With diabetes bringing along a spectrum of ailments as co-morbidities for women, management of the disease needs to involve tackling precursors which will aid in preventing it
Having its roots in the mid 16th century, diabetes mellitus has been growing rapidly. Among all
non-communicable diseases prevalent, diabetes mellitus ranks in the top few which seek serious attention in both high-income as well as developing countries. In India, it is quickly gaining the status of a potential epidemic with more than 70 million diabetic individuals- half of them women, currently diagnosed with the disease.
This reckons us to look at the management strategies to cope with diabetes. Currently, the management strategies used for both men and women are mostly common, even when the ailment is much more complex in women leading to multiple consequences. Thus there is an immediate need to focus on devising tailor-made approaches particularly for women so as to tackle the disease. World Diabetes Day is celebrated every year on November 14 and this year’s theme ‘Women and diabetes – Our right to a healthy future’ aims to draw attention to the complexity and magnanimity of the issue. In a country like India, where socio-economic factors and gender bias are prevalent, women on many levels are still portrayed as the caregiver and in the process neglect their own health. Hence, major strategies to aggressively manage the disease need to be devised particularly in favour of women as diabetes’ effect grows multifold in this segment of the society.
Plethora of ailments
With the advancement of technology, there has been a radical change in the lifestyle of every individual and women are no exception. Also, in Asian countries, including India, the risk factor is relatively higher due to the genetic predisposition towards diabetes adding to the grave situation that already exists.
Amitabh Nagpal, Founder and CEO, Lifeincontrol.com, a diabetes management programme, highlighted about a 2016 study conducted by the Department of Science and Technology (DST) and revealed that the incidence of diabetes is increasing among urban Indian women, leading to premature mortality due to increased vulnerability to other diseases like cardiovascular diseases, glaucoma, neuropathy and skin infections. The report found that the prevalence of the disease condition is 17.7 per cent among urban middle class women while it is 10 per cent in rural areas.
Risk factors for diabetes
The management of diabetes in women does not differ much from that in men. However, there are certain peculiarities that women with diabetes have as the disease causes various other ailments. Sedentary lifestyle along with increase in unhealthy patterns of life act as catalysts in diabetes growth. There are precursors that act as risk factors leading to diabetes.
PCOS: According to a PCOS study, one in ten women has Polycystic ovary syndrome (PCOS) which is a high risk factor for women to develop diabetes in future.
Dr Duru Shah, Scientific Director, Gynaecworld, informs that almost 50-60 per cent of these women develop insulin resistance which is a pre-diabetic state. She emphasises on how constantly monitoring these patients will prevent them from developing more incidents of diabetes.
Gestational diabetes: Women, majorly PCOS patients are at a higher risk of developing diabetes during pregnancy due to the rise in sugar levels which results in gestational diabetes. According to the report ‘Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4),’ prevalence of Gestational Diabetes Mellitus (GDM) has dramatically increased by 16–127 per cent in the past 20 years among various ethnic groups. The International Diabetes Federation (IDF) stated that there is a notable difference in the prevalence of GDM, with the South East Asia Region having the highest prevalence (87.6 per cent) of all the low- and middle-income countries (LMICs), where access to care is often limited. Asian women are more prone to develop GDM than European women and Indian women have 11-fold increased risk of developing glucose intolerance in pregnancy compared to Caucasian women. Studies conducted in the 1980s have shown that the prevalence of GDM in India was 2 per cent, which subsequently increased to 16.55 per cent in 2000.”
Obesity: Obesity is a neuroendocrine disease that is itself associated with numerous metabolic complications. In addition, it has a strong relationship with diabetes and insulin resistance and so it is an important determinant of the long-term risk of developing type II diabetes in genetically predisposed individuals. Consequently, overweight or obese women begin their pregnancy with insulin resistance and increased predisposition towards GDM. An excess of weight gain during pregnancy would further worsen these phenomena and increase the risk of GDM as well, even in women with normal prepregnancy weight.
Let us now look at a few co-morbidities of diabetes that get aggravated if the timely prevention and management of diabetes is not taken seriously.
