Mehta S R, Kashyap A S, Das S
Commandant, AMC Centre & School, Lucknow 226 002.
Senior Advisor (Medicine & Endocrinology) Command Hospital (CC), Lucknow.
Med J Armed Forces India. 2009 Jan;65(1):50-4. doi: 10.1016/S0377-1237(09)80056-7. Epub 2011 Jul 21.
India has a high prevalence of diabetes mellitus and the numbers are increasing at an alarming rate. In India alone, diabetes is expected to increase from 40.6 million in 2006 to 79.4 million by 2030. Studies have shown that the prevalence of diabetes in urban Indian adults is about 12.1%, the onset of which is about a decade earlier than their western counterparts and the prevalence of Type 2 diabetes is 4-6 times higher in urban than in rural areas. The risk factors peculiar for developing diabetes among Indians include high familial aggregation, central obesity, insulin resistance and life style changes due to urbanization. Screening for gestational diabetes and impaired glucose tolerance among pregnant women provides a scope for primary prevention of the disease in mothers as well as in their children. The problems of obesity and impaired glucose tolerance (IGT) (important predisposing factors) are not confined to adults alone but children are also increasingly getting affected. Most long standing macro and micro vascular complications are also more common among Indian diabetics as compared to other races and ethnic groups. A strong familial clustering of diabetic nephropathy among Indian Type 2 diabetics has also been noted. Clustering of cardiovascular risk factor like Syndrome X is common among urban Indians. The rising incidence of diabetes and its complications are going to pose a grave health care burden on our country. Timely effective interventions/measures and screening tests for complications at the time of diagnosis becomes imperative not only for early detection, but also to prevent progression to end stage disease. Screening for gestational diabetes among pregnant women would also go a long way in primary prevention of the disease. Life style changes/interventions and drugs like rosiglitazone are the current strategies that can prevent and/or delay the onset of diabetes. Simple interventional strategies like "Eat less, Eat on time and Walk more" can go a long way in preventing these chronic disorders among present as well as in the future generations.
印度糖尿病患病率很高，且患病人数正以惊人的速度增长。仅在印度，糖尿病患者预计就将从2006年的4060万增加到2030年的7940万。研究表明，印度城市成年人口的糖尿病患病率约为12.1%，发病时间比西方同龄人早约十年，且2型糖尿病在城市地区的患病率比农村地区高4至6倍。印度人患糖尿病的特有风险因素包括家族聚集性高、中心性肥胖、胰岛素抵抗以及城市化导致的生活方式改变。对孕妇进行妊娠期糖尿病和糖耐量受损筛查，为在母亲及其子女中对该疾病进行一级预防提供了空间。肥胖和糖耐量受损（重要的易感因素）问题不仅限于成年人，儿童也越来越受到影响。与其他种族和族裔群体相比，大多数长期存在的大血管和微血管并发症在印度糖尿病患者中也更为常见。印度2型糖尿病患者中糖尿病肾病的家族聚集性也很明显。像X综合征这样的心血管危险因素聚集在印度城市人群中很常见。糖尿病及其并发症发病率的上升将给我国带来沉重的医疗负担。在诊断时及时采取有效的干预措施/方法以及并发症筛查测试不仅对于早期发现至关重要，而且对于预防疾病进展到终末期也至关重要。对孕妇进行妊娠期糖尿病筛查在该疾病的一级预防中也将大有帮助。生活方式改变/干预措施以及罗格列酮等药物是目前可预防和/或延缓糖尿病发病的策略。像“少吃、按时吃饭、多走路”这样简单的干预策略对于预防当代人和后代的这些慢性疾病将大有帮助。
