About 9 in 10 people have lost some degree of vision during the last two years of Covid pandemic, health experts said on Monday. It is because most of them skipped their regular eye check-ups and follow-ups due to pandemic-induced lockdowns, fear among others.
Retinal diseases such as diabetic retinopathy or age-related macular degeneration have few or minor symptoms at first and are only detected by eye examination or a screening. These conditions have the tendency to create severe damage to the eyes if not timely intervened with.
"Unfortunately, 90 per cent of patients lost some degree of vision due poor follow ups, during the first and the second wave of Covid, especially the ones suffering from wet AMD (Age Related Macular Degeneration).
These patients mostly missed taking their Intravitreal injection, owing to which the diseases progressed rapidly," Dr Ajay Dudani, CEO Vitreoretinal Surgeon, Mumbai Retina Centre, told IANS.
"Owing to the fear of Covid, we have witnessed a decline in patients coming for a regular eye check-up in the past 3-4 months. This has resulted in delays in diagnosis and treatment, which can compromise vision in the long run," added Dr Chaitra Jayadev, Senior Vitreo-retinal Consultant, Narayana Nethralaya Eye Institute, Bengaluru.
Doctors said that early detection and treatment is key to control the disease and prevent any loss in vision. The longer one puts off visiting the clinic, the worse the eye health will get.
"While we should take precautions during this Covid wave, patients should not delay visits for macular degeneration or diabetic macular edema, unless the patient has Covid symptoms," Dr Raja Narayan, the General Secretary, Vitreoretinal Society of India, told IANS.
"With the third wave, we are seeing a similar pattern from the past, as patient visits, especially amongst elders, have dropped by nearly 50 per cent. Since the retina cannot be replaced, missing an injection, or treatment follow ups, can magnify the eye disease," Dudani said. Doctors also encouraged patients to take up teleconsultations.
There are vision tests that one can undertake sitting at home, whose reports can be sent to the doctor for examination and further intervention.
"If patients experience symptoms such as blurred vision, sudden loss of vision or black spots in the visual field, they need to go for an immediate eye check-up, as these could be signs of diabetic retinopathy. To prevent worsening of such complications, diabetics must ensure that their sugar levels are under control," Jayadev said.
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With a whopping 77 million people in India living with diabetes, a simultaneous and sharp rise has been observed in the prevalence of diabetes-related preventable vision loss, particularly among the young people, say experts.
Diabetic retinopathy is a chronic, progressive retinal disease that is a leading cause of vision impairment in today's young adults, working population. It's of major concern among children suffering from juvenile diabetes (Type-1 diabetes) and especially if they have had diabetes for over 10 years.
It is estimated that approximately 1.1-crore people are suffering from retinal disorders in India and more alarmingly, about one in every three people living with diabetes have some degree of diabetic retinopathy, a diabetes complication that affects eyes.
"With the growing incidence of diabetes, it has been estimated that diabetic retinopathy affects one in three people with diabetes and remains the leading cause of blindness in young working-aged adults," Dr Mahipal Sachdev, Medical Director and Chairman, Centre for Sight Group of Eye Hospital, told IANS.
"Approximately 7-10 per cent of young diabetics will go on to develop diabetic retinopathy, of which 2-4 per cent will have vision threatening sequelae if not taken proper treatment." added Dr. Aditya Sudhalkar, M.S. Ophthalmology, Consultant Vitreoretinal Surgeon.
The most common form of diabetic retinopathy is Diabetic Macular Edema (DME) which arises when the damaged blood vessels swell and flow into the macula of the retina causing visibility issues in the normal vision.
According to Dr. Chaitra Jayadev, senior vitreo-retinal consultant, Narayana Nethralaya Eye Institute Karnataka, studies have shown that the prevalence of DME and diabetic retinopathy is higher and more severe in young diabetics with a longer duration of diabetes.
"Diabetes in the younger is a distinct pathological entity characterised by a more aggressive presentation and manifestation. An earlier onset of diabetes leads to a longer exposure to insulin resistance and hyperglycemia. This gives rise to a greater propensity for developing long-term microvascular and macrovascular complications," Dr. Jayadev said.
Thus, screening for diabetes is of utmost importance, even if one is "young" and has no symptoms. It becomes more crucial if one has risk factors such as family history, obesity, sedentary lifestyle, or on long term steroid medications.
Dr. Sudhalkar said that in India, there is a general reluctance towards attending clinics and nearly 25 per cent of young patients with DME come late for diagnosis.
"It's important to know, only 11 per cent of diabetic retinopathy patients can actually reverse vision threatening sequelae once they set in. The rest continue to progress even with strict glycemic control," he noted.
