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588 Prevention of Non-Communicable Diseases - Whom to Focus?

Prevention of Non-Communicable

Diseases - Whom to Focus?

PROF.DR.SESHIAH , MD., FRCP, D Sc., (Hony)
Founder of Dr.V.Seshiah and Dr.V.Balaji

Diabetes care centre and Research Institute, Chennai.

Abstract:
Preventive measures against Type 2Diabetes Mellitus follow a healthy lifestyle pattern. “GDM is the mother
(T2DM) and associated cardio vascular complications of Non communicable Diseases” and “Diabetes is
should start during intra-Uterine period and continue synonyms to vascular disease”
throughout life from early childhood. Preventive med- GDM and Maternal hyperglycemia are used inter-
icine starts before birth. In this aspect, Gestational changeably in this article.
Diabetes Mellitus(GDM) offers an important opportu-
nity for the development, testing and implementation Key Words: Non-communicable Diseases, Gestation-
of the clinical strategies for prevention of diabetes al Diabetes Mellitus, Cardio-vascular diseases
and Non-Communicable Diseases(NCDs). Gestation- INTRODUCTION
al Diabetes Mellitus (GDM) is defined as glucose
intolerance of varying severity first detected during The prevalence of diabetes is increasing globally
the present pregnancy. GDM may play a crucial role and India is no exception. The concern is that India
in the increasing prevalence of diabetes and obesity. would be having the highest population of diabe-
Insulin resistance, increased atherogenic lipid profile, tes by 2025.The increased prevalence is attributed
inflammatory markers, hypertension and endothelial to the aging population structure, urbanization, the
1
dysfunction lead to increased risk for Cardio Vas- obesity epidemic, and physical inactivity . While all
cular Diseases(CVD) .GDM is associated with short these factors contribute to the epidemic of diabe-
term maternal, fetal, neonatal consequences for both tes, early life exposures are emerging as potential
mother and the offspring. In most instances the glu- risk factors. The ‘‘fetal origin of disease’’ hypothesis
cose intolerance reverts to normal but substantial proposes that gestational programming may critically
number of women with GDM have increased lifetime influence adult health and disease. Gestational pro-
risk of developing diabetes at over three times com- gramming is a process whereby stimuli or stresses
pared to control after sixteen years of index preg- that occur at critical or sensitive periods of develop-
nancy. By 17 years of age one third of children born ment, permanently change structure, physiology, and
to GDM mothers have had evidence of pre diabe- metabolism, which predispose individuals to disease
tes, T 2 DM, Metabolic syndrome, impaired insulin in adult life. Traditionally and convincingly, lifestyle
sensitivity and secretion. The underlying pathogenic modifications and drug interventions have proved to
mechanism for the abnormal metabolic profile could delay or postpone the development of overt diabetes
be due to epigenetic changes induced by fetal ex- in persons diagnosed to have impaired glucose toler-
posure to hyperglycemia, intrauterine milieu Inter- ance. This is a post primary prevention strategy. The
ieur. Hence timely action taken now in screening all primary prevention of Type 2 DM at best would mean
pregnant women for glucose tolerance, achieving eu- to keep genetically or otherwise susceptible individ-
glycemia in them may prevent in all probability the uals normoglycemic and not only preventing Type 2
epidemic of non communicable diseases. Female DM from developing. The primary prevention is more
gender is key to prevention of non communicable important than post primary prevention, as this effort
diseases. The Post partum follow up is very essen- is likely to reverse or halt the epidemic of disease.
tial and pre GDM women should be advised against Women with Gestational Diabetes Mellitus (GDM) are
gaining weight, similarly their off-springs should also an ideal group for the primary prevention of diabetes

GCDC 2017