IDF and CNS-DMI join hands for improving responses to diabetes care
------------

The International Diabetes Federation (IDF) and CNS Diabetes Media Initiative
(CNS-DMI) have signed a Memorandum of Understanding (MoU) to acknowledge the
commitment of both agencies to scale up documentation, reporting and online
information exchange, dialogue and news monitoring services on issues related to
diabetes-care.

"This MoU will help us in working towards engaging broader civil society in the
United Nations Noncommunicable Disease (NCD) Summit, to document voices of NCD-
affected communities and raise them at such forums on an ongoing basis" said
Nancy Matos of the International Diabetes Federation (IDF).

"This MoU acknowledges the technical and informational support CNS Diabetes
Media Initiative receives from International Diabetes Federation (IDF) to build
capacity and knowledge of its correspondents and partners, and generate reliable
information on diabetes-care" said Shobha Shukla, Editor of Citizen News Service
(CNS).

This MoU is also to promote the spirit of collaboration and genuine partnership
between the International Diabetes Federation (IDF) and CNS Diabetes Media
Initiative (CNS-DMI) and other partners to scale up communications and strategic
messaging on diabetes care.

"This MoU will also help us synergise on long term - and moving beyond
short-term spotlight on diabetes on World Diabetes Day - by recognizing other
strategic opportunities for enhanced quality dialogue, documentation, reporting
or advocacy on issues related to diabetes care on daily basis - like World
Health Day, World TB Day, World No Tobacco Day, International Women's Day and
other such opportunities (days, events, etc)" said Jittima Jantanamalaka,
Director of CNS Diabetes Media Initiative (CNS-DMI).

Spotlight: People with diabetes up to 2-3 times higher risk of TB
Bobby Ramakant - CNS
**************************

[Mods note: To listen to the audio podcast of CNS Exclusive interview with Dr
Anil Kapur, President of the World Diabetes Foundation, on issues around
TB-diabetes, go to:
http://www.citizen-news.org/2010/09/people-with-diabetes-up-to-2-3-times.html .
Comments are welcome. Thanks]
**************************

- PATIENTS WITH DIABETES AND TB TAKE LONGER TO RESPOND TO ANTI-TB TREATMENT
- PATIENTS WITH ACTIVE TB AND TYPE-II DIABETES ARE MORE LIKELY TO HAVE
MULTI-DRUG RESISTANT TB.

"AT POPULATION LEVEL THE RISK WHICH DIABETES CAUSES TO TB CONTROL PROGRAMMES IS
MUCH BIGGER FROM PUBLIC HEALTH POINT OF VIEW BECAUSE OF THE LARGER NUMBER PEOPLE
WITH DIABETES"

People with diabetes are at a high risk of tuberculosis (TB). "There are several
studies that have been done, there are systematic reviews that have been done
which indicates that people with diabetes might have 2 to 3 times higher risk of
getting TB" said Dr Anil Kapur, President of the World Diabetes Foundation
(WDF). "Not only that, patients with TB and associated diabetes, have increased
mortality. The risk of mortality is much higher in TB patients who have
co-existing diabetes. There are also evidences to suggest that when there is
co-existing diabetes it takes longer for the sputum to become negative (for TB)
with anti-tubercular treatment" said Dr Anil Kapur.

"There are also suggestions that there are interactions between drugs that are
used for treating tuberculosis and managing diabetes, which would affect both
the treatment of TB and diabetes. Also there is an issue that because of TB,
people who are at risk of diabetes and are not at this stage dealing with
diabetes (although they may be having pre-diabetes), so when there is a serious
infection like TB, this temporarily leads to a phase where blood sugar levels
are up, of course blood sugar levels come down when TB is brought under control.
But none-the-less these people (with TB) remain at high risk of getting diabetes
in the future" further explained Dr Anil Kapur.

According to a research study done by the University of Texas School of Public
Health Brownsville Regional Campus, people with type-II diabetes might be at
greater risk for contracting TB. This study also further suggested that:
- Type-II diabetes, especially type-II diabetes involving chronic high blood
sugar, is associated with altered immune response to TB, and this was
particularly marked in patients with chronically high blood sugar
- Patients with diabetes and TB take longer to respond to anti-TB treatment
- Patients with active TB and type-II diabetes are more likely to have
multi-drug resistant TB.

"The other problem is that if in a family if somebody has diabetes, and another
person in same family has TB, then the chance of the person with diabetes
acquiring TB becomes high" said Dr Kapur.

