Page 48 - fbkCardioDiabetes_2017

24 Addressing the Twin Epidemics of Diabetes
and Heart Disease in India

white rice varieties”. Studies with this rice show that of Indians live in rural areas whereas 80% of doctors
it has much lower glycemic index than conventional practice in urban areas. Large cohort studies, like the
white rice . Prospective Urban Rural Epidemiologic (PURE) cohort
(11)
study, reported higher rates of major cardiovascular
The big question is how do we take diabetes preven- events and the rates of death from any cause in ru-
tion to the masses. I want to share our success story ral communities than in urban communities in mid-
of Asiad Colony experience. We had carried out the dle-income countries and low-income countries, sug-
Chennai Urban Population study (CUPS), in two urban gesting that the health care systems (the access to
residential colonies one representing the middle in- and quality and affordability of health care) are likely
come group (Asiad colony in Tirumangalam) and the to have a large impact on cardiovascular disease out-
other representing the low income group (Bharathi comes (17) . Hence, we had to innovate and develop
Nagar in T.Nagar) in Chennai city, in southern India. a rural diabetes model called as the “Chunampet
The study was conducted from 1996 to 1998 and as Rural Diabetes Prevention Project (CRDPP)”. CRDPP
expected, showed a significantly higher prevalence was developed with the aim of not only providing
of diabetes in the middle income group (12.4%) com- diabetes health care, but also to take up diabetes
(12)
pared to the lower income group (6.5%) . The results prevention through the use of telemedicine. With the
of the study were discussed with the residents of help of a tele medicine van, 27,014 individuals (86.5%
both colonies. After these awareness campaigns, the of the adult population) were screened in 42 villages
middle income residents realized the value of physi- of Kancheepuram District in Tamil Nadu. As a result
cal activity and built a beautiful park adjacent to their of the follow up treatment given, the mean glycated
colony, by raising funds through their own resources hemoglobin levels among the diabetic subjects in
thus increasing not just their physical activity but also the community decreased from 9.3 ± 2.6% to 8.5±2.4%
people in the neighborhood. The question was did within a year . We also found that less than 5% of
(18)
this help to reduce or at least slow down the rapidly patients needed referral for further management to
escalating the diabetes rates. A follow up study was the tertiary diabetes hospital in Chennai. Thus, the
done after 10 years which showed that in the middle CRDPP can be used as a model for diabetes pre-
income group, the prevalence of diabetes increased vention and health care delivery in undeserved rural
from 12.4 to 15.4% (24% increase), while in the lower areas of developing countries like India . It is clear
(19)
income group, it increased from 6.5 to 15.3% (135% that to tackle the menace of the diabetes epidemic
increase) (13). This study is the first of its kind in In- in India, we all have to work together. The time for
dia to introduce a “real-world” lifestyle intervention in action is NOW!
prevention of diabetes through community empow-
erment.
REFERENCES
Recently, we have carried out a unique ten-year lon- 1. International Diabetes Federation. Diabetes Atlas Seventh Edition 2015,
gitudinal follow-up of the Chennai Urban Rural Epide- IDF 2015. Available at URL: http://www.idf.org/idf-diabetes-atlas-sev-
miology Study (CURES). Our results show that more enth-edition [Accessed on 15th December 2016].
than 80% of cases of diabetes can be prevented in 2. Unnikrishnan R, Anjana RM, Mohan V. Diabetes mellitus and its compli-
this Asian Indian population just by modifying five cations in India. Nature Reviews Endocrinology. 2016;12:357-70.
risk factors (14). Modifying diet and physical activity 3. Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK,
alone will reduce over half (52%) of risk for diabetes Adhikari P, Rao PV, Saboo B, Kumar A, Bhansali A, John
(15) . M, Luaia R, Reang T, Ningombam S, Jampa L, Budnah RO,
Elangovan N, Subashini R, Venkatesan U, Unnikrishnan R, Das
We also published the results of the Diabetes Com- AK, Madhu SV, Ali MK, Pandey A, Dhaliwal RS, Kaur T, Swaminathan S,
munity Lifestyle Improvement Program (DCLIP) in Mohan V, for the ICMR–INDIAB Collaborative Study Group. Prevalence of
people with prediabetes. We found that there is the diabetes and prediabetes in 15 states of India: results from the
ICMR–INDIAB population- based cross-sectional study. Lancet
reduction of incidence of diabetes by a third in com- Diabetes Endocrinology. 2017. Published Online. June 7, 2017
munity settings. The reduction was more impressive 4. Jaspal SK, Saleheen D, Sim X, Sehmi J, Zhang W, Frossard P, Radha
in those with combined IGT and IFG whereas in those V, Mohan V, Chidambaram M, et al. Genome-wide association study in
with isolated IFG, there was only a 12% reduction in people of South Asian ancestry identifies six novel susceptibility loci for
progressive to diabetes. This suggests that different Type 2 Diabetes. Nature Genetics. 2011;43:984-989.
prevention strategies are needed in different sub- 5. Radhika G, Sathya RM, Ganesan A, Sudha V, Mohan V et al., Dietary
types of pre-diabetes . profile of urban adult population in South India in the context of non-com-
(16)
municable disease epidemiology. Public Health Nutrition. 2010;14:
The next huge challenge is how to provide special- 591-96.
ized diabetes care to rural India. Unfortunately, 72%

GCDC 2017