The Dilemma of Diabetes Mellitus

Abstract

Diabetes Mellitus, a metabolic disease is achieving an epidemic proportion particularly in the developing countries including Pakistan. - In Pakistan current available data shows, the prevalence of type-II Diabetes Mellitus almost 10% in the adult population and is likely to be 12.5% in next 10 years. - In 2003 survey it was estimated that in Pakistan 6.9 million people are affected by Diabetes Mellitus, with the International Diabetes Federation estimating that this number will grow to 11.5 million by 2025, unless measures are taken to contain it. It is further estimated that an equal number of individuals have impaired glucose tolerance and impaired fasting glucose, and are equally prone to develop similar complications i.e. cardiovascular events as in Diabetes Mellitus. Diabetes is an independent risk factor for coronary artery disease and 50% of these patients also have associated hypertension. Similarly a significant number of Diabetics also have dyslipidemia and obesity as additional CV risk factors. The Framingham Study was one of the first to quantify the increased risk of cardiovascular mortality and morbidity in Type-II DM. It has further been established that cardiovascular disease is doubled in diabetic men and approaches four times in diabetic women3. In a study from Finland, it was observed that patients with Type-II Diabetes, with no known cardiovascular disease has same incidence of Myocardial Infarction and cardiovascular death as People without diabetes but who had suffered M.I, over a period of 7 years follow-up and similar were the results in 18 years follow-up, suggesting that diabetes mellitus is equivalent to Ischemic Heart Disease1,4,5. In a recent meta-analysis for the Emerging Risk Factors Collaboration from 120 prospective studies including 698782 diabetic patients without initial vascular disease, the risk of Coronary Heart Disease is doubled in men, and almost 3 times in women2. Similarly incidence of stroke, heart failure, and other CV diseases, is significantly increased. The incidence of peripheral arterial disease is almost 4 & 6 times and CV death 2 & 5 times in men and women respectively. Pakistan is a poor country and cannot afford to manage such a huge disease burden as estimated by IDF for the coming years. It is very important that we should try to prevent the disease and for that a strong public awareness campaign should be launched. We must educate our public especially the young population of changes in the life style, avoiding fast foods, cold drinks, and sugary foods. Also to discourage rich & fatty food items in order to cut down their weight and encourage physical activity besides controlling the DM in the patients to prevent complications.