It is a disease that no one really wants to have. Physically impacting on almost every organ of the body, diabetes stalks you from birth through childhood to adulthood and leaves behind a trail of diseases from heart to kidney to liver until your body finally shuts down under their unbearable weight. It is a killer disease. No one knows exactly when it starts until it has reached an advanced stage when you are forced to see a doctor. By then it could be too late and complications would already have set in. The statistics vary according to districts, but experts in the field put the figure at 27 .1 percent in Colombo.
At a media conference at the Sri Lanka Foundation Institute, Tuesday, Consultant Endocrinologist and Diabetologist at the National Hospital Medical Unit, Dr Prasad Katulanda noted that ten percent of pregnant women in Sri Lanka had diabetes and 15 percent were pre diabetic.
Outdated
“More than 50 percent don’t even know they have the disease”, he said. He also noted that every other pregnant woman with diabetes went on to develop type 2 diabetes at a later stage in their life.
Health Ministry ( NCD) Unit Consultant Dr Verginie cited equally grim figures, 75 percent of hospital deaths in the country as occurring due to NCDs with 7 percent due to diabetes and related complications.
Endocrinologist Dr Noel Somasundaram also noted that the current prevalence of diabetes in Colombo and its suburbs was 20 percent and 10.3% in the country, as a whole. At a close look at these statistics however, the Sunday Observer found that most of them were based on limited studies done at least ten to twenty years ago. Dr Katulanda’s study which covered seven districts was in 2008. Prior to that 3 studies, the largest so far in the country, were done in 1990. The last study was published by the World Health Organisation in 2014.
The single connecting thread in all of these studies occurring at different periods, was that each of them revealed the relentless upward surge of diabetes, both, in the rural and urban districts.
The 1990 study showed that only 5 % of the urban and 2 percent of the rural population had the disease. In 2000, the study revealed an increase to 12 % urban population, and 7% rural folk. The 2008 study showed an enormous jump to 2.1 million with diabetes and 2.3 million being pre- diabetes.
“That means, in Sri Lanka, 4.4 million had abnormal blood sugar levels”, says Dr Chamari Pandithage from the National Diabetes Centre.
Causes
So what has caused this disease to run wild? We asked.
“Most parents now work outside their homes. They find it easier to buy all their meals from take away outlets. All these foods laced in unsaturated fats and oils are high in carbohydrates. Sweetened milk based products and malted drinks are also to blame for early obesity and early development of diabetes, as they are rapidly absorbed and transformed into glucose”, she explained.
“Oily foods and pastries, as well as fizzy drinks and sweetened drinks, not forgetting milk products with high sugar content sold as ‘ healthy foods’ or ‘’energy drinks “ are also to blame.
Gaps
“The problem is, we don’t have a proper delivery campaign to stop sponsored tournaments in schools, like cricket, rugby and football, where big time vendors advertise their products under various beguiling captions like ‘ Healthy Foods’ ‘Only food to raise your IQ’ ‘A complete meal by itself’, etc. It’s time we had a national policy on this. Though laws are in place and gazette notifications have been issued about advertisements of so called sweetened foods as healthy foods, such ads continue to appear in all media with impunity, as no one has yet been punished”, she lamented.
Change focus
“Health care has so far been focusing on treatment in Sri Lanka. Now it’s time to change that focus to Prevention”, she emphasized.
“Doctors must go to the public and tell them before they get the disease, how to prevent it.
They should educate them about warning signs. Most have wrong beliefs and fears about diabetes.
They are reluctant to be examined for symptoms as they fear they would have to take medicines for the rest of their lives. This is why it is important that doctors reassure them and inform them of the correct facts”.
Drawing from her experience in the UK, she says, it is the GPs who are the primary point of care in the UK.
“They give patients advice, if someone in the family has had a heart attack, for example, since they already have their family history in their personal records. So, when a family member visits them, they are advised on lifestyle modifications and to take tests for risk factors that could cause a heart attack, since they too are at risk. They have an excellent rapport with their patients and usually keep good medical records”, she said.
What about patients in GPs in Sri Lanka?
Unfortunately, here, the problem becomes complicated because, she noted, patients move from hospital to hospital and often the Physician in charge loses track of them.
This is because there is no proper record system, she said. She observed that the steps taken by the Health Ministry to digitalize hospitals was a step in the right direction as it would enable better hospital communication and record keeping. Dr Somasundaram said, the Sri Lanka Diabetes and Cardiovascular Disease Initiative ( SLDC) had invested Rs 3 million in a THREE YEAR PROGRAM TO CURB THE DISEASE.
Asked if another study was underway, Dr Katulanda said, a study was in progress but would take another two months or so to be completed.
Commenting on the function of the National Diabetes Centre, Dr Pandithage said, the Centre provides clinical and educational services to the general public and it has a state-of-the-art ISO accredited laboratory which assures accurate and dependable test results. “We are not a treatment centre but we do test and advise those who come here. We also carry out awareness programs in hotels and corporates about healthy lifestyles.
“We are swiftly moving into an epidemic of “lifestyle illness” resulting in cardiovascular diseases, diabetes, cancer, chronic respiratory disease and addiction to tobacco and alcohol. Non communicable diseases are the No1 killers in the South-East Asia region, causing an estimated 8.5 million deaths each year; 50% of deaths from NCDs occur in the age group of 30 – 70 and are premature. Therefore, the need to tackle all NCDs together is of paramount importance”.
The Non Communicable Diseases Alliance Lanka (NCDAL) was initiated by Dr Mahen Wijesuriya who was also appointed a Director in the Global NCD Alliance and consists of 4 other associations, namely, Heart Association, Cancer Society, Ceylon National Association for Prevention of TB and Diabetes Association of Sri Lanka.
The vision of the NCDALis to create a healthy community through simple low cost principles of Health Promotion of healthy lifestyles to free people from preventable illness, disability, morbidity and mortality due to NCDs.
Sri Lanka is the first country in the SEARO to incorporate such an alliance legally to combat NCDs. Yes, Diabetes mellitus which was once considered a disease of the developed world has become a worldwide pandemic, with two thirds of the global diabetic population living in the developing countries.
Local studies show a definite upward trend in the prevalence of diabetes mellitus. Wider preventive programs need to be urgently implemented to stem the tide, Dr Katulanda emphasized.
This is a wake up call to all pre-diabetics out there ! If you haven’t already got yourself tested for diabetes do it NOW. All it takes is a drop of blood . Now even some supermarkets are doing it for free apart from government facilities.
The recent budget proposals for minimizing NCD risks, especially, to charge customers for any extra sugar they request, by charging 20 cents per imported drink; and informing all food outlets to serve sugar separately or in less quantities in the cups of tea consumed, and charge an extra fee for every additional spoon of sugar requested by a customer, is a welcome step .
No doubt there will be some initial problems in implementing these proposals, but, if the outcomes are a drop in NCDs it would be a worthwhile experiment.