The GDM (Gestational Diabetes Mellitus) rate in India is 26.3%, which is highest in the world, according to Dr Nam Han Cho. Gestational diabetes is a serious form of diabetes which occurs during pregnancy.



New Delhi: Dr Nam Han Cho, president-elect of International Diabetes Federation (IDF), was recently in India to co-inaugurate Dr Mohan’s International Diabetes Update 2017. A world renowned diabetes epidemiologist, Dr Cho has published over 80 peer reviewed papers on type-1 & type-2 diabetes and gestational diabetes. He is also founder of the type-1 diabetes registry in Korea and is also responsible for estimating the prevalence of type 2 diabetes for the Korean population.

In an email interview with ETHealthworld, Dr Nam Han Cho provided insights on to the state of diabetes in India.

How do IDF’s South East Asia regions function? What are your observations/findings in diabetes for India?

The South East Asia (SEA) region is one of the seven IDF regions. It is the most active region for promoting diabetes awareness and advocacy, providing patient & professional education and humanitarian support, hosting numerous international congresses for professionals, as well as conducting quality public health and clinically related diabetes researches.

Diabetes in India is a more serious problem than in other parts of the world. Indians stand at second highest number of people living with diabetes, especially highest in gestational diabetes in the world. A rapid economic growth, sedentary lifestyles and urbanization alter national culture and social structures, and eventually will put more people at high risk of diabetes in the future.

What do you have to say about high glycaemia cases in pregnancy? What are the solutions to such cases? How is the situation in India?

GDM (Gestational Diabetes Mellitus) issues in India are more problematic than the rest of the world. We do not know the exact cause but Indians are at higher risk for gestational diabetes. Gestation diabetes is a serious form of diabetes which occurs during pregnancy. The GDM rate in India is 26.3%, and it is the highest in the world. GDM has significant adverse health impacts on both foetus and mother. Offspring of GDM shows increased risk of both short-term and long-term adverse health effects. For short-term adverse effects, numerous reports show increased frequency of macrosomia, hypoglycaemia, persistent hypoglycaemia, hypocalcaemia, hyperbilirubinaemia, transient tachypnoea, polycythaemia, respiratory distress syndrome and intra-uterine growth retardation. For long-term adverse health effects, ailments like central nervous system (CNS), congenital heart disease, respiratory disease, intestinal atresia, anal atresia, renal & urinary defect, upper limb deficiencies, lower limb deficiencies, upper + lower spine, and caudal dysgenesis have been reported. Furthermore, there are high chances of pre-diabetes and diabetes in the offspring of GDM. Thus, the best solution to solve these problems is to detect GDM at early stage of pregnancy by frequent screening. It is also advisable to control high glucose level throughout the pregnancy.

What latest have you observed in diabetes for the year 2017, specific to the Southeast Asia population?

The latest issues of diabetes in SEA are inclining number of diabetes cases, increased level of obesity with limited access or no access to medicine and/or medical care. The Southeast Asian population has also been presented with a high number of undiagnosed diabetes cases, more than 52% cases, as well as a high level of diabetes related mortalities in people less than 60 years of age. All these were discussed in the 4th edition of ‘Dr Mohan’s International Diabetes Update’ in Chennai.

What are the global challenges involved in endocrinology? What solutions could be implemented?

The global challenge in endocrinology is how to win the war against diabetes. We have observed that every 7 seconds, one person dies from diabetes-related complications. In 2015, diabetes caused almost 5 million deaths worldwide, almost half of them were people under 60 years of age. Diabetes intersects with all major dimensions of global development, including poverty reduction, gender equality or education. The costs of treatment and care push individuals and households into cycles of catastrophic expenditure and impoverishment. Also, poverty and the social determinants of health increase exposure and vulnerability to diabetes. Diabetes is currently unstoppable, thus utilization of risk factors for undiagnosed cases and identification of high risk populations accompanied with early management may be the roles for endocrinology to stop the war against diabetes.

What would be the one thing that you wish to bring in India for diabetes care?

If I may, one thing I wish to bring in India for diabetes care is a message, “Learn how to live with diabetes”. Diabetes is no longer stranger to us or Indians. It is a part of our life. No one is protected from diabetes and no places are safe from diabetes. Thus, it is better to learn how to live with it. The best way to win a war is to know your enemy better. In other words, learn to live with diabetes so that we know how to prevent, manage and live normal life without fear of diabetes.

What are the future plans for IDF, anything in plans specific to India?

IDF is an international organization consisting of almost 170 countries with more than 230 member associations. Our strength is global network, thus our plan is to tackle diabetes at international level but focus on each region including each country’s culture, economic status and social structures. IDF’s long-term plans are to strengthen diabetes education for both patients and healthcare providers via IDF School of Diabetes, diabetes retinopathy screening project in low and middle income countries, diabetes foot care project, humanitarian “diabetat” project, diabetes in women, and blue circle voice for advocacy are in the packet as the future plans.

For India, IDF hopes to see that Indian women leaders take the “Diabetes in Women” project into the future and nurture it to become the reference model for better care of women living with diabetes, as well as promote it to be the global women’s health project.