Fight against a silent murderer

Afia Islam Lopa Of all the non-communicable diseases (NDCs), diabetes is one of the most debilitating, life threatening and incurable ailments. It is one of the major causes of sudden illness and death worldwide. World Health Organisation estimates that more than 346 million people have diabetes worldwide and developing countries will bear the brunt of this epidemic in the 21st century. Currently, more than 70 per cent people with diabetes live in low and middle income countries like Bangladesh. This number is likely to more than double by 2030 without intervention. The largest age group currently affected by diabetes is between 40-59 years. By 2030 this "record" is expected to move to the 60-79 age groups with some 196 million cases. To protect the world population from diabetes, different events have been arranged to raise awareness of the people about the disease. In 1991 the International Diabetes Federation (IDF) and WHO arranged a big event for raising awareness about the increasing warning of diabetes worldwide in response to calls for a "World Diabetes Day." In 2010, over 900 monuments and buildings in 84 countries around the world were illuminated with blue lights on November 14 to mark the World Diabetes Day. Since 2011, the IDF has been continuing to encourage people to use the blue lightings in all World Diabetes Day related grassroots level activities and events, reinforcing the link between the blue colour and diabetes, and strengthening recognition of the Blue Circle as the global symbol of diabetes. The slogan of campaign chosen for this year is, "Act on Diabetes." Now, the focus of the theme for next five years is, "Diabetes education and prevention." In Bangladesh, the prevalence of diabetes is 3.9 per cent. To determine this number only the self reported diabetes cases with documented evidence were considered during survey. This is the latest finding as per the Bangladesh NCD risk factor survey 2010. However, the increasing trend of the disease shows, there is no doubt that the prevalence of diabetes is rising. Another report suggests that in urban areas the prevalence is just double (10 per cent) than the rural area (5.0 per cent). It is said that 95 per cent diabetes patients look after themselves and the rest 5.0 per cent by hisher family. So, diabetes education is essential for the patients with diabetes and their family members. The finding shows some critical scenario about the high burden of diabetes in our country. Firstly, most of the diabetes patients in Bangladesh do not know that they carry the dreadful disease. Secondly, they do not prefer to go to doctor for diagnosis and treatment. Thirdly, many patients begin treatment for diabetes but do not continue the treatment. Fourthly, patients with diabetes cannot afford long time treatment. On the other hand, in rural area there is a lack of hospitals and institutes for diabetes treatment and management. As a result most of diabetes patients live without treatment. The finding suggests that the people have to know first about diabetes. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime. Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin produced by the pancreas lowers blood glucose. Absence or insufficient production of insulin causes diabetes. Diabetes treatment depends on the type and severity of the disease. Type- 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type-2 diabetes is first treated with weight reduction, diabetic diet and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered. The early symptoms of untreated diabetes are related to elevated blood sugar levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration causes increased thirst and water consumption. A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite. Some untreated diabetes patients also complain of fatigue, nausea and vomiting. Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas. Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as micro vascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macro vascular disease. Recent studies have shown that impaired glucose tolerance itself may be a risk factor for the development of heart disease. Overall diabetes is the key to all deadly diseases. Sometimes it passes on genetically. Therefore, diabetes education is essential for all irrespective of patients or not. We should keep in mind that prevention is better than cure in case of diabetes. If we regulate our lifestyle and food habits diabetes prevention is possible to a large extent. Changing lifestyle could be a big step towards diabetes prevention and it is never too late to start. We can consider the following tips to get free from the scourge of diabetes: i) increase physical activities; ii) eat plenty of fibrous food; iii) go for whole grains; iv) lose extra weight; and v) skip fad diets and make healthier choices. Tips for diabetes caregiver: i) voice your support; ii) learn about diabetes; iii) talk about your feelings; iv) exercise together; v) choose healthy foods; vi) encourage; vii) be considerate; and viii) seek outside help. The financial burden borne by people with diabetes and their families depends on their economic status and the social insurance policies of their countries. In the developed countries medical cost of any diseases is borne by the government and workplace. The health policy is controlled by the government so it is possible to control the diseases by applying appropriate policy involving people. In a developing country like Bangladesh, people with diabetes and their families bear almost all the cost of medical care. Most of the people are poor so to bear the lifetime treatment cost is not possible for the people. Besides, excess healthcare expenditure due to diabetes also imposes large economic burdens in the form of lost productivity and foregone economic growth. Unless addressed, the mortality and disease burden from diabetes and other NCDs will continue to increase not only in low and middle-income countries like Bangladesh but also in the entire world. Therefore, it is high time to create awareness about "diabetes education and prevention" among the citizens. In Bangladesh a vast number of people are suffering from diabetes, but the treatment facilities and knowledge of diabetes among the people are inadequate. So, there is a vast scope for the government and non-governmental organisations, the print and electronics media to take a comprehensive action against this silent murderer. (The writer is an Assistant Coordinator (Communication) of Eminence, and can be reached at email: lopa@eminence-bd.org)