In Pakistan, there has been a significant surge in diabetes cases, prompting us to question what factors have led to this alarming growth. Bhutta, Haq, and Basit delved into this concerning issue in an article published in The Lancet last year, writes Zafar Mirza, former SAPM, in Dawn. The root causes of this crisis are intricate and stem from a blend of genetic and environmental influences. But what precisely has changed in terms of genetics and the environment that has precipitated this critical situation? Let’s delve into the details.
Researchers have pinpointed specific genes associated with diabetes and their various variants. The relevance of genetic factors is magnified due to the prevalence of marriages between close relatives, known as consanguinity. With a high rate of consanguineous unions in Pakistan, the likelihood of genetic traits manifesting increases. Consequently, the occurrence of diabetes becomes more probable due to repeated marriages within families.
Nevertheless, the crux of the problem lies in the realm of the environment. The drastic and adverse shifts in our lifestyles and dietary habits are primarily held accountable for the widespread prevalence of diabetes. This issue is not isolated; other non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, and chronic respiratory ailments share the same connection with environmental and behavioral factors. These factors encompass unhealthy eating habits (malnutrition), a lack of physical activity (leading to obesity), smoking, high blood pressure, air pollution, and stress. All of these are categorized as high-risk elements. The shift from rural to urban living has also significantly contributed to the rise in non-communicable diseases. Analyzing the past three decades, the data indicates that in 2010, more deaths in Pakistan were attributed to NCDs compared to infectious diseases for the first time.
So, what can be done to address this issue? The crucial steps include prevention, early diagnosis through large-scale screenings, and effective management. Yet, these steps are easier said than done, as they necessitate a comprehensive healthcare system response. This response entails the integration of preventive, promotive, curative, and rehabilitative health services at all tiers of the healthcare system, especially at the primary healthcare level. Coping with the onslaught of NCDs, including diabetes, cannot be solely managed by large hospitals. Instead, it requires a robust primary healthcare sector, involving adequately trained community health workers, and a lifelong continuum of care. Our existing healthcare system is ill-equipped to tackle the diabetes epidemic; addressing it demands a sustained and well-coordinated effort from all sectors of the government and society. The private healthcare sector should also be actively engaged.
Professor Abdul Basit, the head of the Baqai Institute of Diabetes and Endocrinology, is a leading figure in diabetes research in Pakistan, striving to reverse the trend. He has spearheaded national diabetes surveys, registries, and research, contributing significantly on both national and international levels. He has formulated a plan to establish a nationwide diabetes network encompassing 3,000 NDN clinics across the country, facilitated by private providers. These clinics are designed to provide equitable and high-quality care to individuals with diabetes.
With nearly one in every four adults in Pakistan affected by diabetes, it is imperative for all of us to assess our risk scores and take appropriate action. This entails adopting a wholesome diet and lifestyle and, if necessary, consulting competent healthcare professionals. A locally developed risk score calculator tailored to Pakistan’s context is accessible. Properly managed, individuals living with diabetes can lead fulfilling and prolonged lives.