Question

It is projected that by 2035 the number of diabetes will increase by 96.2% in the Arab world.

Discuss 3 approaches of prevention to control the disease.

 

Answer 1

We can talk about Precention in 3 levels, which are - Primary, Secondary and Tertiary, there's also primordial prevention which is more or less unimportant.

1 . Primary prevention
Two strategies for primary prevention have been suggested: (a) population strategy, and (b) high-risk strategy
a. POPULATION STRATEGY
The scope for primary prevention of type I diabetes is limited on the basis of current knowledge and is probably not appropriate However, the development of prevention programmes for type 2 diabetes based on elimination of environmental risk factors is possible. There is pressing need for primordial prevention - that is, prevention of the emergence of risk factors in countries in which they have not yet appeared. The preventive measures comprise maintenance of normal body weight through adoption of healthy nutritional habits and physical exercise.
The nutritional habits include an adequate protein Intake, a high intake of dietary fibre and avoidance of sweet foods. Elimination of other less well defined factors such as protein deficiency and food toxins may be considered in some populations. These measures should be fully integrated into other community-based programmes for the prevention of non-communicable diseases (e.g., coronary heart disease).

b. HIGH-RISK STRATEGY
There is no special high-risk strategy for type I diabetes. At present, there is no practical justification for genetic counselling as a method of prevention. Since NIDDM appears to be linked with sedentary lifestyle, over-nutrition and obesity, correction of these may reduce the risk of diabetes and its complications. Since alcohol can indirectly increase the risk of diabetes, it should be avoided. Subjects at risk should avoid diabetogenic drugs like oral contraceptives. It is wise to reduce factors that promote atherosclerosis, e.g., smoking, high blood pressure, elevated cholesterol and high triglyceride levels. These programmes may most effectively be directed at target population groups.

2. Secondary prevention When diabetes is detected, it must be adequately treated. The aims of treatment are :

(a) to maintain blood glucose levels as close within the normal limits as is practicable., and

(b) to maintain ideal body weight.

Treatment is based on (a) diet alone - small balanced meals more frequently, (b) diet and oral antidiabetic drugs, or (c) diet and insulin. Good control of blood glucose protects against the development of complications.

Proper management of the diabetic is most important to prevent complications. Routine checking of blood sugar, of urine for proteins and ketones, of blood pressure, visual
acuity and weight should be done periodically. The feet should be examined for any defective blood circulation (Doppler ultrasound probes are advised), loss of sensation and the health of the skin. Primary health care is of great importance to diabetic patients since most care is obtained at this level.

Glycosylated haemoglobin : There should be an estimation of glycated (glycosylated) haemoglobin at half-yearly intervals. This test provides a long-term index of glucose control. This test is based on the following rationale: glucose in the blood is complexed to a certain fraction of haemoglobin to an extent proportional to the blood glucose concentration.
The percentage of such glycosylated haemoglobin reflects the mean blood glucose levels during the red cell life-time i.e., about the previous 2-3 months).

Self-care; A crucial element in secondary prevention is self care. That is, the diabetic should take a major responsibility for his own care with medical guidance - e.g., adherence to diet and drug regimens, examination of his own urine and where possible blood glucose monitoring; self administration of insulin, abstinence from alcohol. maintenance of optimum weight, attending periodic check-ups, recognition of symptoms associated with glycosuria and hypoglycaemia, etc.

Home blood glucose monitoring : Assessment of controlhas been greatly aided by the recent facility of immediate, reasonably accurate, capillary blood glucose measurements
either by one of the many meters now available or the direct reading Haemoglukotest strips.

The patient should carry an identification card showing his name, address, telephone number (if any) and the details of treatment he is receiving. In short, he must have a working knowledge of diabetes. All these mean education of patients and their families to optimize the effectiveness of primary health care services.

3. Tertiary prevention
Diabetes is major cause of disability through its complications, e.g., blindness, kidney failure, coronary thrombosis, gangrene of the lower extremities, etc. The main objective at the tertiary level is to organize specialized clinics (Diabetic clinics) and units capable of providing diagnostic and management skills of a high order. There is a great need to establish such clinics in large towns and cities. The tertiary level should also be involved in basic, clinical and epidemiological research. It has also been recommended that local and national registries for diabeticshould be established