Exercising for at least half an hour every day imperative to prevent Type 2 diabetes complications

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Doctors should motivate patients to undertake a regular exercise routine

New Delhi, 6 February 2019: Patients with Type 2 diabetes should be prescribed physical activity to control their blood sugar and improve heart health, recommends a position paper from the European Association of Preventive Cardiology. The paper provides practical recommendations for doctors on how to motivate patients to incorporate physical activity into their daily routine, set achievable and measurable goals, and design customized exercise-training programmes to meet these goals.

Increasing cardio-respiratory fitness (CRF) and glycemic control are key clinical targets of exercise training programmes in patients with type 2 diabetes with cardiac co-morbidities, the paper recommends. It adds that patients should be evaluated for CRF to classify them according to their risk and optimal exercise prescription.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “A high-calorie diet rich in processed and junk food, obesity, and inactivity are some of the reasons for the increased number of younger people with diabetes in the country. Not getting checked in a timely manner and not following the doctor’s protocol further complicates matters for them, putting them at a risk of acquiring comorbid conditions at a relatively younger age. About 30 minutes of physical activity in any form every day can not only prevent and manage Type 2 diabetes but also a host of other health conditions and associated complications. There is also a belief that because young people with Type 2 diabetes do not need insulin, it is not as sinister as it seems. However, this is a false notion. This condition requires immediate treatment and management.”

The symptoms of Type 2 diabetes include increased thirst and hunger, frequent urination, weight loss, fatigue, blurred vision, slow healing of infections and wounds, and skin darkening in certain areas.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Small and gradual changes can be made in the family will also be encouraging for youngsters for a healthy lifestyle. These can help youngsters lose weight (if that is the issue) or help them make better eating choices, thereby lowering the chances of developing Type 2 diabetes. This is truer for those with a genetic susceptibility to the condition. Operating as a team, a family, is much more likely to be successful.”

Some tips from HCFI

·     A diet rich in whole grain, fruits, and vegetables is very good for the body. Fibrous food will ensure that you feel fuller for a longer period and prevent any cravings. Avoid processed and refined food as much as possible.

·     Limit your alcohol intake and quit smoking. Too much alcohol leads to weight gain and can increase your blood pressure and triglyceride levels. Men should limit drinks to two per day and women to one per day. Smokers are twice as likely to develop diabetes as non-smokers and therefore, it is a good idea to quit this habit.

·     Understand your risk factors as it can help you in taking preventive measures at the earliest and avoid complications.

Hepatitis B and Hepatitis C Program should be integrated with National AIDS Control Program

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India has the worlds third largest number of people with HIV, next to South Africa (7.1 million) and Nigeria (3.2 million). As per HIV Estimations 2017 report, India has around 21.4 lakh people living with HIV (PLHIV) with adult prevalence of 0.22% vs 3.2% in Nigeria vs 18.8% in South Africa.

India has a National AIDS Control Programme (currently NACP IV) since 1992, when NACP I was launched and the National AIDS Control Organization (NACO) was constituted to implement the programme.

The main objective of NACP IV is to reduce new infections by 50% (2007 Baseline of NACP III) and provide comprehensive care and support to all persons living with HIV/AIDS and treatment services for all those who require it.

The HIV Estimations 2017 has acknowledged the significant impact of the National AIDS Control Programme on new infections and AIDS-related deaths. There has been more than 80% decline in estimated new infection from peak of epidemic in 1995 as well as 71% decline in AIDS-related deaths since its peak in 2005.

However, challenges still remain.

One such challenge is co-infection with hepatitis B and hepatitis C viruses. Important thing is prevention of AIDS should also reduce isolated cases of hepatitis B and C.

This is of public health concern because HIV and viral hepatitis coinfection can complicate the management of HIV infection. Also, progression of liver disease to cirrhosis and hepatocellular carcinoma is faster in co-infection; moreover, they may not respond well to treatment. Mortality is higher in these patients.

HIV, hepatitis B and hepatitis C have similar routes of transmission. They spread by contact with infected body fluids such as blood, semen and vaginal fluid or sexual contact with an infected person or via injection drug use (sharing contaminated needles, syringes) or from a mother to her baby during pregnancy or delivery. Needle stick injuries or exposure to splashes of blood are major routes of hepatitis B transmission.

Because of these shared routes of transmission, people at risk for HIV infection are also at risk for hepatitis B or hepatitis C infection and also vice versa.

Of the three blood-borne viruses (Hepatitis B, hepatitis C and HIV), hepatitis B is the most infectious. The HIV virus lives for 24 hours in dried blood at room temperature. Hepatitis C virus can survive on environmental surfaces for up to 16 hours. It can also spread from infected fluid splashes to the conjunctiva.

The hepatitis B virus can survive in dried blood on floors and tables at room temperature for up to 7 days and remains capable of causing infection. Hepatitis B is therefore a more dangerous infection than HIV. Preventing hepatitis B will also prevent HIV.

The government launched a National Viral Hepatitis Control Program for the prevention and control of viral hepatitis in India. With this program, India aims to eliminate Hepatitis C by 2030 and achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C (cirrhosis and hepatocellular carcinoma).

Instead of a separate national program for viral hepatitis (hepatitis B and hepatitis C), it should be integrated with the National AIDS Control Program. There can be a separate program for hepatitis A, which can also be made a part of National Diarrheal Diseases Control Program again because of shared routes of transmission.

The budget allocation for NACP should also incorporate the allocated budget for viral hepatitis.

The barrier method of contraception (condom) should also be a part of this program as they protect against STIs including HIV.

Take home points

Prevention of hepatitis B (and C) also means prevention of AIDS.
AIDS prevention with condoms is also linked to prevention of unwanted pregnancies.
Hepatitis C is curable; hepatitis B and HIV are manageable.
One national health program with common budget should handle both the prevention and the treatment.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA