Prevention and Control of Diabetes: Diabetes mellitus is a chronic condition with a chronic hyperglycemic state. Diabetes mellitus is caused by a variety of factors. This is due to the inadequate production of insulin (a hormone. that regulates the metabolism of glucose, fat, and amino acid).
The number of cases of diabetes mellitus is currently estimated to be about 150 million worldwide, according to WHO (2003), which is expected to double by 2025. The prevalence of diabetes in adults in India is found to be 2.4 percent in rural areas and 4.0-11.6 percent in urban areas.
India’s population has a high susceptibility to diabetes mellitus. If it remains undiagnosed or inadequately treated, then it leads to complications that cause permanent disability and may lead to conditions such as; nephropathy, retinopathy, neuropathy, and death. Industrialization and socio-economic problems are correlated with the growing prevalence of diabetes.
Types of Diabetes Mellitus
There are two types of diabetes mellitus:
- Diabetes mellitus (Type-1) IDDM
- Diabetes mellitus (Type-II) NIDDM
Agent
Diabetes mellitus occurs due to several mechanisms such as; a defect in the formation of insulin, destruction of beta cells, pancreatic disorders, genetic defects, or autoimmunity. Diabetes mellitus occurs due to Neoplasms of the pancreas, cystic fibrosis, viral infection, genetic defect in insulin gene, auto-immunity, chemical agents, and pancreatitis.
All the above factors lead to decreased or no production of insulin, thereby causing reduced utilization of glucose and increased level of glucose in blood and urine (hyperglycemia).
Host Factor
- Diabetes can occur at any age but studies have shown that the prevalence of diabetes rises with age. It occurs equally in both sexes.
- It occurs among individuals having defective immunological mechanisms destroying their insulin-producing cells.
- Obese people and the Offspring of diabetic pregnancies are at risk for developing diabetes.
Environmental Factors
- Lack of exercise.
- High intake of saturated fat.
- Malnutrition in early infancy and childhood causes partial failure of cells of islet of langerhans.
- Excessive intake of alcohol.
- Life style changes.
Prevention and Control of Diabetes
1. Primordial prevention: Primordial prevention consists of avoiding the emergence or development of risk factors that have not appeared in the population. The initiatives are aimed at preventing the adoption of unhealthy lifestyles from childhood onwards. In the case of diabetes, efforts should be geared by parents towards children to follow a balanced lifestyle such as; exercise, low saturated fat intake, and malnutrition prevention, etc.
2. Primary prevention: Primary prevention refers to the action taken before diabetes mellitus occurs. It involves two types of strategies:
(a) Population Strategy: Population strategy for non-insulin-dependent diabetes mellitus should be based on the elimination of all the environmental factors which are responsible for causing diabetes.
It includes; maintaining normal body weight, adopting healthy nutritional habits, doing physical exercise, high intake of dietary fibers, avoiding alcohol and sweet foods prevent malnutrition by adequate intake of proteins, eliminate food toxins or chemical ingestion.
(b) High-risk strategy: High-risk strategy means finding out the population who is at high risk and taking appropriate measures to prevent the occurrence of diabetes mellitus among them. Take an example; an obese person is at high risk for developing diabetes mellitus type-II. Then the person should be guided, counseled, and motivated to correct and maintain weight by balanced intake of nutrition and exercise. Same way, a child of diabetic parents is at high risk and then he also has to adopt the lifestyle which prevents the occurrence of diabetes mellitus. In a high-risk strategy, avoid the factors which cause diabetes such as; alcohol, diabetogenic drugs, and a high-fat diet.
These strategies should be directed towards the target population who is at high risk.
2. Secondary Prevention: Secondary prevention includes:
(a) Early diagnosis and treatment: The cases of diabetes mellitus should be detected as early as possible and need to be treated adequately. Its treatment and management are important to prevent complications. The diabetes causes should be diagnosed by blood sugar testing and require fasting blood sugar and 2 hours blood sugar test after 75 gm oral ingestion of glucose. The oral glucose tolerance test should not have the values given below diabetes mellitus.
Fastingvalue > 120mg / dl
2 hrs after glucose load > 180 mg/dl
If the values are detected abnormal, then appropriate treatment should be initiated immediately. Along with the treatment, the diabetic patients should be checked from time to time for:
- Blood sugar levels
- Urine for proteins and ketones
- Visual disturbances
- Neurological problems – loss of sensation
- Nephrological problems – decreased urine output, oliguria
Patients should be taught about self-care which includes:
- Compliance with diet
- Compliance with drugs
- Self administration of insulin
- Abstinence from alcohol
- Periodic check-up
- Maintaining weight
- Self assessing blood glucose by glucometer using blood sugar testing strips
- Recognizing signs and symptoms of a complication
- Preventing hypoglycemia
In case of severe hyperglycemia or diabetic ketoacidosis, the patient should be managed at the hospital.
(b) Referral: The detected cases should be referred for appropriate treatment and management of diabetes mellitus.
3. Tertiary Prevention: Tertiary prevention includes the measures which limit the disability which has occurred as a result of a complication of diabetes such as; kidney failure, neuropathy, blindness, gangrene of lower extremities or coronary thrombosis, etc. So, specialized clinics and units should be organized where diagnostic and management skills of high order are available to provide services. In case disability has occurred, then the objective is to rehabilitate the individual vocationally, economically so that he can earn his livelihood. It requires the establishment of local and national units to achieve tertiary prevention.
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