Diabetes Epdemiology

1. Diabetes: Prevention
Through
Lifestyle Modifications
Dr. Rahul Netragaonkar
Professor,
Dept. Of Community Medicine
ZYDUS MEDICAL COLLEGE.
DAHOD 1

2. Disclaimer
“The information, including but not limited to,
text, graphics, images and other material
contained in this presentation are for
informational purposes only.
Interventions mentioned here are mere adjunct
to the mainline treatment and not to replace it,
without professional medical advice.”
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3. The Secret Of Good Health (आरोग्य हेतव)
नित्यं नहताहारनवहारसेवी समीक्ष्यकारी
नवषयेष्वसक्त:।
दाता सम: सत्यपर: क्षमावािाप्तोपसेवी च
भवत्यरोग:॥
Ashtanga Hridayam. (Vagbhata, 6th century
AD)
He, who indulges daily in healthy foods and activities,
who discriminates the good and bad of everything and
then acts wisely,
who is not attached too much to the objects of the senses,
Who, develops the habit of charity,
of considering all as equal, of truthfulness, of pardoning and
keeping company of good persons only, becomes free from
all diseases. 3

4. Time To Turn The Tide Back….
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5. WHYSHOULD WE PREVENTDIABETES?
To reduce human suffering
Improve Quality of Life of
individuals
Reduce the number of
hospitalization
To reduce human suffering
Reduce mortality from diabetes
Prevent Sudden cardiac death 5

6. Know the warnings….Early Diagnosis
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7. Urban – Rural Effect
•There is positive association between
Urbanisation & higher prevalence of
Type 2 Diabetes
•Population density and GDP are the
main determinant of diabetes
•Globalisation is playing an important
role in the rise of T2D worldwide
•Epidemiological and nutritional
transition
•Westernisation of the diet
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8. Diet
 Replace refined carbohydrates
with wholegrain foods & nuts
 Low Glycemic Index food
 Eat less salt
 Drink plenty of water
 Eat less red and processed
meat
 Eat more fruit and veg
 Choose healthier fats
 Cut down on added sugar
 Consume more amount of fiber
 Drink alcohol sensibly
 Increase intake of vegetables
 Other foods high in dietary fiber.
 No Junk food
 Go Organic: Detoxify, Helps to
shed weight naturally &
Rejuvenate body
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9. Junk food & Diabetes
•Highly calorific
•Nutritionally poor
•Low in fiber
•High in fat, sugar and salt
•May include additives such as Monosodium Glutamate
(MSG)
•May contain trans fats
•Often contain processed meats
•Can have addictive properties
•Research indicates that fast food promotes Insulin
resistance, which can lead to type 2 diabetes, as well as
weight gain 9

10. Meal Timings
•Regular & Fixed Meal timing helps with blood sugar
regulation
•Meal timings help regulate your internal clock
•Better glycemic control
•Better eating control
•Better energy levels
•Better biological balance for the body
•Have breakfast within an hour and half of waking up.
•Eat a meal every 4 to 5 hours after that.
•Have a snack between meals if you get hungry.
• Dinner ideally before sunset or 2 to 3 hrs before sleep 10

11. Exercise & Diabetes Mellitus
•The best time to exercise is one to
three hours after eating, when your
blood sugar level is likely to be higher
•Activities like brisk walk for 40 min
•Cycling
•Skipping , Dancing, Running ,
Swimming
•Push-ups, Lunges, and Squats
•Aerobic exercises like walking,
running, hiking, swimming, skiing,
and dancing are all
considered isotonic exercise. 11

12. Exercise reduces risk of DM
12

13. WEIGHT REDUCTION
 Weight reduction as little as 5% to
10% of body weight in
overweight people may
fundamentally lower
cardiovascular risk.
 For most patients, a normal
weight reduction of 10 kg can
helps in reduction of insulin
requirement, 13

14. YOGA
Enhance the body Immune System
Reduces Stress, reducing Glucagon
Increases Blood flow & slow the heart
rate
Reduces the feeling of Depression, ,
Anxiety, Anger & Confusion
Increases Energy level
Eg. Bhujangasan, Uttanasan,
Trikonasan, Halasan, Salabhasan,
Dhanurasan, Sarvangasan &
Matsyasana 14

15. Herbal & Ayurvedic Medicine
•Allium sativum: (Garlic)
•Allium cepa: (Onion)
•Aegle Marmelos: (Bel or Bilva)
•Cinnamon (Cinnamomum zeylanicum
•Momordica Charantia: (Bitter Gourd)
•Ocimum sanctum: (Holy Basil)
•Trigonella foenum graecum: (Fenugreek)
•Tinospora cordifolia: (Guduchi)
•Eugenia jambolana: (Indian gooseberry, Jamun)
•Azadirachta indica: (Neem)
•Aloe vera and Aloe barbadensis
•Acacia arabica: (Babhul) 15

