Indian Medical Association (IMA) National Headquarters New Delhi has proposed several initiatives in interest of Public health under which Indian Medical Association, Gujarat State Branch (IMA-GSB) launched this National Initiative-“Preventing Diabetic Blindness” on 19th April 2015. On 24th August 2015, All India Ophthalmological Society (AIOS) joined hands with IMA for this Initiative. This article is part of this awareness drive meant to up tune the diabetes care ecosystem towards reducing diabetic blindness.
Diabetes is a disease in which blood sugar is raised causing damage to inner lining of blood vessels and capillaries leading to impaired blood circulation in vital organs of many systems e.g, heart ( attack), brain( paralysis), eyes(blindness), kidneys (failure), legs (ulcers), Teeth and gums (infections) etc. Thus it can damage the body in many ways.
India is home to about 60 million diabetics and the number is rising fast. It is estimated to be about 100 million by 2030. This may be due to
1) Unhealthy lifestyles ( stress, fast/fatty/sugary food, lack of physical activities etc.)
2) Genetic or ethnic factors
3) Increased life span
Since it is not an acute disease and may not have symptoms initially, about 50% of diabetics remain undetected for months to years after having it. More the duration of uncontrolled blood sugar, more is the cumulative damage to various organs. Hence it is important to detect diabetes as soon as possible and control it as best as possible.
To avoid such risk of multi organ involvement, itis best to avoid diabetes itself by healthy lifestyle– healthy food ( more of fruits, vegetables, skimmed milk and its products, nuts,eggs, fish and less of sugars, creams, fried, oily, salty, meaty foods) being physically active, avoiding rat race and stress.
Next best thing is early detection of diabetes. All otherwise healthy people should get their blood sugar tested latest at age 45 yrs. Earlier testing is recommended for high risk individuals like obese, people with family history of diabetes, stressful people, hypertensives, pregnancy etc. Testing should also be done if there is abnormally high frequency of hunger, thirst, urination or fatigability. If fasting blood sugar is >126 mg/dl, Post meal blood sugar is 200 or more or HbA1c is >6.5, there is diabetes. If blood sugar is normal, test should be repeated every three years or earlier if a risk factor is added.
The risk of multi organ damage in diabetes can be significantly reduced by good control of blood sugar along with good control of blood pressure & lipids if they are high, under care of a good doctor. The control should be preferably monitored by checking HbA1c twice a year if the control is good ( HbA1c<7.0) or 4 times a year if control is not good (HbA1c>7.0), while attempting better control.
After variable period of onset of diabetes it causes damage to Retina of the eyes which is called Diabetic Retinopathy (DR). The timing depends on duration of diabetes, level of control, presence of hypertension, increased lipids, smoking etc.DR may be present at the time of diagnosis of diabetes (indicating that diabetes itself was detected late) or may occur years later. It starts in a mild form and may stay so for a very long time or progress to moderate or severe forms, again, depending on control or otherwise of diabetes and other diseases.
Till it reaches severe stage when there is threat to vision, no symptoms are felt by the diabetic person. It is only when the vision is damaged by occurrence of bleeding or swelling in the retina that the person experiences the problem and often feels it happened suddenly.
The fact is that this event of loss of vision follows a long period of build up over months and years which goes un noticed unless the diabetic undergoes check up for retinopathy by an eye doctor at the time of diagnosis of diabetes and regular review once every two years. If such retinal check up is done as strongly recommended, retinopathy can be detected BEFORE it damages vision.This damage can be prevented or delayed by timely LASER treatment at the high risk stage.
However, often during the course of diabetes which is a chronic disease, no one may have informed the diabetic to undergo check up for Retinopathy. Even if informed, the diabetic may consider it unnecessary (as there are no symptoms) and/or an additional burden/hassle. If the diabetic community is aware of the consequences of missing this opportunity to prevent loss of vision, they would more likely undertake preventive check ups and LASER treatment. Once vision is damaged, treatment is available but the costs and troubles are far more and the outcome may not match undamaged vision.
The aim of this write up is to inform the readers about the troubles diabetes can cause and motivate them to prevent diabetes to the extent possible by healthy life style,, detect it early, treat and monitor it well and undertake preventive check ups for retinopathy and LASER treatment when needed.
An Android smartphone App called “DiabRet” promoted by Indian Medical Association-Gujarat State Branch in public interest can be downloaded for free from playstore. It helps a diabetic to keep track of his reports datewise, gives them appropriate messages and reminders for check up for Retinopathy, Blood Sugar, B.P etc. and also give them basic information about diabetes and preventive eye check ups. The App is under trial phase.
More details are available on www.diabret.com
DR. PRADEEP SHETH M.S.; F.R.F
Chairman: IMA –GSB Initiative “Preventing Diabetic Blindness”