World Diabetes Day: Nov 14

A diabetes awareness month special

The month of November is observed as Diabetes Awareness Month and November 14 is World Diabetes Day. On this occasion we spoke to Dr Amit Dias, the co-principal investigator of the ICMR INDIAB study on Diabetes, that was published in The Lancet Endocrinology. He says, “The government of Goa has implemented innovative ideas to break the barriers and bridge the gaps for diabetes care in the State — the difference will be seen when we make efforts to avail these facilities” He adds, “It is time that we not only concentrate on treating diabetes but also reversing and preventing it —that is when we will change the diabetes barometer in Goa.”
An interview with Dr Amit Dias on World Stroke Day

Goan Observer: What does the diabetes barometer reveal? What is the burden of diabetes?
Dr Amit Dias: The burden is enormous and growing. According to the WHO, 1 in 10 people globally have diabetes, equating to around 537 million individuals. Alarmingly, almost half of these adults (44%) remain undiagnosed. The ICMR INDIAB study reveals the situation in Goa, as we have the highest prevalence of diabetes in the country accounting for 26.4% of the people above the age of 20 years. Evidence also shows that with the right interventions, diabetes can be managed effectively.
The theme for the Diabetes Awareness Month this year is “Breaking Barriers: Bridging Gaps.” The government of Goa has implemented innovative ideas to break the barriers and bridge the gaps for diabetes care in the State — the difference will be seen when we make efforts to avail these facilities. It is time that we not only concentrate on treating diabetes but also reversing and preventing it. That is when we will change the diabetes barometer in Goa.

Q: Can you throw mote light on the key findings of the ICMR-INDIAB study? We would like to know the findings specific to Goa?
A: The ICMR-INDIAB study is one of the largest epidemiological studies on diabetes in the country and provided crucial insights. As I mentioned, it revealed that Goa has the highest prevalence of diabetes in India, with a staggering 26.4% of individuals over the age of 20 years affected. The study encompassed a total of 113,043 individuals across India, with 79,506 from rural areas and 33,537 from urban areas. In comparison, the national prevalence of diabetes and pre-diabetes is significantly lower, at 11.4% and 15.3%, respectively. We have now extended the study to the Union territories and have covered the UT of Daman Diu, Dadra Nagar Havelli and Lakshadweep.

Q: What are the main barriers to diabetes care?
A: Several barriers impede effective diabetes care. These include limited access to healthcare services, lack of awareness about diabetes management, inadequate facilities for screening and early detection, the myths and stigma associated with the disease. Additionally, the fragmentation of healthcare services can lead to gaps in patient care and continuity.

Q: How can we break these barriers?
A: To break these barriers, we must focus on improving access to care through community outreach and education initiatives. This includes integrating diabetes care into existing healthcare frameworks, enhancing patient education, and fostering collaboration between public and private sectors. The Goa model of diabetes care, which emphasizes multidisciplinary approaches and patient-centered care, can significantly contribute to overcoming these challenges thorough our health and wellness centers.

Q: Let’s get to the basics, what are the targets for blood sugar control?
A: Monitoring blood sugar levels is fundamental to diabetes care. The Indian Council of Medical Research (ICMR) and the Indian Diabetes Association provide specific diagnostic criteria for diabetes. Here are the key cut-off values for diagnosing diabetes in adults:
Fasting Plasma Glucose (FPG): A fasting glucose level of 126 mg/dL or higher indicates diabetes. For prediabetes, the range is 110-125 mg/dL.
Postprandial Glucose (PPG) (after a meal) or 2-Hour Plasma Glucose: After a 75-gram oral glucose tolerance test, a level of 200 mg/dL or higher confirms diabetes, while 140-199 mg/dL suggests impaired glucose tolerance (IGT), indicating prediabetes.
Glycated Hemoglobin (HbA1c): An HbA1c level of 6.5% or higher suggests diabetes, while 5.7-6.4% points to a prediabetic state.
Random Plasma Glucose: If symptoms of diabetes are present (e.g., frequent urination, excessive thirst), a random plasma glucose reading of 200 mg/dL or higher supports a diabetes diagnosis.

Q: Can you elaborate on how the Goa model for diabetes care?
A: The Goa model focuses on access to care and the implementation of the Changing Diabetes Barometer Program through a PPP model. The highly efficient team at the Department of Endocrinology under the leadership of Dr Ankush Dessai at GMC plays a pivotal role in this model by providing specialized services, building capacity and resources. The National Program for the Control of NCDs closely monitors the availability for drugs and the statistics for diabetes through an online portal with immediate feedback. The staff at the health and wellness centers are trained in diabetes care.
Furthermore, ongoing research in Goa helps identify local challenges and tailor interventions to effectively address the diabetes burden in our population.

Q. What are the gaps that we still need to bridge in diabetes care?
A: We need to bridge gaps in awareness, early detection, and patient engagement. Addressing these gaps involves enhancing screening programs for pre-diabetes and diabetes, promoting regular health check-ups, and ensuring that all individuals have access to diabetes education and management resources. Education on lifestyle in schools can make a difference. It’s essential to create an environment where patients feel supported and empowered to take charge of their health.

Q: Can we reverse diabetes?
A: Yes, there is substantial evidence indicating that type 2 diabetes can be reversed through lifestyle changes. The term “reversal” means achieving normal blood sugar levels without the ongoing need for medication. Focusing on lifestyle modifications, weight loss, and improving insulin sensitivity is crucial. However, lifestyle changes and monitoring has to continue.

Q: Can you elaborate on the strategies for diabetes management?
A: Certainly! Here are key strategies that you could remember using the word — M.A.N.A.G.E.M.E.N.T.
M – Monitor Blood Sugar Levels: Regularly check your blood glucose levels to understand how your body responds to food, activity, and medication.
A – Adhere to Medication: Take prescribed medications as directed by your healthcare provider to manage blood sugar levels effectively.
N – Nutrition Awareness: Pay attention to your diet, focusing on balanced meals with the right proportions of carbohydrates, proteins, and healthy fats.
A – Active Lifestyle: Engage in regular physical activity, such as walking, cycling, or swimming, for at least 150 minutes a week to improve insulin sensitivity.
G – Get Support: Join support groups or seek help from healthcare professionals, dietitians, or diabetes educators to share experiences and gain knowledge.
E – Emergency Preparedness: Know how to handle diabetes emergencies, such as hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), and have a plan in place.
M – Maintain a Healthy Weight: Strive to achieve and maintain a healthy weight through a combination of diet and exercise to improve blood sugar control.
E – Educate Yourself: Stay informed about diabetes management strategies, new research, and advancements in treatment options.
N – Nurture Emotional Wellbeing: Manage stress and prioritize mental health, as emotional well-being plays a crucial role in overall diabetes management.
T – Track Progress: Keep a record of your blood sugar levels, food intake, exercise, and any symptoms to help identify patterns and make necessary adjustments.
It’s essential for individuals with diabetes to collaborate with their healthcare team to tailor an approach that fits their unique needs, ensuring regular monitoring and adjustments to their treatment plan.

Q: What message would you like to convey to our readers on World Diabetes Day?
A: I encourage everyone to adopt a healthy lifestyle. Diabetes is a wake-up call highlighting the need for change in diet, exercise, and overall lifestyle. Early screening and detection are essential to prevent progression to diabetes. Furthermore, integrating diabetes care into health and wellness centers across Goa can provide much-needed support.
We now have effective medications to manage diabetes, but successful management encompasses more than just medication; it includes lifestyle changes, adherence to treatment, and constant monitoring.
Remember the word DIABETES and this is what it tells us:
• Dietary balance: Focus on whole foods and limit processed sugars
• Increase activity: Aim for regular physical exercise
• Avoid smoking: Quit to reduce complications
• Blood sugar monitoring: Keep track of your glucose levels
• Educate yourself: Stay informed about diabetes management
• Take medications as prescribed: Adhere to treatment regimens
• Engage in self-care: Prioritize mental and physical health
• Schedule regular check-ups: Ensure ongoing medical supervision