"As with TB, which often occurs in social-economically less well-off people,
people living in crowded places, in urban environments where they don't have
access to care, and are often smoking and they also consume alcohol, many of
these same risks apply to diabetes" said Dr Kapur. "So what is starting to
happen is that diabetes is much more often seen in people who are poor in the
developing countries and also in countries where there is a high burden of TB"
further added Dr Kapur.

Also the environment in which TB happens is the one where diabetes is occurring.
"This has very dangerous portents especially for countries like India where we
have a very high level of diabetes and a very high level of TB" said Dr Kapur.
In fact there have been studies that have been published which estimates that
the level of tuberculosis caused by diabetes might be quite substantial in
India.

"If you look at from an individual point of view, if a person is living with
HIV, then the risk of TB is 7 to 8 times and the risk of developing diabetes is
2 to 3 times. But at the population level there are far more people with
diabetes (50 million) than with HIV in India (close to 2.5 million). So at
population level the risk which diabetes causes to TB control programmes is much
bigger from public health point of view because of the larger number people with
diabetes" said Dr Kapur.

"This is something we are trying to advocate for that in countries where there
is a double burden of risk (associated with diabetes and TB) we need to do
programmes where people with TB are screened for diabetes, because often people
with diabetes have no symptoms especially when they have another serious
infection where symptoms are kind of merged with symptoms of diabetes. So we
should screen these people for diabetes" advised Dr Kapur.

Similarly people with diabetes who complain of persistent cough for more than
two weeks, the doctors should be aware of the double risk (for TB and diabetes)
and therefore should investigate these people for potential risk for TB. So this
is something we are working with the International Union Against Tuberculosis
and Lung Disease (The Union) and also with Stop TB programme of WHO. In addition
to that we have funded programmes where we are doing this kind of screening and
training of community healthcare workers who are working in areas with TB to
look for diabetes. One such programme is right now ongoing in Tamil Nadu, India,
with diabetes research centre and National TB Research Institute in Chennai.
There is another one being undertaken in China" said Dr Kapur.

One clear learning from being part of single-issue specific programmes like TB
control programme, tobacco control programme, AIDS care initiatives, diabetes
and others, is to collaborate - synergise - join forces. It reminds me of the
words of Dr Michel Sidibe, Executive Director of the joint United Nations
programme on HIV/AIDS (UNAIDS) "If a virus (HIV) and a bacteria (TB) can work so
well together, then why can't we?" This similar argument is quite pertinent for
diabetes and TB programmes, where both conditions have joined hands and posing
enormous public health challenge. I do believe such collaborative public health
approach will yield positive public health outcomes, keeping fingers crossed for
a healthy future.

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...
Website: www.citizen-news.org

Online at:
http://www.citizen-news.org/2010/09/people-with-diabetes-up-to-2-3-times.html

WHO SEARO Flags Self-Discipline As Key To Diabetes Fight
Jittima Jantanamalaka – CNS
----------------------------

To listen to CNS Exclusive Interview with Dr Samlee Plianbangchang, Regional
Director of World Health Organization South-East Asia Region Office (WHO-SEARO),
go to: http://www.myflashfetish.com/playlist/66643545
----------------------------

(CNS): According to the International Diabetes Federation (IDF), the number of
people in Thailand living with diabetes, in the age group 20-79 years, has risen
from 3,162,400 in 2007 to 3,538,000 in 2010. Thus, during the past three years
375,600 more Thais have joined the band wagon of this non communicable disease,
increasing the national incidence of diabetes from 7.2% in 2007 to 7.7% in 2010.
This is more than the current prevalence in India (7.1%) and China (4.5%) in the
age group of 20-79 years. Thailand urgently needs to increase efforts to raise
awareness of diabetes among its population in order to stem the potential of a
burden epidemic.

"I don't want to call 'diabetes' as a disease actually it is Hyperglycemia, or
it is the level of the high blood sugar that becomes the problem all over the
world at this moment. So I think this is the big problem. We already know how to
prevent ourselves from diabetes especially through better nutrition, exercise
and so on. The problem is how about those who are starting to have risk of
Hyperglycemia, what should they do? One thing that needs to be done is blood
testing. Since diabetes now affects all ages, at some point when a person
reaches age 30 they certainly need to check their blood and continue controlling
the glucose level yearly" said Dr Samlee Plianbangchang, Regional Director of
World Health Organization South-East Asia Region Office (WHO-SEARO) in an
exclusive interview with CNS.

