what to do in the society to prevent diabetes but even today these is no one to listen to the views of independent modern medicine doctors like me with neither Pharma connections nor AYUSH connections Building fitness centres for making exercise popular is a dirty idea to prevent diabetes, as suggested in the write up attached below.Instead of fitness centres, let us have more public places and play grounds for at least each 200 houses where people would walk around and children would be playing games. Let us have foot paths and cycle paths along as many roads as possible. Let us encourage physical activity and cycling starting from childhood onwards, or in whatever way possible like participating in some household works or agricultural activities Let us enable people to do some physical activity every day without even being aware of it, as part of their daily routine Let us instil that habit in primary education rather than promoting religious sentiments alone in childhoods.Let us educate people on the concept of balanced diet in schools and colleges. Even before that let the doctors be taught in the medical schools regarding balanced diet and the need for restricting carbohydrates- at the moment doctors themselves are least bothered about or concerned about these issues More importantly let us educate people on the need to reduce carbohydrates intake Let them identify the sources of carbohydrate in the diet Let us give practical tips for proper nutrition and eating habits Let us teach them on what all are the sources of carbohydrates-rice, wheat, ragi, millet, maize, potatoes, yams, tapioca and jackfruit are all just sources of carbohydrates There is no need to change the carbohydrates to control or prevent diabetes In fact none of the carbohydrates is superior- it is the quantity and the combinations that matterEqually important is to educate people and empower them for eating more high fibre vegetables, as the major portion in each meal and let us educate them and empower them for regular consumption of fruits in moderation at each meal Let us stop spreading scare of pesticide in vegetables and fruits, if they stop eating vegetables and fruits for fear of pesticides, they need to stop breathing due to fear of carbon monoxide in the air we breathe Not eating enough high fibre vegetables and not consuming fruits and ending up eating more of carbohydrates is the number one reason for diabetes, heart attacks and cancers in India Due to the heightened pesticide awareness now the people have stopped taking whatever little vegetables and fruits they used to eat before and filed up that space too in stomach with carbohydrates only.Let people know that excess carbohydrates in any form are more poisonous than alcoholIt is more dangerous than alcohol because its adverse effects are more serious especially since it is not easily sensed or understood by people. Excess carbohydrate is a slow poison- it causes several diseases in one go ; diabetes is just one of them The Rashomon effect in the medical profession prevents medical professionals, doctors, policy makers and people from having a proper insight into the social connections to diseases; Each one identifies one issue and tries to address that with their expertise and experience and narrow vision We need trained and motivated modern medicine doctors with holistic approach- the only group with that approach is trained family doctors- but India has already eliminated them – that is another major reason for making India the diabetes capital of the world Diabetes prevention is possible only by several social measures involving all ministries and departments and the present kind of health ministry has very limited insight or role in its prevention especially since its polices are designed by arm chair doctors, unscientific practitioners, quacks and single system specialists Even for early diagnosis of diseases, better cost effective treatment and advocacy work for prevention of diabetes and other chronic diseases, what we need is large numbers of trained family doctors and not any kind of specialists The only doctors who would gather adequate insight while on the job regarding ground realities and social issues are the GP doctors which India has eliminated over seven decades Even today we have not done anything to revive family practice – As a result India will continue to remain capital of all diseases We need a radical overhaul of the totally wrong health system in India.
