DIABETES is a scourge unaddressed in Pakistan. Though official statistics have put the number of people living with diabetes at eight million, the actual number has long been assumed to be much higher. One recent report in this paper put the estimated number at more than 35m with 1.6m children living with diabetes.

In terms of percentage between 16 to 19 per cent of the population is living with diabetes with one in six persons with confirmed diabetes. This statistic, though close to assumed prevalence, does not include undiagnosed cases which often run into the millions in a poorly functioning health system like ours. Diabetes cannot be ignored for its long-range fatal effects on the heart, kidney, eyes and feet. Moreover, diabetes intersects with high blood pressure, high cholesterol and strokes.

Together diabetes with its fatal complications imposes huge costs on health financing and health systems. The UK, despite having a lower number of patients with diabetes than Pakistan, spends about £10 billion annually to treat diabetes and its complications.

Despite this huge outlay diabetes still kills about 22,000 people a year. There are also thousands of amputations carried out every year due to diabetes. One can only imagine how bad the situation in Pakistan is against the setting of a misaligned, under-resourced health system and public health campaigns.

Many steps are needed to tackle this growing health problem. First, a massive public health campaign is required to educate general population about the need for physical activity and diet restriction and lifestyle changes to prevent the onset ofthe disease.

Despite the massive challenge of diabetes prevention and control looming on our horizon, Pakistan`s record on promotion of physical activity is poor.

In advanced countries, promotion of physical activity is now part and parcel of health strategies. The chief medical officer in the UK has recommended 75 minutes of vigorous or 150 minutes of moderate exercise for adults in a week. Physical activity and exercise is one of the key preventive and controlling strategies in relation to diabetes.

Second, long overdue changes in our dietary habits must form part of diabetes prevention and control plans. This change involves cutting carbohydrate-rich diets and taking to low-carb and fibre-rich diets.

Persons at risk or diagnosed with diabetes should be enrolled into special health education programmes.

Third, on the regulatory front, salt and sugar content of processed foods, foods served at restaurants and drinks should be monitored and regulated. Mexico has led the way in this with the imposition of sugar taxon fizzy drinks and beverages. This has not only raised much-needed revenue for funding healthcare, but has also contributed to reduction of diabetes and high sugar glucose levels.

Similarly, advertising seeking to promote processed foods should be regulated.

Advertising aimed at children is of significance here for its contributory role in causing child obesity. Child obesity is one of the areas which is not on the policy horizon and does not get discussed very often. In Pakistan, sugar consumption per person is quite high relative to South Asian countries.

This is worrisome from the point of view of diabetes prevention and control. Moreover, the culture of consumption of mithai, cakes and biscuits is widespread enough to trigger alarm bells for their negative health consequencesinrelation to diabetes.

Fourth, the key plank of any diabetes prevention and control programme is early detection. Those identified as at risk should be targeted for dietary changes and physicalactivity as part of the treatment. This goes a long way in delaying the onset of diabetes in atrisk groups.

General practitioners can play a vital role here. GPs in their hurried daily routines often tend to miss thesign of diabetes as they neither look actively for it nor do patients often complain of diabetes as a pressing health concern when they visit clinics. Diabetes is often a chance finding. This means the GP must be trained and advised to screen all patients for signs and symptoms of diabetes so that it can be detected at early or pre-diabetes stage and appropriateinterventionsinstituted.

In the UK, GPs keep a registry of patients at risk of developing diseases or those already having diabetes. This catches diabetes at a very early stage and those diagnosed with diabetes are routed through appropriate treatment and referral pathways.

Fifth, given the scale of the problem diabetes prevention and control programmes should be instituted at the national and provincial levels and integrated with cardiac prevention, kidney and eye care programmes. The national diabetes prevention and control programme has been a great success in the US while the UK is expanding the footprint of this programme. • The writer is a public health and development consultant.

drarifazad@gmail.com