"Once you know someone is at risk then you have to prevent the complication by
keeping the sugar level of blood. In many cases we may have to give them
insulin, and try our best to prevent them from the other diseases as much as we
can. If we can control the blood sugar in the person well enough and prevent
them from the complication diseases, they would be just fine with their life,
just only in one condition, don't let there come the complication," added Dr
Samlee Plianbangchang.

He said that diabetes is a condition requiring lifelong treatment, care and
management which currently affects a lot of people around the world.

"Diabetes is alarming; it's happening all around the world. For developing
countries, there is a need to access medication but people don't even know that
they have diabetes, and the access to treatment is limited. So we have to make
them aware of their condition and make it possible to access medication. Primary
prevention is a very important issue as well," said Dr Samlee Plianbangchang.

He added that Thailand has had so many campaigns during the past few years such
as 'Kon Thai Rai Pung' but campaigning is just only a part of it. Success or
failure is up to the discipline of individual persons, he said.

"To exercise you need to have discipline, most people don't have discipline. If
you're not disciplined then the campaign will not be successful. To make the
campaign work out, we have to campaign for people to have discipline. I think
this is very big issue" said Dr Samlee Plianbangchang.

Dr Samlee Plianbangchang stressed the need for people to take care of their
health in the lead up to the World Diabetes Day, 14 November, and beyond.

"We have to take care of our health, the most important thing that we have to be
concerned with is food and nutrition. Along with good exercise and enough rest,
these will certainly help to prevent diabetes and other diseases. It is simple
saying it but hard in terms of doing, because whoever has no discipline will not
be able to work it out, to have discipline in taking care of your health is a
very big issue, anyone who has not enough discipline they can never be able to
do this" said Dr Samlee Plianbangchang.

The slogan of World Diabetes Day this year is 'Let's take Control of Diabetes
Now,' perhaps the best way for us to start with is to have self-discipline.
(CNS)

Jittima Jantanamalaka - CNS
(The author is the Managing Director of Jay Inspire Co. Ltd (JICL), and produces
radio programmes in northern Thailand. She is also the Director of CNS Diabetes
Media Initiative (CNS-DMI) in Thailand, and a Fellow of CNS Writers' Bureau.
Website: www.jay-inspire.com, Email: jittima@... )

Online at:
http://www.citizen-news.org/2010/09/who-searo-flags-self-discipline-as-key.html

Not Screening For Diabetes During Pregnancy Is Dangerous And Costly
Shobha Shukla – CNS
--------------------

Online at:
http://www.citizen-news.org/2010/09/not-screening-for-diabetes-during.html

(CNS): The theme for the World Diabetes Day 2009-2013 campaigns is: "Diabetes
Education and Prevention"; with a view to "Understand Diabetes and Take
Control". Diabetes, mainly type-2 diabetes is very common in India and there are
50.8 million people living with diabetes currently in the country. The
International Diabetes Federation (IDF) estimates this number to rise to 70
million by the year 2025. So there is an urgent need for a national diabetes
control programme.

Women are as equally affected by diabetes as men. When compared with men, women
have a 50 percent greater risk of diabetic coma, a condition brought on by
poorly controlled diabetes and lack of insulin. Diabetes also poses special
challenges during pregnancy. Diabetes during pregnancy (gestational and type-1
diabetes) results in an increased risk for problems such as high birth weight,
birth defects, and other complications for the mother. It also puts the woman
and her child to an increased risk for developing type-2 diabetes later.

"Women who have uncontrolled or undiagnosed diabetes in pregnancy can have
several complications like: infertility, recurrent spontaneous abortions, higher
risk of congenital malformations in the developing foetus, cardiac
malformations, gastro-intestinal malformations etc. Moreover, they have a higher
chance of having a macrosomic baby who can have several complications in the
early neonatal period like hypoglycemia, hypocalcemia. A large baby can also
create problems during childbirth and lead to increased incidence of operative
delivery" said Dr Amita Pandey, a leading gynaecologist and Assistant Professor,
Department of Obstetrics and Gynaecology, CSM Medical University (CSMMU,
erstwhile King George's Medical College - KGMC).

Yet, diabetes as a maternal health issue is largely unaddressed in developing
countries like India. Gender inequality places a higher burden of social and
economic consequences of diabetes on women, while at the same time imposing
greater barriers to access to care. Diagnosis of gestational diabetes identifies
women as well as their children at very high risk of future diabetes. So
identifying and providing care for diabetes during pregnancy are crucial.

