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Type 2 Diabetes Prevention needs the Knowledge of both Dyslipidemic and Diabetic Biophysical-Semeiotic Constitutions
- Sergio Stagnaro (7 November 2003)
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Diabetes: A Modern Epidemic in South Asia
- Sasi K Attili (8 November 2003)
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Intervention needs to be evidence based
- Dan JR Harvey (9 November 2003)
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Re: Diabetes: A Modern Epidemic in South Asia
- P Chakravarthy Munipalle (24 November 2003)
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preventing diabetes+cad in indians
- manan vasenwala md, mrcp (uk) (27 November 2003)
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Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8. 16037 Riva trigoso (Genoa) Italy
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Sir, A 46 year-long clinical experience allows me to state that type 2 diabetes mellitus occurs exclusively in individuals with both dyslipidemic and diabetic constitutions, fully described, from the Biophysical Semeiotic view-point, in the site www.semeioticabiofisica.it,"Constitutions". In fact, it is well known that among obese individuals with hyperinsulinemia-insulinresistance NOT all are in ther life course affected by diabetes. Really, obese patients, without also diabetic constitution, do not suffer from type 2 diabetes mellitus, despite its high insulin blood level and insulin-resistance. I agree completely with the "great" Josslin: first comes altered lipid metabolism, and then diabetes, but always in people with dyslipidemic and diabetic biophysical-semeiotic constitutions, which play, therefore, a paramount role in both obesity and type 2 diabetes prevention. Competing interests: None declared |
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Sasi K Attili, SHO in Endocrinology & Diabetes Sandwell General Hospital, West Bromwich. B71 4HJ
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The alarming rise in the prevalence of Diabetes and Microvascular disease in South Asians is quite frightening. The World Health Organization (WHO) estimated that a total of 300 million people will be affected by 2025. Approximately half of this population will be Asians and Pacific Islanders. China is predicted to have the highest rise in prevalence rate (68%)followed closely by India (59%) and other Asian countries and Pacific Islands (41%). It has been postulated that the prevalence of Diabetes in Urban India is between 10-12% (2-6% in Rural India). Even more alarming is that only 12% of these are actually being treated, the rest either undiagnosed or cannot afford treatment. The higher incidence in urban populations correlates with the fact that diabetes is more common in migrant Asians all over the world. Doubtlessly there must be genetic factors but one cannot ignore the fact that the hormonal constitution of asians was adapted to a lot of exercise (as manual labour was common) and a lean body mass (due to undernutrition). Development being almost synonymous with 'Westernisation' has lead to more sedentary lifestyles, lack of traditional dietary fibre and thus weight gain. Therefore even minimal body fat is enough to cause insulin resistance and deficiency, relative to the luxury of a lean, healthy body that asians enjoyed in olden days. Moreover 'westernisation' has not correlated with 'education' and there is a gross lack of health awareness among these population groups. This is quite obvious in everyday practice, especially in first generation Asians. Therefore Health Education is the pivot to any measure designed to stop this epidemic. Competing interests: None declared |
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Dan JR Harvey, SHO in Anaesthetics Nottingham City Hospital NG5 1PB
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Editor- Chowdury et al are correct to highlight the increased risk of diabetes in South Asians and point out the increasing evidence base for intensive intervention to prevent complications. However it is misleading to suggest that as Asians have higher risk of complications a lower threshold for intervention should be adopted. An assumption of increased benefit from lower intervention thresholds is made and no such relationship is proven. Evidence taken from major randomised double-blinded trials is valid only for the population groups studied. Likewise claims of statistical or clinical benefit are valid only for treatment regimens studied. Even if increased benefit does accrue from adoption of lower intervention thresholds, there is no guarantee the relationship will remain linear, and therefore no guarantee of clinical significance. Clinical decision making in the NHS unfortunately also needs to reflect cost-benefit analysis, likely to be radically altered by the adoption of lower intervention thresholds. We must wait for trial data to show clear benefit before departing from current evidence based guidelines on risk assessment and intervention. Competing interests: None declared |
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P Chakravarthy Munipalle, SHO Orthopaedics Royal Cornwall Hospital, Truro TR3 6DS
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I entirely agree with the views of Dr.Attili. He reminds the health professionals of South Asia about the importance of managing Diabetes effectively, otherwise Diabetes may become a disease of epidemic proportions. Competing interests: None declared |
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manan vasenwala md, mrcp (uk), consultant-cardiologist(non-invasive) k.k.heart center, aligarh-202002.india
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many indians are astonished when they are diagnosed to have diabetes or cad. they deny a family history and often go into a denial mode. after several blood sugars from different laboratories, the reality sinks in. there is an increase of prevalence of diabetes and cad by 300% in the last three decade. while adult obesity has doubled and child obesity quadrupled in the west, similar situation can be seen in urban india. what is disturbing is that coronary artery disease in usa have in fact declined by 60%, but there is no sign of any downturn in india.most indians are vegetarians, but the vegetarinism is contaminated.in fact indians are lacto-0vo-vegetarian. an average indian consumes about 35% to 50% of saturated fats all derived from milk products in the form of butter, ghee, cheese, curd, bakery products,and ice cream to overcompensate for not eating meat products.contrary to popular beleif, dairy products are majot source of calories and SAFA, or saturated fatty acids. SAFA isthe principal dietary culprit of elevated serum cholesterol and therefore primary determinant of atheroma formation.another common indian practice is deep frying and re-use of cooking oil. this leads to formation of trans -fatty acids or TRAFA. this produces greater perturbation in lipid profile. TRAFA not only increase LDL but also decreases good cholesterol HDL. thus the present indian dilemma is consumption of too many calories from the wrong sources and a sedentary life style. the corner stone of prevention appears to lie in adoption of "prudent" diet which means(6 components) vegetables,fruits, legumes, whole grains, fish and poultry. avoid ghee and tropical oils.this refers to coconut, and palm oils.tropical oils are more atherogenic and thrombogenic than mutton and beef fat.these oils contain mostly SAFA and in addition have 18% of myristic acid which is a very potent atherogenic SAFA. kerala renowned in india for its coconuts and scenic beauty, have highest levels of serum cholesterol and highest rates of cad. as for physical activity, brisk walking is a good form of exercise. a brisk walk of 5km/day in 45mins, 5 times a week would provide the needs of cardiovascular fitness. to conclude, cornerstone for prevention of diabetes + cad is prudent diet with less calories and physical exercise. excerpts from: enas a enas, a senthilkumar, hancy chennikara, marc a bjurlin. prudent diet and preventive nutrition.indian heart journal 2003;55:310-338. Competing interests: None declared |
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