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a proinflammatory state, leading to type 2 diabetes and ChD. role of stress and depression in the
development of t2DM is being implicated. the successes of primary prevention trials in t2DM
supports the notion that environmental influences were a cause of their t2DM and encourages
further to concentrate on earlier interventions.
better understanding of aetio-pathological genetic and environmental factors are suggesting
prevention should begin much before the stage of iGt, and interventions in high-risk subjects
i.e. families of people living with diabetes alone will not be sufficient. it is necessary to initiate
population based programmes for primary prevention of t2DM and must include a range of
activities targeted at different age groups from fetal life to old age.
Diabetes epidemic: need of Control programmes for the Community –
rising above the Limited Concept of primary prevention in individuals.
Prof. Madhur Dev Bhattarai
the prevalence of diabetes in migrant or urbanized asian indians, arabs, Chinese, africans, and
hispanics is already 14% to 20% and is above 30–50% in indigenous peoples of Canada, usa,
australia and pacific regions. the prevalence in the rural populations in such populations is also
rising due to increasing urbanization and temporary or permanent intra-country and inter-country
migration of the population. Cardiovascular disease alone also accounts for nearly 30% of all deaths
worldwide and 27% in low-income and middle-income countries. Glucose intolerance is one of the
major predisposing factors for deaths due to cardiovascular disease and is rapidly emerging as
a global health care problem that threatens to reach pandemic levels by 2030. even with such
dimension of public health burden of diabetes and glucose intolerance and its complications,
there is no formation and implementation of its control programmes for the community by the
responsible international health organizations. the major discussion and focus is just on primary
prevention of in individuals, which is frequently supported by the pharmaceutical industries.
With increasing obesity, decreasing physical activity, and rising life expectancy of population,
prevalence of diabetes increases. accordingly modest loss of excess weight and moderate-intensity
exercise has been recommended as primary prevention interventions in people, especially with
impaired glucose tolerance. ageing, sedentary life and obesity of people explain gradual rise in
europids leading to the current prevalence of 4–9% now rising over almost a century. in contrast
to europids, the degree of ageing or overweight or obesity predisposing diabetes has generally
been found to relatively less in different vulnerable populations, where diabetes prevalence has
paradoxically increased much rapidly over just a few decades, as among asian indians, arabs,
Chinese, africans, and hispanics. Due to the rapid transition in nutritional status of the populations
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