Hypertension: According to the report ‘Hypertension in India: A systematic review and meta-analysis of prevalence, awareness, and control of hypertension’ about 33 per cent urban and 25 per cent rural Indians are hypertensive. Only 25 per cent rural and 38 per cent of urban Indians are being treated for hypertension. Uncontrolled diabetes is a major risk factor for hypertension and thus unmanaged diabetes will drastically increase the burden of diabetes.
Cardiovascular disease: Diabetes is a powerful risk factor for heart disease in women. These women also experience more complications after developing a heart disease. Dr V Mohan, Chairman, Dr Mohan Diabetes Specialties Centres states that normally, women in the reproductive age group i.e. up to menopause are protected from coronary heart disease. However, when women get type II diabetes at a young age, this protection from the heart disease disappears and they have the same, if not higher risk, of developing heart attacks as men with diabetes of the same age group.
Management of diabetes in women
There is a need for prevention, monitoring and controlling diabetes in women at multiple levels. The key to managing diabetes better is through education and awareness. Spreading the word about symptoms and measures to be taken at different levels will certainly bring about a change in the statistics. Currently, many initiatives have been set in motion. For instance, Dr Mohan highlights that the government has initiated the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS). This programme includes prevention and control of diabetes at several levels i.e. at the school level, community level and worksite under the primary, secondary and tertiary prevention of diabetes. The private sector has been extremely active in diabetes and India has one of the largest number of diabetologists in the world.
One such programme by institutions like Dr Mohan’s Diabetes Specialities Centre is large scale capacity building in the field i.e. training doctors and other paramedical personnel to diagnose and treat diabetes well. Another programme, D-CLIP studied 600 people with pre-diabetes and put them on intensive lifestyle management programme i.e. diet and exercise and weight reduction were appropriate. The results were very impressive. Upto 32 per cent of people with pre-diabetes could be prevented from developing diabetes. Programmes such as these are needed to be expanded throughout the country.
Dr Mohan also suggested that if we start focussing on young girls and prevent obesity in them, we can prevent and control PCOS and thereby prevent gestational diabetes. By this process, we can also bring down the incidence of type II diabetes and cardiovascular disease in women in the future. Routine screening of all pregnant women to rule out gestational diabetes has now become mandatory and if this is followed right from the first trimester of pregnancy, gestational diabetes can be diagnosed early and hence the associated morbidity both in the mother and the child can be prevented.
Dr Shashank Joshi, Consultant Endocrine and Metabolic Physician, shared a different perspective. He said there is a need to promote physical activity like cycling and aid such programmes. Another way of preventing diabetes is by formulating strict laws for food labelling so as to curb the unhealthy foods to promote better lifestyle.
The way forward…
India is the world capital of diabetes. The disease contributes substantially to many deaths that are ultimately ascribed to other causes, such as cardiovascular disease. Diabetes causes special problems during pregnancy, and the rate of congenital malformations can be five times higher in the offspring of women thus causing tremendous increase in cost of healthcare. If some of these resources can be directed towards research of the ailment , it will help us level up in fighting the disease. Much has been learned about the basic biology, epidemiology and treatment of diabetes, yet immense scope exist to understand, treat, cure, and prevent diabetes.
Research in the field of regenerative medicine to cure and prevent diabetes may also help in managing the burden. Dr Prabhu Mishra, CEO, Co-founder, StemGenn Therapeutics, states, “Another revolution aiding the removal of diabetes is regenerative medicines witnessed through stem cell therapy or bone marrow harvest. It directly heals the ailing pancreas and regenerates it. It prevents vascular complications and one would be liberated from the constant jabbing of the insulin needles. Diabetes severely affects multiple organs, puts us at a greater risk of kidney failure, blindness, heart attack and is a breeding ground for other infections as well.”
Many more efforts need to be put in the form of initiatives, awareness programmes and advance research so as to achieve the shift from merely diabetes care and management to the issue of attaining a better quality of life through prevention and curing it.