PaDiabetes is the biggest Public Health challenge the World is facing today as it has assumed an epidemic proportion. Diabetes is the name of a condition where the blood sugar level consistently runs too high. In the previous generation, diabetes remained a disease of the affluent. The present scenario has changed dramatically. The disease has trickled down to the lowest strata of the society and has spread its tentacles far and wide. Diabetes has far reaching consequences as it affects the overall productivity of a person. The incidence of diabetes in a population is considered a significant health indicator. Diabetes adds to the public health burden of a country and causes a subsequent increase in health care costs. Diabetes contributes to DALY (Disability adjusted life year) which is a health indicator that is used to compare health of Nations as well as to describe its disease burden.
The statistics of diabetes is quite alarming. The WHO estimates that 180 million people worldwide are affected by diabetes. This figure is expected to double by 2030 (Wild et al, 2004) i.e.7.7% of the global population. Diabetes is projected to affect Indians most among all others in the World by 2025 (Ahuja, 1979). Over the next 20 years, the developed World will see an increase of 20% in the number of adults living with Diabetes and developing countries will see an increase of 69% (Shaw et al, 2010). As per the International Diabetes Federation (2013) approximately 50% of all people with diabetes live in just three countries: China, India and the USA. It is said that then every fifth diabetic subject in the world would be an Indian (Sicree et al, 2006).
India is called the diabetic capital of the world as major proportion of the World's Diabetic patients is in India. The Diabetes Atlas, 2006 published by the International Diabetes Federation, expects the number of people with Diabetes in India to increase to 69.9 million by 2025. The so- called 'Asian Indian Phenotype' makes Asian Indians more prone to Diabetes (Joshi, 2003; Deepa et al, 2006). This term refers to the peculiar metabolic features of Asian Indians characterized by a propensity to excess visceral adiposity, dyslipidaemia with low HDL cholesterol, elevated serum triglycerides and increased small, dense LDL cholesterol, and an increased ethnic (possibly genetic) susceptibility to diabetes and premature coronary artery disease (Deepa et al, 2006; Joshi, 2003). Despite having lower prevalence of obesity when compared to western counterparts, which is defined by body mass index (B.M.I.), Asian Indians tend to have greater waist circumference and waist to hip ratio (Ramachandran et al, 1997) thus having greater degree of central obesity. A systematic review of longitudinal studies assessing the association between abdominal adiposity and incidence of type 2 diabetes by Freemantle et al, in 2008 establishes a strong association between measures reflecting abdominal obesity and the development of type 2 diabetes. In this context, it is worth mentioning the 'Thrifty Phenotype and thrifty Genotype Hypothesis' proposed by geneticist James V Neel (Neel; 1998). In both the theories, low birth weight plays an important role. Studies indicate that Asian babies have low birth weight compared to Caucasians predisposing Asian babies more to metabolic disorders (Hales and Barker, 1992). It is said that nutritional deficiencies inutero resulting in low birth weight leads to reduced beta cell mass (insulin producing cells in pancreas) or impaired beta cell function. These atypical beta cells may be unable to produce sufficient insulin in an individual's life which later on manifest as overt diabetes (Hales and Barker, 1992). The genotype hypothesis proposes that some genes are selected over previous millennia to allow survival in times of famine by efficiently storing all available energy during times of feast. These same genes lead to obesity and T2D when exposed to a constant high energy diet of the present generation (McCance et al, 1994). The result is widespread chronic obesity and related problems like diabetes.
According to one study conducted in India, Kerala stands number one in prevalence of diabetes i.e. 20% – more than double the national average of 8% (CADI, 2004). Though Kerala has high literacy, high life expectancy and other indicators of socioeconomic progress, one would expect a lower prevalence of heart disease and life style diseases like diabetes. But the truth is far from this. This is referred to as the 'Kerala Paradox'. Kerala Paradox refers to the unexpectedly and paradoxically high prevalence of lifestyle diseases – heart disease, diabetes, high blood pressure, and obesity resulting in very high mortality and morbidity (CADI Research Foundation, 2004). The crude prevalence of diabetes among 322 adults in an urban settlement in Central Kerala was found to be 16.3 percent (Kutty et al, 1999). In another study in southern Kerala the crude prevalence rate of diabetes among urban residents was 12.7 per cent compared to 2.7 percent among coastal residents (Kutty, 2000). The Amritha Diabetes and Endocrine Population Survey (ADEPS, 2005) identified 9 percent reported prevalence and 10.5 percent prevalence of newly detected diabetes among semi-urban and urban adult resident in central Kerala (Menon et al, 2006). Poulose and colleagues in 2002 Studied the profile and association of type 2 diabetes patients in more than 8000 patients and noted that more than 50% had a family history of type 2 diabetes mellitus. This rapidly changing scenario in Kerala may be due to socio-economic transition occurring in rural areas also. Environmental and life style changes resulting from industrialization and migration to urban environment from rural settings may be responsible for the increasing incidence of diabetes to a large extent. Availability of improved modes of transport has resulted in decreased physical activities. Better economic conditions have produced changes in dietary habits, replacing the traditional indigenous diet with fast food culture. The conditions seem more favourable for expression of diabetes in a population which seemingly has a racial and genetic susceptibility to the disease.
This study is confined to the Syrian Christians of Kerala who constitute an ethnic minority group. As per the 2001 census, of the total 32 million population of Kerala, the Christians constitute 6.5 million. The Syrian Christians numbering about 5 million form the largest group among the Kerala Christians.
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