Diabetes :A Paradigm and its Prevention

Diabetes is a progressive disease with acute and chronic morbidities and high mortality. At present there are 171 million diabetic patients in the world with India accounting for 31.7 million. Prevalence in India is expected to increase to 79.4 million by the year 2030[1]. Approximately 85 -90% of these people have type 2 diabetes mellitus. The illness is best managed by combining patient education and long-term medical care to prevent or to reduce the risk of long-term complications. Diabetes is associated with serious health consequences. It has been the leading cause of coronary heart disease (CHD), stroke and chronic renal failure, hypertension, atherosclerosis, endothelial dysfunction. Management of diabetes is intricate and requires many issues be addressed beyond glycemic control alone. According to American Diabetic Associtaion (2002), the cost related to diabetes for hospitalization and complications was $132 billion [3] and formed 34% of the medical budget. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. The studies like UKPDS [4-6], DCCT [7, 8] and Kumamoto [9] have shown a significant decrease in cost and complications with an intensive glycemic and blood pressure control.Diabetes is a chronic disease treated for long with goal of ‘secondary prevention’ but failed to provide complete prevention of complications. The rising prevalence of the disease and cost of treatment will probably offset its benefits to the community. A shift in paradigm from secondary prevention to primary prevention of diabetes is the need of the hour but has been neglected or as has been underachieved in routine clinical practice.