Diabetes Mellitus (DM) is increasing at an alarming rate globally. According to WHO report published in 1997, there were 124.7 million diabetics in 1995, which is predicted to more than double by 2025 and become the world's biggest epidemic. Unfortunately, the brunt if this increase will be borne by the developing countries than developed countries even though we now know how we can stop even getting it at all by not being over weight, remaining physically active and avoiding high fat and high calorie diet. Many diabetics (1/2 – 1/3rd) remain undiagnosed. Foe every diagnosed diabetic 2-3 remain undiagnosed in the community because in the beginning diabetes does not give any problem and person feels fine. But it is very important to find out if one has diabetes or not right at the beginning as onset & progression of many of the long – term complications of DM can be delayed, if not avoided, by early diagnosis & optimal management.

India is going to the diabetes capital of the world by having the largest number of people with diabetes followed by China. Contrary to popular belief, Nepal too is witnessing an epidemic of diabetes in Nepal. Most of the public expenditure in health is directed at infectious diseases and maternal & child health. Due to these health priorities there is little attention given to diabetes. Most of our people with diabetes have poor diabetes control due to inadequate knowledge about the disease. As a consequence, many prac ticing physicians in their clinical experience have noted an increasing number of cases of diabetes often presenting with established complications requiring expensive treatment.


A study done by Astha Nepal in 2001 in Ombahal, Kthmandu found the prevalence of unknown diabetes to be 13% in 40 years & above healthy persons. In the study, 6.08% males and 9.56% females were at high risk for developing diabetes. A study by Shankar P. et al. in 2002 showed in his MD thesis work that the prevalence of diabetes in urban Katmandu (Known & New) in subjects 40 Yrs and above was 19.70%.
As an initiative to tackle the WHO forecast, Astha Nepal has started a program entitled "Community Development Program for Education, management and Preventing of Diabetes Mellitus" in Katmandu valley and some adjoining towns. The program has major target of educating diabetics and their family members at their doorstep by Local Community teams trained by Astha Nepal along with awareness programs.

The program aims to:

• Create awareness about DM in general public.
  
• Emphasize DM is preventable by simple lifestyle modifications.
  
• Empower diabetics with necessary knowledge and updates.
  
• Motivate for good management beyond glycemic control by the community at the doorstep of the community.
  
• Clarify dietary and other misconceptions about diabetes.
  
• Help from diabetes clubs.
  

Longer-term complications due to poor/uncontrolled blood sugar include eye damage leading to laser therapy/blindness, kidney failure requiring renal dialysis/kidney transplant, high blood pressure, heart attacks, stroke leading to paralysis, nerve damage and gangrene with probable amputation. But successfully keeping blood sugar within the optimal range at all times right from the beginning have shown to reduce/prevent each of these problems. Other factors that should, be controlled to reduce problems associated with diabetes include not smoking, optimal lipid profile, reducing body fat, exercising regularly, preferably with increasing intensity and being on a proper diabetic diet advised by a dietitian.
(to be continued..)

This is Part-1 of Diabetes can be stopped, Part-2 of this article will be
published Next Week

About The Author
Dr. P.K. Shrestha, MBBS. MD (AIMS)