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Sunday, 23 October 2016

Prompt intervention can help lower blood sugar and bad cholesterol: medical experts

Doctors from all over India deliberated that changing lifestyle, coupled with genetic pre-disposition have adversely affected the young generation of India’s population. The doctors were speaking on the sidelines of Protect Young India Summit, hosted by the NCD PreDisease Forum in New Delhi.

Deliberations were based on the findings of the ESSENS study, conducted across India to evaluate the efficacy and safety of food-derived bio-actives in lowering the risk factors for heart disease and diabetes. 

ESSENS, a multicentre, randomized, double-blind study was a first of its kind study conducted at 16 centres across India under the guidance of Dr Naresh Trehan from Delhi, Dr. Ravi Kasliwal from Delhi, Dr. Hemant Thacker from Mumbai and Dr Sanjay Kalra from Karnal. 27 clinicians participated as investigators. The ESSENS study has been published in the North American Journal of Medical Sciences (NAJMS) and the international journal -NUTRITION.

This burden of premature cardio-metabolic diseases on the productive workforce aged 30–60 years is cause of larger social and economic concern, said experts. 

Diabetes and heart disease present serious health challenges for India. Guidelines governing treatment mandate that prescription drugs usually come into play only after the confirmed diagnosis of the condition (diabetes or high cholesterol).  

This also implies that for a large section of population that is on the cusp of these conditions, which is known as the pre-disease state, with higher than normal blood sugar and cholesterol levels, there is no pre-emptive intervention presently possible. Lifestyle modifications are one possible pre-emptive avenue but experience has shown that these often do not have desired impact due to low compliance.

“We need to focus on delaying the onset of disease in this at risk population using novel lifestyle interventions or interventions through food - derived bioactives in high risk population there by saving huge expenses and complications of disease”, said Prof. N K Ganguly, former director-general of Indian Council of Medical Research (ICMR) and director of the NCD Pre-Disease Forum, India, an affiliate of the Global Forum. 

“India has a high burden of non-communicable disease. We are facing a perfect storm of compounding factors which is unique in almost every aspect- epidemiology, genetics, patient beliefs, availability of resources, and finally, governmental will and efforts to fight them. But, policy interventions by government or awareness campaigns will be effective only when individuals take pro-active steps for their own health care”, he added.

According to Dr. Ravi Kasliwal, chairman – Preventive Cardiology, Medanta- The Medcity, “Every day at Medanta we see younger and younger adults coming in with heart attacks. This in not only a tragedy for the individual, but has consequences for the family and society as a whole. It is imperative we focus on solutions which young people can adapt easily and set achievable goals, for example, lowering the LDL-Cholesterol to 100 mg/dL”.

Dr. Abraham Oomman, a senior consultant cardiologist from Chennai, one of the investigators in the study, said “The ESSENS data showed that most subjects could achieve the goal of LDL-Cholesterol level of 100 mg/dL during the period of the study using the investigational bio-active”.  

He went on to add “Now, this bio-active is included in the 2016 clinical practice guidelines to lower cholesterol by the European Society of Cardiology.”

The meeting was focused on solutions particularly geared for the at risk population and the educated workforce, Dr. Sanjay Kalra, executive editor of the Indian Journal of Endocrinology and Metabolism said, “Instead of diabetes, we should focus on the pre-diabetes state, where we have the best opportunity to reverse the course of the young individual’s future health.”  

He further added, “In fact, the guidelines also clearly state that lifestyle modification and nutritional intervention should be tried before any medication for a newly diagnosed patient with increased blood sugar.” 

Dr. Banshi Saboo, secretary of the Diabetes-India, added “ESSENS studied the efficacy and safety of well-known ingredients in our food supply in lowering blood sugar levels in newly diagnosed subjects”.

“We must intervene earlier before our patients develop disease. But, in order to do that, the first step is to recognize the entity of pre-disease,” said Dr. Hemant Thacker, a leading doctor from Mumbai. “While there is no complete cure, we should, in the least, know when and with what to pre-emptively strike disease from progressing, in the pre-disease stage,” he added.

South Asians, including Indians, have a greater pre-disposition towards lifestyle diseases. Even in the US, the MASALA (The Mediators of Atherosclerosis in South Asians Living in America) study currently underway, aims to understand what factors lead to the magnitude of heart disease among South Asians.

The Pre-Disease Forum represents a cross-section of the public from physicians, patients, media, policy makers, celebrities, industry representatives, and other key healthcare stakeholders. The Forum’s goal is to bring the attention to earlier intervention in the pre-disease state of NCDs (Non Communicable Diseases). 

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