Misra A, Ramchandran A, Jayawardena R, Shrivastava U, Snehalatha C
Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; Diabetes Foundation (India), New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India.
Diabet Med. 2014 Oct;31(10):1153-62. doi: 10.1111/dme.12540.
Economic, dietary and other lifestyle transitions have been occurring rapidly in most South Asian countries, making their populations more vulnerable to developing Type 2 diabetes and cardiovascular diseases. Recent data show an increasing prevalence of Type 2 diabetes in urban areas as well as in semi-urban and rural areas, inclusive of people belonging to middle and low socio-economic strata. Prime determinants for Type 2 diabetes in South Asians include physical inactivity, imbalanced diets, abdominal obesity, excess hepatic fat and, possibly, adverse perinatal and early life nutrition and intra-country migration. It is reported that Type 2 diabetes affects South Asians a decade earlier and some complications, for example nephropathy, are more prevalent and progressive than in other races. Further, prevalence of pre-diabetes is high, and so is conversion to diabetes, while more than 50% of those who are affected remain undiagnosed. Attitudes, cultural differences and religious and social beliefs pose barriers in effective prevention and management of Type 2 diabetes in South Asians. Inadequate resources, insufficient healthcare budgets, lack of medical reimbursement and socio-economic factors contribute to the cost of diabetes management. The challenge is to develop new translational strategies, which are pragmatic, cost-effective and scalable and can be adopted by the South Asian countries with limited resources. The key areas that need focus are: generation of awareness, prioritizing health care for vulnerable subgroups (children, women, pregnant women and the underprivileged), screening of high-risk groups, maximum coverage of the population with essential medicines, and strengthening primary care. An effective national diabetes control programme in each South Asian country should be formulated, with these issues in mind.
在大多数南亚国家，经济、饮食及其他生活方式正在迅速转变，这使得其民众更容易患上2型糖尿病和心血管疾病。最新数据显示，2型糖尿病在城市地区以及半城市和农村地区的患病率都在上升，包括社会经济地位处于中低水平的人群。南亚人患2型糖尿病的主要决定因素包括身体活动不足、饮食不均衡、腹部肥胖、肝脏脂肪过多，以及可能存在的不良围产期和早期生活营养状况及国内移民情况。据报道，2型糖尿病影响南亚人的时间比其他种族早十年，而且一些并发症，例如肾病，比其他种族更为普遍且病情发展更快。此外，糖尿病前期的患病率很高，发展为糖尿病的转化率也很高，而超过50%的患者仍未被诊断出来。态度、文化差异以及宗教和社会信仰对有效预防和管理南亚人的2型糖尿病构成了障碍。资源不足、医疗保健预算不足、缺乏医疗报销以及社会经济因素导致了糖尿病管理的成本增加。面临的挑战是制定新的转化策略，这些策略要切实可行、具有成本效益且可扩展，能够被资源有限的南亚国家采用。需要重点关注的关键领域包括：提高认识、优先为弱势群体（儿童、妇女、孕妇和贫困人群）提供医疗保健、筛查高危人群、使基本药物覆盖尽可能多的人群，以及加强初级保健。每个南亚国家都应考虑到这些问题，制定有效的国家糖尿病控制计划。
