Wednesday, November 7, 2012

Can We Stop Diabetes?




A
 lot of people in India are already affected by the condition diabetes. Many studies have shown that Indians are particularly prone to develop diabetes and its complications. Experts have warned that about 9% of our population will soon be affected by this condition. For a country with over a billion population, this forms a huge number. Isn't it important for us to look for solutions?  

A study by Ramachandran and others in India have shown some promising answers. The study tried to understand the benefit of different interventions in preventing diabetes. It was conducted among people aged between 35 to 55 years who have not become diabetic, but shown a relatively high level of sugar in their blood, a condition known as pre-diabetic stage. Among the 531 people who were included in the study by dividing them into four groups, the first group was given medicines to lower their blood glucose levels and the second group was helped though regular classes and counselling to change their lifestyles including adherence to a better healthy diet and consistent moderate daily physical activities. The third group of people received both medicine and help for lifestyle modification. The fourth group was not any intervention.

Then, what happened to them?
After three years of follow-up of all the four groups, the researchers calculated the number of people who moved from a pre-diabetic stage to diabetic condition. The maximum benefit of the interventions was shown by the group which received regular help for their lifestyle modification. Compared to the group which did not receive any intervention, the group which modified their lifestyles had shown 28.5% less chance of developing diabetes. Even the group which had received both medicines and guidance for lifestyle modification had slightly lesser benefit than the group which only modified lifestyles

Though the benefit of lifestyle modification in preventing diabetes has already been established in several populations across the world, this study has confirmed the beneficial effect in the Indian population.  Interestingly, the study also showed that even though there was no overall weight reduction in the group that was helped to change lifestyles, the intervention benefited in terms of reducing their potential to develop diabetes in the future.

What does this study implicate?
The increasing prevalence of diabetes in our population is explained at least partly by the changing lifestyle in recent years in relation to diet and physical activity. These life-style choices are fueled by the development model that we pursue. It is important that we reverse these trends to the extent possible to stop diabetes from crippling more and more people. The core of such a change should be at two levels. The first and foremost is a change at the level of individuals, families and communities who are to embrace healthier choices.  Equally important is the creation of a facilitative environment that helps individuals, families and communities to choose healthier lifestyle choices in relation to diet and physical activities. This requires a stronger political commitment to regulate unhealthy foods and invest in policies and programs that promote healthier habits.

It is always better to turn off the faucet than mopping up the floor when the sink overflows!  


Reference
Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V; Indian Diabetes Prevention Programme (IDPP). The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006 Feb;49(2):289-97. PMID: 16391903.

9 comments:

  1. Very informative! I think that this blog post would be even better if it was more accessible to non-scientifically minded lay people. For example, more of a conversational tone, expressions of emotion and excitement, and "what this means for you". The pictures are interesting, but actually noting why they are important could help!

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  2. Overall, this is an interesting and informative post. I agree with Joe that it needs some downgrading. Also I would suggest putting in the end some specific examples of structural interventions so readers have better understanding of what can be done to prevent diabetes (e.g. taxing unhealthy food, banning soda at school, increasing PE class hours or subsidizing fruits and vegetables etc.)

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  3. I would agree that the tone could be more conversational. I think drawing on risk factors and treatments that people can relate to in the US would be helpful (i.e. a 'what does this mean for you' on a more personal level, like instead of simply mentioning a change in family choices to be healthier, give examples--"whole family bike rides, changing ingredients in meals, etc.).

    David

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  4. Joe, this was very informative and I liked the focus on primary prevention. I agree that toning down the language would be helpful for a general audience, but the information provided and focus of your post is great.

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  5. I think this is very interesting and engaging. I would have liked a little more detail on what exactly the lifestyle intervention entailed. It would be great to have a specific idea of for example, the type and frequency of exercise, so that the lay person can take steps in preventing diabetes.

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  6. Hi Joe,

    Great topic! I agree with the others about the overall tone of the post being over the head of most people. To fix that, I would recommend taking out most of the stuff on the methods -- people don't really understand that stuff. Instead, I'd focus more on detailing the stuff at the end (what people are supposed to do).

    Similar to my comments on the other posts, you may want to think about listing that last section in bullet points and changing the subheading to be more along the lines of "What can we do to stop diabetes?"

    I know that translational research is very important to you, and I'm happy to talk with you more about how to make your research accessible to people. I'm also interested to hear more about what this looks like in another country.

    Ariela

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  7. One more comment -- I like the quote you use at the end. Maybe think of reframing your post around that instead of sticking it at the end. I think people like things like that, and the analogy makes sense!

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  8. Great post about an important (an very urgent) public health problem! I like Ariela's idea of putting the quote you closed with at the beginning. You could even put it right under the title and highlight it as a stand-alone quote! Couple of comments- while your blog was comprehensibile to us public health folks, I would recommend using less jargon and defining key terms. For example, what is diabetes? What are the clinical implications? What does it mean to be pre-diabetic?

    There were a couple of times when it seemed that this blog post was reporting out the direct results of the study, rather than focusing on the broader implications of the study (i.e. the effect of these primary prevention strategies on diabetes incidence). You could still address some of the key points of the study while condensing sentences. For example, when describing your study, you could simply state that in the subjects were divided into 4 groups: 1)... 2)... etc. and then really delve into the meat of the issue.

    All in all, great blog post about a super important topic. I think highlighting the clinical implications will make this stand out even more!

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  9. Helpful post, Joe! You have translated all the research process and results into easy words and avoided mentioning specific terminologies. Also, I like the drawings in your blog which make the article funny and attractive!
    By the way, that simply lifestyle modification can contribute to decrease diabetes is really exciting and useful.

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