Dr Pandey rues that "doctors working in the smaller cities and in the peripheral
health centres, are not programmed to diagnose and manage diabetes in pregnancy.
Most of the times it goes unnoticed, and only when complications, like
congenital malformation or abortion, occur and the patient consults a
specialist, is it diagnosed. So although the health system is equipped to screen
for the disorder and diagnose it early (there are simple screening tests, like
the 50g, one hour blood sugar screening test, available to diagnose GDM in all
government hospitals), the doctors don't lay enough emphasis on this and often
overlook the problem. In fact, it may appear to be shocking, but in the state of
Uttar Pradesh at least, very often the doctors do not even get the haemoglobin
of the woman estimated during the entire pregnancy. So how can one expect them
to think about blood sugar screening to diagnose gestational diabetes? One may
justify it by calling it a result of system failure or adverse effect of
over-population, but we do fail on this aspect as far as public health services
are concerned."

A study carried out in 2004, by Diabetes Care and Research Institute, Chennai,
and the Tamil Nadu Health Department, in and around the rural/urban areas of the
city found a 13.8% prevalence of gestational diabetes. This prompted the Tamil
Nadu state government to make diabetes screening compulsory for all pregnant
women, since 2007. This needs to be emulated on a national level.

Dr Pandey agrees that "diabetes is perhaps a complication of the
super-mechanised lives we lead these days. We Indians have very poor dietary
habits--a high intake of simple carbohydrates and fats with very little physical
exercise. This results in fulminant diabetes in those (like Indians), who are
genetically predisposed for the same. Moreover, Indian women are more negligent
in controlling blood sugar levels and often end up with grave consequences and
complications of diabetes. They are also not able to spend sufficient money on
getting a proper treatment for themselves as the husband and the sons get a
higher priority as far as health and treatment expenditures are concerned."

So while on the one hand, we have an overburdened health system which is ill
equipped to conduct basic health checkups, on the other hand we have educated
but ignorant expectant mothers, who have been traditionally tutored to neglect
their own health. Little do they realize that undetected/untreated gestational
diabetes involves a higher risk of maternal and prenatal morbidity and poor
pregnancy outcomes.

Hence it is important that women shed their apathetic attitude and pay proper
attention to eating a healthy diet and to go for regular walks and other forms
of exercise. Merely doing household chores is not enough exercise. Exercise
lowers glucose levels, helps weight loss, maintains a healthy heart and helps
relieve stress. They also need to demand to have their blood sugar tested in
both the first and second trimester, if pregnant. It is to their advantage to
discover gestational diabetes early, if it exists.

Also, there is an urgent need for government action, to not only focus on women
with diabetes, but have compulsory screening for gestational diabetes in all
public/private hospitals. It should also be mandatory for all government/non
government enterprises and educational institutions to have annual health tests
for diabetes and other non-communicable diseases for their staff.

In the words of Dr Anil Kapur, President of the World Diabetes Foundation (WDF),
"focussing on gestational diabetes is a low cost preventive way to improve
maternal and child health, and a small investment in providing screening for
mothers at risk for gestational diabetes is likely to have an impact on the
beneficiaries as well as on health care systems and budgets." (CNS)

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the
Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI).
She has worked earlier with State Planning Institute, UP, and teaches Physics at
India's prestigious Loreto Convent. Email: shobha@..., website:
www.citizen-news.org)

Online at:
http://www.citizen-news.org/2010/09/not-screening-for-diabetes-during.html

To read the latest issue no.89  of CNS Diabetes-News-in-Spotlight , click here  or go to: http://diabetes.citizen-news.org/2010/11/cns-diabetes-news-in-spotlight-30.html 

CNS Diabetes News In Spotlight: 30 October - 05 November 2010

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CNS Diabetes News In Spotlight is produced by CNS Diabetes Media Initiative,facilitated by Jay-Inspire Co., Ltd., Thailand

CNS Diabetes News In Spotlight: 27 November - 03 December 2010

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CNS Diabetes News In Spotlight is produced by CNS Diabetes Media Initiative,facilitated by Jay-Inspire Co., Ltd., Thailand

CNS Diabetes News In Spotlight: 04-10 December 2010

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CNS Diabetes News In Spotlight is produced by CNS Diabetes Media Initiative,facilitated by Jay-Inspire Co., Ltd., Thailand