Lack of screening facilities and unavailability of anti-diabetes medicines continue to challenge the fight against diabetes in India.

Dr. R.Guha Pradeepa of Madras Diabetes Research Foundation (MDRF) has done years of extensive research into diabetes in India, particularly in the states of Tamil Nadu, Maharashtra and Jharkhand. At MDRF she leads a team of researchers. When asked about the government role in addressing the crisis, she said government has an “active role” to play.

Primarily, it must ensure access to anti-diabetes medicines, mainly in rural India, where its unavailability has aggravated the crisis. “The first thing that the government must do is to ensure that medicines are available,” she said.

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She also pointed to the lack of diabetes screening facilities in many parts of the country. If diabetes management is the goal, “early intervention is a key,” she said. The lack of screening facilities stands in the way of early intervention, and thus, effective management of diabetes.  Government should “set up more screening facilities and conduct more awareness programs,” she said.

Around the world, type 2 diabetes has affected 415 million people as of 2015, International Diabetes Federation (IDF) data shows. Of these, more than 70 million are in India, which has become the diabetes capital of the world.

Talking of early intervention, she soon raised the issue of childhood obesity in India and the need to confront it. Indians have a high Body Mass Index (BMI), which predisposes them to insulin resistance, she said.

She pointed to a study done at MDRF. Published in the Indian Journal of Medicine, it noted India is “experiencing rapid epidemiological transition.” “Under-nutrition due to poverty which dominated in the past, is being rapidly replaced by obesity associated with affluence,” the study claimed. Dr Pradeepa led the team of researchers who did this study in 2015.

Another research published in the same journal puts the prevalence rate of childhood obesity in India at 19.3%. This is concerning as researchers around the world have established a causal link between obesity and type 2 diabetes.

The rising number of obesity cases in India has led many researchers to fear that the country is facing an impending “diabetes explosion.”

So, why are more children getting obese? Does the answer lie in genetics?

Lifestyle holds the key, Dr Pradeepa noted. Modern life has become sedentary. “These days we see children spending a lot of time with gadgets, instead of going out and playing,” she said. As physical activities take a backseat, young adults become vulnerable to obesity. She lamented that most public schools in Tamil Nadu do not place adequate stress on physical training. “Physical training should be made a part of the curriculum in schools,” she said, adding that it should not be left as “optional.”

Growing consumption of fast food is another key factor, she said.

Fast food chains have a growing number of takers in the country. “As the name implies, it’s [fast food] fast. Also it’s tasty. It’s better than eating Idly or Dosa,” said Avinash Ramachandran, a student based in Chennai who confessed that health concerns don’t deter him.

No wonder then that a study by Dr Ramen Goel of Asian Heart Institute found that young adults in India were consuming four times the daily recommended intake of fat.

As home to world’s largest diabetes population, the disease poses a significant challenge to public health in the country. It affects the overall productivity of individuals, and by extension, the country’s economic prosperity.

So far, government efforts to tackle diabetes have yielded little. National Diabetes Control Program was launched in 1987. It was a landmark initiative. One of its aims were to prevent diabetes through identification of high-risk subjects and early intervention. However, the project was soon fraught with funding deficiencies. Also, early identification requires a national level awareness programme, which was never implemented.

Nevertheless, as the scale of diabetes challenge in the country grows, governments at the state and national level have shown a renewed sense of urgency. Recently, Kerala government proposed a fat tax to curb obesity. Weeks later, the central government proposed sugar tax, a move that is lauded by many at MDRF, including Dr. Pradeepa. These are “good examples” of how governments can make an effective intervention. Sugar tax, will help bring down the consumption of fizzy drinks and fast food, she is confident. Further, she believes the government should go one-step ahead and subsidize fruits and vegetables.

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