India Diabetes Summit
Dr. R. K. Tuli MBBS MD Ph D
There has been a huge shift in the health burden of the country with a transition from communicable (CDs) to non-communicable diseases (NCDs).
There is a greater need for prevention, screening, early intervention and new medical treatments reducing the burden of chronic diseases. These measures are essential for the health of the nation as well as its economic progress.
Diabetes as one of the most prevalent diseases in India has witnessed a steady increase in its incidence, along with other NCDs, over the last 3-4 decades. It was once prevalent only among adults, but is now found commonly in younger generation and children, threatening India to be the ‘Diabetes Capital’ of the world.
Anti Diabetic Medication comprising oral hypoglycemic agents and/or insulin therapy does not effectively control blood sugar in majority, with inevitable morbidity and expensive mortality. This is the scenario in spite of the best of currently available strategies in its management to modern medicine.
No doubt, as stated, the disease is such that it can be effectively managed. Hopefully, this summit shall enable an opportunity to audit our practices so far and be open to perceive “OUT-OF-THE-HAT suggestions!
OBJECTIVE OF IDS – 2012
To derive an action plan, establish and strengthen national policies for Prevention, Management Control of NCDs with a focus on ‘Diabetes’.
POINTS TO PONDER
1.The incidence of Diabetes in our country has more than doubled in last 30 years.
2.It is rising faster in our country than anywhere else in the world.
3.Diabetes is occurring at younger and younger age; from known to be a disease of the old age it is now striking the young in their twenties and thirties.
4.Diabetic medication comprising oral hypoglycemic agents and/or insulin therapy does not effectively control blood sugar in majority.
5.No medical intervention can adequately control or reverse long term complications of diabetes, leading to progressive poor health and irreversible damage to target organs.
6.The diabetes epidemic continues to worsen, with ever rising cost in its treatment, Increasing morbidity and inevitable mortality.
7.With its ever increasing incidence, morbidity and mortality, it’s apparent that there has not been any significant improvement in care of diabetics in spite of various advances in medical science in the past four decades.
8.Modern medicine, as it stands today, cannot by itself curb the havoc being caused by diabetes.
WHAT WE MUST REMEMBER
1.Nearly 50% of freshly cases of diabetes can be controlled adequately for life by diet management alone.
2.This control can be further improved significantly by disciplined life style including healthy diurnal rhythm, regular exercise yoga, adequate sleep relaxation, nutritional support, weight management, and cessation of tobacco alcohol.
3.The long-term results of treatment of diabetes with drugs are disappointing as most patients are not able to control blood sugar levels adequately by medication.
4.Even a good control of blood sugar with oral drugs and/or insulin (with mean HbA1c of 7%) over a long time may help to reduce its inevitable complications by merely 25%.
SUGGESTED MANAGEMENT OF DIABETES
It is well known that freshly detected diabetes responds the best when it is managed conservatively without any drugs. A majority of people detected to have raised blood sugar, disturbed lipid balance or high blood pressure, and most of the CDCs, can overcome these harbingers of life-long morbidity with sincere life style corrections and conservative management at primary level of health care to continue to enjoy positive health total wellness for all their life.
In the long run, this strategy only can enable to curb the ever growing epidemic of diabetes and other life style diseases in the country. It shall, further, relieve pressure on expensive secondary as well as tertiary care services in the country and prove to be highly cost-beneficial.
WHAT’S CONSERVATIVE MANAGEMENT
Management of diabetes and related diseases without resorting to medication, but by monitoring disciplined life-style, timely sleep, adequate relaxation, stress relief, regular aerobic exercise, daily yoga comprising pranayama-meditation-asanas, etc., optimum nutritious diet, minimal intake of salt sugar, weight control, cessation of tobacco and control of alcohol intake, etc., is termed Conservative Management.
It definitely minimises dependence on medication, helps to normalise blood sugar and restore sense of positive health in majority of freshly detected cases of diabetes and related metabolic disorders.
WHAT’S THE ROLE OF PRIMARY CARE PHYSICIAN?
The ONLY way to curb diabetes and minimise its menace is to avoid life-long dependence on medication by its dedicated conservative management at the primary care level itself. Each freshly detected diabetic must be adequately educated about advantages of drug-free conserv management which restores positive health for life versus limitations of drug treatment with progressive morbidity due to it and long term complications leading to slow painful death.
All FRESHLY detected cases, unless an emergency, must be treated by Primary Care / Family Physician for at least THREE MONTHS and ONLY those patients who do not show significant reversal of blood sugar should be referred to a Diabetologist. The specialists in hospitals should be forbidden to entertain such patients unless referred to by Primary Physician.
WHAT’s THE ROLE OF STATE IN CONTROLLING DIABETES?
The health authorities in the country must enforce thorough professional conservative management of diabetes at primary health level by family physicians. Drug treatment by specialists, in the first instance, should be left only for serious patients and for those who prove resistant to conservative management.
WHAT’S THE ROLE OF COMPLEMENTARY MEDICINE?
The conservative management of diabetes by well trained physicians, when complemented with non-conflicting officially recognised drug-free systems of Therapeutic Yoga Naturopathy, Panchakarma, Acupuncture Refleotherapy and Psycho-Hypnotherapy, offer additional support in further enhancing long term management of diabetes. In fact, this ‘synergy’ of Conservative Medicine with drug-free modalities of Complementary Medicine proves highly effective even in improving management of drug (oral/insulin) resistant diabetics and further assist in arrest or even reversal of target organ complications in most of such patients.
However, we need large scale studies to establish its scientific credibility and develop universal protocols for developing this concept termed Holistic Medicine.
WHAT IS HOLISTIC MEDICINE?
The ‘science’ of modern medicine complemented with the ‘art’ of various officially recognised drug-free harmless and non-conflicting systems of traditional indian as well as chinese health creates a ‘synergy’ termed Holistic Medicine to take care of the human being as a whole ( body, mind soul) and all the ailments of an individual concurrently.
Holistic Medicine=Modern Medicine +AYUSH+Acupuncture+Psychotherapy
It enables to add life to years of each victim of diabetes and related diseases, at all the stages of sickness, as well its complications to reinforce advantages of one system with benefits of all the other systems, overcoming deficiencies in any single system of medicine for a much improved outcome of sickness including permanent cure of the majority.
