Diabetes And Kidney Disease In India
Dr. Ajay K. Singh
The World Health Organization (WHO) has forecast that diabetes rates
worldwide are growing in epidemic proportions. It is estimated that by
2025 over 100 million people will have diabetes in South Asia – in
India alone 57 million will be affected. While in the developed world,
the complications of diabetes are frequently treatable, in India this
is far from true. (Dr. Ajay K. Singh,
is a kidney specialist in Boston, USA, and is on the Harvard Medical School faculty. He is leading a program termed “Screening and Early Evaluation of Kidney Disease (SEEK) based in India at 10 leading centers and targeted at screening and early detection of kidney disease.
One of the most common complications of diabetes is kidney disease.
Approximately 5 to 10 years after the onset of diabetes, the kidneys
frequently become affected. If diabetes in its early phase goes
undetected and uncontrolled the likelihood of getting kidney
involvement is high. Over 30 to 40% of diabetics may eventually develop
kidney disease. Once the kidneys become involved they start leaking
protein and kidney function suffers. High blood pressure also develops.
As kidney function worsens other complications of kidney disease
ensure, including anemia and bone disease. Continuing to tightly
control the blood sugars remains a key issue, but control of blood
pressure and the use of kidney protective drugs is also paramount. The
use of drugs such as angiotensin converting enzyme inhibitors (ACE
inhibitors – for example, enalapril or lisinopril) or angiotensin
receptor blockers (ARBs – for example, losartan or irbesartan) becomes
The problem for the developing world is that there are few if any
programs targeting early detection of diabetes and kidney disease. As
well, medications for the treatment of blood pressure and for kidney
protection are out of the economic reach of most of the population.
Once kidney disease progresses to kidney failure the situation becomes
dire. In India, relative to the average income, dialysis and kidney
transplantation are expensive and not feasible. As well, most people
either have no access to a dialysis facility or are unaware that these
are treatment options. In over 90% of people developing kidney failure
in India the outcome is death. In 2005, it is estimated that over
100,000 people died because of kidney failure.
The cost of dialysis in India is approximately 1000 rupees per
treatment. At a minimum, kidney failure patients need dialysis 2 to 3
times each week – amounting to 2 to 3 thousand rupees in direct
expenditure. Adding to this cost is the money that needs to be spent on
medications such as epo (to maintain the blood count) and vitamin D (to
maintain healthy bones). Most people in India cannot afford to pay this
amount of money for treatment even on a short-term basis.
The case for early detection and prevention can be made on economic
grounds alone. The human case is obvious and greatly tragic. If
diabetes can be detected early then attempts to prevent kidney disease
can be vigorously pursued. Once the earliest stages of kidney disease
become apparent, preventing progression of kidney disease to kidney
failure is important. Unfortunately, the public health care system is
starved of resources and doctors can scarcely take care of the patients
they already manage. What is urgently needed is a concerted effort
involving leaders in India as well as those in the developed world to
formulate a strategy to deal with this evolving crisis.
If we have learnt anything from the AIDS crisis in Africa it is that a
multi-pronged international effort is needed. It needs to start now and
it needs to focus on prevention. Recognizing that both governmental and
non-governmental organizations (NGO’s) need to be involved is key. Like
the AIDS crisis, both governmental funds and private donations will be
required. At least one aspect of the response to this crisis needs to
be an embrace of education targeted at increasing awareness among the
population. There also needs to be a focus on developing inexpensive
screening methods – their value evaluated through the prism of what is
pragmatic in a developing country. Changing the medical and health
curriculum towards chronic diseases such as diabetes and kidney disease
also needs to be a goal because we need skilled doctors and nurses to
take care of these patients. As a start, we need to develop pilot
programs that can test out strategies aimed at education and
prevention. With the size of the impending diabetes and kidney failure
epidemic there is no time to wait.
One such early detection program has begun in Saragur at the HD Kote
Taluk near Mysore, Karnataka. The project is part of the “Screening and
Early Evaluation of Kidney Disease” (SEEK) project. The SEEK project
has 11 sites in India, including several academic centers who are
participating. The project is coordinated out of the Brigham and
Women’s Hospital in Boston. The Boston team comprises of Dr. Ajay K.
Singh, Dr. Bharati Mittal, and Paula Hertello. The SEEK program is
supported by the Indian Society of Nephrology and is funded by
Janssen-Cilag, a member of the Johnson and Johnson global family.
The HD Kote project is being conduced under the aegis of the Swami
Vivekananda Youth Movement (SVYM) -- a leading Indian NGO that has
achieved many ground-breaking accomplishments in community health care.
The plan is to embark on a kidney disease and diabetes screening
program. The first screening was held this week and over 60 subjects
were enrolled. Led by Dr. Sreedhara, a nephrologist at Apollo Hospital
in Bangalore and Dr. Seetharam a pathologist at SVYM, the pilot program
aims to understand the prevalence of diabetes and kidney failure in
this rural population.
The progress that’s already been achieved by the SEEK project
emphasizes that, for a country as vast and complex as India, more
initiatives are needed. More people need to get involved: more
private-public, national-international collaborations are essential. If
we can recognize diabetes and kidney disease early and consequently
prevent kidney failure we would have wisely learnt lessons from the
AIDS crisis in the developing world: being pro-active and open to
innovative ideas aimed at prevention may be able to prevent a huge
human and economic calamity.
|1.gmfisnynd December 8, 2020
|2.gqortpv November 30, 2019
|3.new cartoon movies August 12, 2013
|4.fresh men pics April 18, 2013
|5.new video August 20, 2012
|6.where to buy cheap cialis May 1, 2012
|7.replica watches technomarine March 29, 2012
|8.replica watches from dubai March 29, 2012
|9.iWWipnSJIgDKgEybnEw February 15, 2012
|10.iSValfXYGYhKh February 12, 2012
|11.PKRLCZVXNxYFrzSFI February 10, 2012
|12.hovmSRdLWeDQBJo February 9, 2012
|13.RTuMhIaxFQtPiPs February 6, 2012
|14.FlXUIDzOxYLCwGWkH January 26, 2012
|15.QdwwVHUrfJuvefRhhyT January 26, 2012
|16.PTNtIiTYsmNbY January 25, 2012
|17.xNhTTNPAiItNvgQu January 23, 2012
You may also access this article through our web-site http://www.lokvani.com/
Mr. Bhushan Akshikar, Dr. Ajay Singh and
Dr. Bharati Mittal.