Control and prevention of diabetes only way to prevent a grave crisis

Awareness could go a long way towards fighting and preventing diabetes. Diabetes is a group of metabolic diseases, clinically known as Diabetes mellitus (DM). Anyone who has high blood sugar either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced, is affected by Diabetes. Glucose is vital to human health because it's the main source of energy for the cells that make up muscles and tissues. Glucose is also the main source of fuel for the body. High blood sugar produces the classical symptoms of frequent urination, increased thirst and increased hunger. If anyone has diabetes, no matter what type, it means he has too much glucose in his blood though the reasons may differ and too much glucose can lead to serious health problems.

There are three main types of diabetes. Type 1 Diabetes results from the body's failure to produce insulin, and presently requires the person to inject insulin. Type 2 Diabetes results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. More people should know that type 2 is, to a large extent, preventable. The future need not be gloomy; a full and healthy life is possible with diabetes. That is a very important message for all affected by diabetes. The developing countries typically focus on communicable diseases. Non-communicable diseases like diabetes have been neglected in these countries for a long time. More attention is required urgently before these countries are overwhelmed by the diabetes epidemic.

The third type is Gestational Diabetes. It is triggered by pregnancy which to some extent can lead to insulin resistance. Because high blood sugar levels in a mother are circulated through the placenta to the baby, gestational diabetes must be controlled to protect the baby's growth and development.

The term diabetes, coined by Aretaeus of Cappadocia, was derived from the Greek verb diabaínein. In 1675, Thomas Willis added the word mellitus, from the Latin meaning "honey", a reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. Diabetes mellitus appears to have been a death sentence in the ancient era. Indian philosopher Sushruta identified diabetes and classified it as Medhumeha. The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (Madhumeha). In his 14 volume medical encyclopedia 'The Canon of Medicine',( 1025) Avicenna (980-1037) provided, for the first time , a detailed account on diabetes mellitus, "describing the abnormal appetite and the collapse of sexual functions," he also documented the sweet taste of diabetic urine. The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not further clarified until 1921, when Sir Frederick Grant Banting (1891-1941) and Charles Herbert Best (1899-1978) discovered an effective treatment-insulin injections. For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923.

The International Diabetes Federation (IDF) estimated that 7.2 million or 4.8 per cent of people living in Bangladesh had diabetes in 2007 and by 2025, that number is projected to grow to 9.2 million or 6.1 per cent of the population. This explosion in diabetes prevalence will place Bangladesh among the top ten countries in terms of the number of people living with diabetes in 2025.

The Bangladesh Diabetic Samity (BADAS), established on February 28  in 1956 with the initiative of Late National Professor Dr M Ibrahim (1911-1989), has the motto - look after all people with diabetes irrespective of their ability to pay, their status or other factors. [At the moment, three special days are observed in Bangladesh to generate awareness about diabetes. The days include: World Diabetes Day on November 14; Service Day on September 6, which is also the death anniversary of the late Prof Dr M Ibrahim; and Diabetes Awareness Day on February 28, which is also the foundation day of BADAS.]

BADAS has developed several institutions/projects and inspired a large number of affiliated associations spread all over the country to fulfil the mission. BADAS is self-reliant and not donor dependent. It is the pioneer, model and first success story of Public Private Partnership (PPP) development in Bangladesh as it has developed infrastructure through partnerships with the government. BADAS provides services to the affluent patients and even to people who don't have diabetes. Through a policy of cross-financing, the organisation then helps those living with diabetes through the surplus capital generated.

Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) is the central institute of BADAS which provides comprehensive diabetic healthcare to people. BIRDEM has been acclaimed as a model institution in Asia and the Pacific. The institute has: (a) 650 in-patient beds (b) A large out-patient programme. BIRDEM has about 0.5 million registered diabetic patients. More than 4,000 people visit BIRDEM every day. In view of this influx of patients treated every day, BIRDEM has been adjudged as a unique and successful health service provider across the globe. 

BADAS adopted a decentralised model and has spread care throughout the country. BADAS has 61Affiliated and 9 sub-affiliated associations in the country. These organisations have to follow certain standards. They must be democratic, transparent, must be run by social workers, and must be non-profit. Through these affiliated organisations, BADAS has been able to create comparatively excellent diabetes awareness. Bangladesh is a developing country, but in terms of awareness of diabetes she is far ahead of some developed countries. Here people in general are aware of the need to act to soften the possible impact of the diabetes epidemic

Research is another area where BADAS places great emphasis. Research is a tool for generating context-based knowledge and also for generation of skilled manpower. Recognising the contribution of BADAS in this sector, in 1982 the World Health Organisation declared BIRDEM as a collaborating Centre for Research on Prevention and Control of Diabetes.

Dr Muhammad Abdul Mazid is former secretary to the government and former chairman NBR.

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