The prevalence of Diabetes Mellitus in the Indian population now ranks first in the world even ahead of China. In the last twenty years there has been a three fold increase in the prevalence of diabetes and today it is estimated that there are over 32 million people with diabetes in India.
The problem in diabetes is that very often it is silent. The symptoms of diabetes such as increased thirst and urination, etc., occur only when the diabetes is severe. In early stages it can remain totally asymptomatic. Moreover after 10-15 years duration of diabetes, the prevalence of all diabetes related complications increase markedly. These include Retinopathy leading to blindness, Nephropathy leading to kidney failure, Heart attacks, Gangrene of the feet, Stroke and even less known complications like Impotency, or sexual weakness. Thus diabetes is a serious threat to public health and this shows the urgent need for prevention of diabetes.
I. PRIMARY PREVENTION:
Primary prevention refers to the prevention or the postponement of diabetes in those who are susceptible to diabetes. Early detection is the key to prevent and control diabetes. As diabetes is largely asymptomatic, regular screening for diabetes is most important.
Indications for screening:
1. Positive Family History:
It is a well-known fact that diabetes is caused mostly due to hereditary factors. Hence it is clear that screening of diabetic families would be the first priority.
Hence it is clear that anyone who has positive family history should be screened for diabetes.
At what age the screening should be started?
The onset of diabetes is earlier in Indians i.e., around 20-30 years of age. If the family history is strong, e.g., members of more than two generation in the family have diabetes, the first screening could be done even by 20 years of age and thereafter on a yearly or two yearly basis.
Obesity causes resistance to Insulin. Your body makes insulin but the extra weight prevents it from using the insulin the way it should be used. For this reason, obesity is another risk factor for diabetes.
3. Physical inactivity (those with sedentary jobs):
Which test is to be done?
The Glucose Tolerance Test (GIT) is the confirmatory test since it helps to diagnose even the early stage of diabetes. Most people check only Fasting, Postprandial or Random Blood Sugar which may not reveal diabetes until it is at a more advanced stage. Even if the GTT results show normal values at the time of testing, it does not mean that the person will never develop diabetes. Such individuals should have an annual GTT done if the family history of diabetes is very strong
II. SECONDARY PREVENTION:
Secondary Prevention refers to the prevention of complications once diabetes set in. This can be achieved by good control of diabetes with the help of diet, exercise, medication and regular monitoring of blood sugars. Blood sugars can be checked even on daily basis with the help of blood sugar meters which facilitates quick determination of blood sugars. Since blood sugars tend to fluctuate a lot, from day to day or hour to hour, HbAIC (Glycosylated haemoglobin) test should be done to assess the blood sugar for the previous 2-3 months.
III. TERTIARY PREVENTION:
Tertiary prevention refers to the rehabilitative measures once the complications have set in. For example, for Diabetic Retinopathy, Laser Photocoagulation will help to prevent or reduce he incidence of blindness. Laser photocoagulation helps to seal leaking blood vessels in the retina and thus prevent visual loss
Tt is recommended that at least once a year every diabetic individual should do a complete check-up of all complications especially the eyes, kidneys, heart and feet in order to reduce the morbidity due to diabetes.