A creeping killer?

DIABETES is a frightening disease, and, today, many are trying to create and increase awareness around the globe, celebrating World Diabetes Day. Sri Lanka has been grappling with diabetes for decades, but the threat is greater than ever before with jaw-dropping numbers becoming the norm.

Local health experts have noted non-communicable diseases as the main killer in Sri Lanka, and a countrywide study done by Dr. Prasad Katulanda, a consultant endocrinologist/diabetologist, in 2009 showed the alarming extent of the problem. Urban populations (16.4%) display a higher incidence over rural populations (8.7%). The switch from rural to urban living almost always includes an upgrade to bigger portions of fattier foods, but often includes a steep drop in activity level - both of which are recognised as major contributing causes to diabetes.

Reflecting these findings, the Western Province had the highest rates of incidence while the Uva Province had the lowest. Also well known is the relatively low incidence of Type 1, insulin dependent diabetes (4.4% in Sri Lanka); but that more women (10.9%) have diabetes than men (9.8%) in Sri Lanka was something of a surprise.

A little over 10% of Sri Lankan’s population currently has diabetes and 36% of all diabetic subjects were previously undiagnosed. But the biggest finding may have been the high incidence of pre-diabetes. Before a person develops type 2 diabetes, they almost always have pre-diabetes, a condition in which blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. So much so that Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG) have both been identified as two intermediate stages in the progression to diabetes mellitus, with experts labelling them together as ‘pre-diabetes.’

Research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. But by early diagnosis and effective treatment of pre-diabetes, doctors can help patients nip the disease in the bud. At an estimated incidence of 11.5%, (higher than the incidence of diabetes itself) it seems inevitable that without immediate and effective intervention, pre-diabetes cases will mature into diabetics and that an overwhelmed healthcare system would be left scrambling to cope.

Taking both diabetes and pre-diabetes into consideration, overall, 21.8% of the population had some form of dysglycaemia - a state in which glucose levels are not properly controlled by the body.

Diabetes is no longer perceived as a western disease; instead its prevalence in Asia has begun to outstrip that of western countries. It is estimated that nearly 80% of the global population with diabetes live in developing countries.

Obesity has long been identified as one of the main causes of diabetes, but it turns out that in Sri Lanka your weight becomes a problem much earlier than originally estimated. While in the west those with a Body Mass Index (BMI) of 32 are considered obese and at risk for diabetes, in Sri Lanka you need only have a BMI of 18 + to see the risk of your contracting the disease actually double.

This makes Sri Lankans particularly vulnerable as the population expands and begins to adopt a more urban lifestyle. Sri Lanka’s rapidly aging population also puts higher risk on the table and makes diabetes possibly the number one creeping killer.