16. MEDITATION
•Minimizes stress,
•Reduces blood sugar levels
•Decreases Insulin level
•Decreases HbA1c
•Decreasing the risk of
cardiovascular disease.
•A 10-15 minute meditation helps in
reducing your stress and keeps your
blood sugar level in check.
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17. MINDFULNESS
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18. Pollution
•Air pollution is a novel risk factor
for insulin resistance and
occurrence of type 2 diabetes
•Air pollutants (e.g., PM and
NO2) are associated with higher
odds of diabetes.
•Air pollution is associated with
dysregulation of Glucose
metabolism.
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19. Stress Management
• Perform yoga/meditation.
• Perform deep breathing exercises
(avoid if hypertensive)
• Listen soothing music
• Visit place of worship.
• Share your problems with your
family members or friends. 19

20. ♪ Listening to music relaxes blood vessels.
♪ In 2008, the journal Circulation reported on subjects who
listened to music that “evoked joy.”
♪ Their upper arm arteries expanded by an average of 26%.
♪ Listening to music reduces levels of stress hormones such as
cortisol.
♪ Music strengthens the immune system.
♪ Music can help improve mental balance.
♪ Sleep and eat better.
♪ Music reduces anxiety.
♪ Atharva - Vedic Richa For Diabetes | Ashwini Bhide Deshpande |
Times Music Spiritual
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21. Improving Sleep
 Some research suggests that
 Not getting enough sleep
may impair insulin use and
increase the risk for obesity.
 It is always wise to improve
sleep habits
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22. Family relationships/social pressures.
High levels of family
conflict and family
distress are linked to
higher HbA1c’s in
kids/teens with diabetes.
Contentedness of life
Family support is crucial
Harmonious relationship
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23. Prevention of Dementia due to Diabetes
•Type 2 diabetes mellitus (DM) has been shown to increase the risk for
•Cognitive decline
•Dementia, Alzheimer disease (AD) and
•Vascular dementia (VaD).
1 Eat a healthy diet rich in vitamin D, folate, and B6 and B12
2 Exercise regularly – both your body and mind,
3 Stay socially active and challenge yourself daily, and
4 Protect your head when playing sports.
•Is Alzheimer’s disease actually “Type 3 diabetes”?
• Increased risk of dementia in T2DM and obesity could be linked to chronic
hyperglycemia, peripheral insulin resistance, oxidative stress, accumulation of
advanced glycation end products, increased production of pro-inflammatory
cytokines, and/or cerebral microvascular disease
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24. Dr. Dixit Sir Diet Plan
• Based on Known and proven
principle of ‘Intermittent Fasting’
• Fixed Meal timings, reduces
frequency of Insulin secretion
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25. Socio-cultural Barriers For Diabetes
Control
Obesity is not considered negatively
Fad Food Culture has
caught up
Changing diet is very
difficult
No value given to physical exercise
No time for physical
exercise at work
Fatalism
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26. ABCDEF of Diabetes Control
A- HbA1c Control to keep it at <7.0%
B- Blood pressure Control (<140/90mm Hg)
C- Cholesterol Control to keep your LDL below 100
mg/dL
D- Diet & Drug.
E- Exercise & Eye check up every 2 years thereafter
F- Foot Care on regular basis.
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27. T
AKE HOME MESSAGES…
• Type 2 diabetes can be prevented
• Glycemic control
• Low GI diet with lots of GLV
• Blood pressure Control
• Exercise
• Stop Smoking
• Lifestyle interventions are effective in
prevention 27

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29. References
• Textbook of Preventive & Social Medicine. K. Park, 23rd edition
• Text-book-of-public-health-and-community-medicine_compress.pdf
• Pollution and Diabetes - Diabetes Self-Management (diabetesselfmanagement.com)
• Air pollution and diabetes: it's time to get active! - The Lancet Planetary Health
• The Role of Exercise in Diabetes - PubMed (nih.gov)
• Effect of 6 Months of Meditation on Blood Sugar, Glycosylated Hemoglobin, and Insulin Levels in
Patients of Coronary Artery Disease
• https://pubmed.ncbi.nlm.nih.gov/31062329/
• https://adoretrust.org/eng/dr-jagannath-dixits-diabetes-reversal-and-effortless-weightloss-programme/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/
• https://www.cdc.gov/diabetes/managing/eat-well/meal-plan-method.html
• https://ayushnext.ayush.gov.in/detail/writeUps/what-is-a-healthy-lifestyle
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2275761/
• Urbanization and prevalence of type 2 diabetes in Southern Asia: A systematic analysis (nih.gov) 29

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