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Multi-pronged battle against diabetes
As the world grapples with deadly diabetes which has gained ‘endemic’ status in many regions, top endocrinologists will gather in Colombo next week to discuss this silent killer at a three-day conference.
Dr. Charles Antonypillai
Dr. Noel Somasundaram
Powerful action to prevent, control and eradicate diabetes will be the focus of ‘SLENDO 2019’ (Sri Lanka Endocrine Congress) from August 1-3 at the Shangri-La Hotel, where a detailed Colombo Declaration is to be adopted.
The Colombo Declaration will act as a catalyst to encourage:
- Communication between various stakeholders in diabetes prevention
- Confidence in their ability to work as an effective team
- Consolidation of existing activities and programmes on diabetes prevention
- Conversion of existing ideas and plans into meaningful and productive action
- Creation of focused and sustained prevention plans to help stem this epidemic
All the participants of SLENDO 2019 drawn from the Sri Lanka College of Endocrinologists (SLCE); the South Asian Federation of Endocrine Societies (SAFES); the International Society of Endocrinology (ISE); and the International Diabetes Federation (IDF) will make a far-reaching pledge.
They will resolve to promote the concept of diabetes prevention at all levels, practice preventive strategies as an integral part of diabetes and endocrine care; prioritize prevention in public outreach and advocacy activities; proactively launch prevention activities; and partner with national and international societies to create and strengthen prevention programmes.
This is the largest endocrine meeting in South Asia, the Sunday Times understands, with 1,000 delegates including 300 from abroad and more than 80 international speakers.
Packed tight with an interesting line-up, ‘SLENDO 2019’ with its theme of ‘Where the world meets for endocrinology’ will have 170 sessions including plenaries, symposia, ‘Meet the Professor’ slots, master classes, debates and a court room scene.
“Sri Lanka will take the lead in unveiling a plan to stem the tide of diabetes in South Asia by joining hands with other countries in the region,” said SLCE President Dr. Charles Antonypillai.
The Colombo Declaration which is to be adopted by SAFES will be formally issued at the SLCE’s annual congress held in collaboration with ISE and SAFES, he said, adding that it will be one of the biggest international medical academic programmes to be held in this region.
It is SAFES President Dr. Noel Somasundaram who sheds light on what the Colombo Declaration is all about. The declaration has been drafted with input from leading endocrinologists both locally and internationally, guided by Dr. Somasundaram.
The Colombo Declaration quotes data from the International Diabetes Federation (IDF) that in 2017 the global prevalence of diabetes was 425 million. The numbers are expected to increase to 629 million by 2040. There are 78 million people living with diabetes in South Asia today and this number is expected to double to reach 140 million by 2040.
“A healthy diet, regular physical activity and maintaining a normal body weight are the three key strategies to prevent or delay the onset of type 2 diabetes (T2D). Diabetes can be treated and its consequences avoided or delayed with healthy eating practices, physical activity, medication and regular screening and treatment for complications,” states the Colombo Declaration, reiterating that the impact of diabetes on individual, family and societal health is enormous.
The impacts include:
- Economic productivity impairment as two-thirds of persons affected by diabetes are of working age.
- Diabetes is also a major cause of blindness, renal failure, heart attacks, stroke and lower limb amputation.
- In 2016, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributed to high blood glucose according to 2012 statistics. Every year, 1.2 million lives in South Asia are lost prematurely due to diabetes. At a global level, diabetes care consumes 12% of the total health expenditure.
This is why the Colombo Declaration is urging that it is imperative to prevent and control diabetes, with immediate effect.
As the prevention of diabetes should be carried out at different levels, the Colombo Declaration clearly sets out the groundwork. It includes:
- Primary prevention – with the prevention of diabetes being possible in those who are obese, overweight or have impaired glucose tolerance, the key interventions include vigorous physical activity and adoption of a lower calorie diet that is rich in fibre and low in carbohydrates. Weight reduction in those at risk and identification of high-risk groups such as pre-diabetes, gestational diabetes mellitus (GDM) and obesity are crucial.
- Secondary prevention – the timely diagnosis of diabetes allows the early institution of both non-pharmacological and pharmacological therapy. Modern endocrinology seeks to provide timely and comprehensive vasculo-metabolic care, in a patient-centred manner, to all persons with diabetes.
- Tertiary prevention – in this prevention mode, treating physicians aim to minimize the impact of chronic complications. This includes post-myocardial infarction rehabilitation, renal replacement therapy and corrective intervention for diabetic retinopathy. Modern diabetes therapies allow the slowing or regression of atherosclerosis and chronic renal disease as well as the prevention of heart failure in high-risk patients. Patients with foot complications can be provided rehabilitation and spared from amputation through multidisciplinary intervention. Close collaboration between endocrine care providers and colleagues from other specialties is required.
- Quaternary prevention – as diabetes care becomes more complex, endocrinologists should ensure that evidence-based methods of screening, diagnosing and managing diabetes are followed. Improper diagnosis of diabetes and its subtypes such as pancreatic or gestational diabetes may lead to inappropriate management strategies and suboptimal outcomes.
- Quinary prevention – hearsay, including e-hearsay, has emerged as a significant barrier to diabetes care and a concerted and sustained campaign led by the endocrine fraternity is necessary to educate people living with diabetes and society at large about the pathogenesis, management and prevention of diabetes.