Diabetes is a group of metabolic diseases, clinically known as Diabetes mellitus, in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. Glucose is vital to human health because it’s the main source of energy for the cells that make up muscles and tissues, and that is why it is the main source of fuel of the body.
This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger). If anyone has diabetes, no matter what type, it means he has too much glucose in his blood, although the reasons may differ and too much glucose can lead to serious health problems.
There are three main types of diabetes: Type I diabetes results from the body’s failure to produce insulin, and presently requires the person to inject insulin (also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes). Type II diabetes results from insulin-resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. Acute complications out of this disease include hypoglycenia.
Serious long-term complications include cardiovascular diseases chronic renal failure adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.
The term diabetes was coined by Aretaeusus of Cappadocia, derived from the Greek verb diabainein. In 1675, Thomas Wills added the word mellitus, from the Latin meaning “honey,” a reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. Diabetes mellitus appears to have been a death sentence in the ancient era.
Indian philosopher Sushruta identified diabetes and classified it as Medhumeha. The ancient Indians tested for diabetes by observing whether ants were attracted to a person’s urine, and called the ailment “sweet urine disease” (Madhumeha). In his 14-volume medical encyclopedia The Cannons of Medicine (1025), Avicenna (980–1037) provided, for the first time, a detailed account on diabetes mellitus, “describing the abnormal appetite and the collapse of sexual functions,” and he documented the sweet taste of diabetic urine.
The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not further clarified until 1921, when Sir Frederic Grant Banting (1891-1941) and Charles Herbert Best (1899-1978) led to the availability of an effective treatment -- insulin injections. For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923.
The Bangladesh scenario
The International Diabetes Federation (IDF) estimated that 7.2 million or 4.8% of people living in Bangladesh had diabetes in 2007 and by 2025, that number is expected to grow to 9.2 million or 6.1% of the population. This explosion in diabetes prevalence will place Bangladesh among the top ten countries in terms of the number of people living with diabetes in 2025.
The Bangladesh Diabetic Samity (BADAS), established on February 28 in 1956 with the initiative of late National Professor Dr M Ibrahim (1911-1989), has a declared motto -- look after all people with diabetes irrespective of their ability to pay, status, or other factors. BADAS, turning 60 today, has developed several institutions/projects and inspired a large number of affiliated associations all over the country to fulfill the mission.
BADAS is self-reliant and not donor dependent. BADAS is the pioneer, model, and first success story of Public Private Partnership (PPP) development in Bangladesh, and it has developed infrastructure through partnerships with the government. BADAS provides services to the affluent and to people who don’t have diabetes and through a policy of cross-financing, and then help those living with diabetes with the surplus capital that it generates.
BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) is the central institute of BADAS which provides comprehensive diabetic health-care to the people. It is a unique creation of BADAS and has been acclaimed as a model institution in Asia and the Pacific. The institute has: (a) 650 in-patient beds, and (b) a large out-patient program.
BIRDEM has about 0.5 million registered diabetic patients, more than 4,000 people visit every day here, and out of these patients, 75-100 are new patients. In review of this influx of patients treated every day, BIRDEM has been adjudged as a unique and successful health service provider across the globe.
BADAS adopted a decentralised model and has spread care throughout the country. There are 61 Affiliated Associations, almost one in every district and 10 sub-affiliated at sub-district levels in Bangladesh. They are all affiliated with BADAS. They have to follow certain standards -- they must be democratic, transparent, must be run by social workers, and must be non-profit.
In that, BADAS has been able to create comparatively excellent diabetes awareness. Bangladesh is a developing country, but in terms of awareness of diabetes, she is far ahead of some developed countries. Here, people in general are aware of the need to act to soften the possible impact of the diabetes epidemic.
Research is another area where BADAS puts great emphasis and this is unlike many other associations, particularly in developing countries. Research is a tool for the generation of context-based knowledge and also of skilled manpower. Recognising the contribution of BADAS in this sector, in 1982 the World Health Organisation declared BIRDEM as a Collaborating Centre for Research on Prevention and Control of Diabetes.
Awareness could go a long way towards fighting and preventing diabetes. More people should know that type II is, to a large extent, preventable. The future need not be gloomy; a full and healthy life is possible with diabetes. That is a very important message for all affected by diabetes. The developing countries typically focus on communicable diseases. Non-communicable diseases like diabetes have been neglected. More attention is required urgently before these countries are overwhelmed by the diabetes epidemic.
