Prevention is Better than Cure

Diabetes is a cost intensive disease because of its chronic condition, severe complications and the means of control.

In many families, financial constraints force people to choose between health care, food or clothing. Therefore prevention seems to be a very important factor, especially in Type 2 Diabetes Mellitus (T2DM) as the increase is mainly due to lifestyle changes that have resulted in overweight, obese and physically inactive people.

Environmental changes and genetic predisposition increase insulin resistance, which, along with β- cell failure results in rising blood glucose levels.

Prevention can be carried out through health promotions, early detection of high risk individuals and timely intervention to prevent these high risk individuals from progressing to diabetes. Prevention programs are important at various stages in the natural history of the disease.

1. Primordial prevention focuses on health promotion activities such as – preventing smoking, fighting obesity, promoting physical activity and improving dietary habits.

Obesity and diabetes are linked. Weight gain leads to insulin resistance through several mechanisms. Insulin resistance places greater demand on the pancreas to produce insulin. Diabetes occurs when the body’s need for insulin exceeds the ability of the pancreas to produce it. Therefore, most cases of T2DM can be prevented by weight reduction through life style changes – diet and exercise.

The World Health Organization recommends:

Increased physical activity of just 30 minutes of moderate exercise a day to promote good health and prevent the onset of diabetes.

A healthy diet of 3 - 5 servings of fruit and vegetables a day, less sugar and saturated fats can help maintain appropriate weight ,as well as, help in weight loss.

Non- smoking: People with diabetes are at greater risk of dying from coronary heart disease, stroke, or peripheral vascular disease than those without, and smoking increases the risk further.

2. Primary prevention focuses on effective screening to detect people at risk of diabetes, pre-diabetes and also their treatment.

1. Detecting people with increased risk of diabetes – the pre- diabetics.

People with pre-diabetes show symptoms such as higher than normal blood glucose which is not high enough to be classified as diabetes. (Typically IFG: >100 mg/dl but < 126 mg /dl; 2 hr IGT value: > 140 mg/dl but < 200 mg/dl , or both.)
Detecting pre-diabetes in people is very important because appropriate treatment can prevent progression to diabetes.

3. Secondary prevention focuses on preventing complications of diabetes with appropriate and comprehensive treatment of diabetes and screening for complications.

Without timely diagnosis and adequate treatment, complications and morbidity from diabetes increases drastically. Most complications can be prevented if diagnosed early enough.

Good control of blood glucose decreases the risk of developing both micro- and macro- vascular complications Self monitoring of blood glucose is very important for proper management of the condition. A healthier life style with an increase in physical activity and a reduction of body weight based on control of calories and fat intake and quitting smoking are very basic steps in treatment and the prevention of complications.

Medical nutritional therapy is an essential part of diabetes management. Every person with diabetes should get dietary education from a dietitian.

4. Tertiary prevention focuses on rehabilitation of people with diabetes.

Preventing diabetes is a phenomenal task but it can be done.It needs a unified effort from every person or organization directly or indirectly linked to the disease.- organizations, health care workers, doctors, governments, and people with diabetes have to work together to put stop to this ‘epidemic’.

Reference:

A World Without Diabetes and Its Complications – A Preventive. Programme; Dr. Prof. A.K. Das, Dr. Maneesh Rai.