"Retinopathy, unfortunately, is the most neglected complication of diabetes. We see so many patients come to OPD where eyes have not been checked for. So the screening, also known as Funduscopy, should be done at the time of diagnosis of Type-2 diabetes, in adults, and in children, five years after the onset of diabetes, and thereafter annually," Dr Dheeraj Kapoor, HOD, Endocrinology at Artemis, Gurugram, told IANS.
If diabetes occurs near puberty, then funduscopy should be checked for potential retinopathy.
"It is important because the condition poses no symptoms in the initial days. And once symptoms set in, such as bleeding in the eye, red vision, sudden loss of vision, it's too late," Kapoor said.
The doctors advised to adhere to the treatment and maintain a healthy lifestyle to effectively manage diabetes and to prevent the onset or progression of eye diseases.
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One in 12 adults or more than 74 million people living in India are diabetes patients, according to a new report from the International Diabetes Federation (IDF), ahead of the World Diabetes Day on Saturday.
The figure is the second highest in the world after China, which has 141 million people living with diabetes.
The findings are from the 10th edition of the IDF Diabetes Atlas to be published on December 6.
The report added that another 40 million adults in India have impaired glucose tolerance (IGT), placing them at high risk of developing Type-2 diabetes, while more than half (53.1 per cent) of people living with diabetes in India are also undiagnosed.
"The increasing number of people living with diabetes and at risk of developing the condition in India confirms diabetes as a significant challenge to the health and well-being of individuals and families in the country," said Professor Shashank Joshi, Chair, IDF South-East Asia Region, in a statement.
Moreover, the report showed that worldwide, 537 million adults are now living with diabetes, a rise of 16 per cent (74 million) since the previous IDF estimates in 2019. Globally, 90 per cent of people with diabetes have Type-2 diabetes.
The total number of diabetics is predicted to rise to 643 million (11.3 per cent) by 2030 and to 783 million (12.2 per cent) by 2045. Currently, one in ten (10.5 per cent) adults around the world are living with diabetes.
Diabetes was also responsible for an estimated $966 billion in global health expenditure in 2021. This represents a 316 per cent increase over 15 years.
Excluding the mortality risks associated with the Covid-19 pandemic, approximately 6.7 million adults are estimated to have died as a result of diabetes, or its complications, in 2021.
This is more than one in ten (12.2 per cent) of global deaths from all causes. The South-East Asia Region accounts for 11 per cent (747,000) of total diabetes-related deaths, according to the report.
The rise in the number of people with Type-2 diabetes is driven by a complex interplay of socio-economic, demographic, environmental and genetic factors. Key contributors include urbanisation, an ageing population, decreasing levels of physical activity and increasing levels of people being overweight and developing obesity.
"We must do more to provide affordable and uninterrupted access to diabetes care for all in India, and around the world. Policy makers and health decision-makers must turn words into action to improve the lives of people with diabetes and prevent the condition in those at high risk of developing it," Joshi said.
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Indians eat more fibre-rich plant based diet than people in the Western countries, reducing their risk of gut-related problems such as inflammatory bowel diseases like crohn's disease, Irritable Bowel Syndrome (IBS), colitis, and colon cancer, according to a research on Tuesday.
The international study, including researchers from the Indian Institute of Science Education and Research (IISER)- Bhopal, sought to understand the relationship between gut bacteria and inflammatory diseases.
"Increased intake of carbohydrate in the form of fibre such as wheat, vegetables, fruits and lentils, mostly found in Indian diet lowers the incidence of IBD, crohn's disease, colitis, colectral cancer, etc., than western diets that are generally meat-based," lead author Dr Vineet K. Sharma, Associate Professor, Department of Biological Sciences, IISER Bhopal, told IANS.
The human gut contains 300-500 types of bacteria that are necessary for our survival. These bacteria help in digestion, protect us from infections and even produce essential vitamins and neurochemicals.
Depending on the kind of bacteria that dominates the gut, human beings are generally classified into three "enterotypes" -- Prevotella, Bacteroides or Ruminococcus.
The study included 586 healthy samples from western and non-western populations including 200 samples from India, and 189 IBS samples from western populations.
The 200 gut samples from India were taken from people from several locations in -- Madhya Pradesh, Delhi-NCR, Rajasthan and Maharashtra, Bihar, and Kerala. It is also the largest gut metagenome study from India, as most such studies are largely based on the Western population.
The findings, published in the Nature's Biofilms and Microbiomes journal, showed that the Indian gut microbiome has the highest abundance of the Prevotella genus of bacteria, in particular, a species called Prevotella copri (P.copri).
This bacterium was also found to dominate the guts of other populations that consume a carbohydrate and fibre-rich diet, such as the Italian, Madagascarian, Peruvian, and Tanzanian. But, the gut microbiomes of people from Western countries like the US are dominated by Bacteroides.
Further, they found that P. copri is significant in the metabolism of complex polysaccharides and dietary fibres in non-western populations.
It is thus logical that this type of bacteria predominates the gut microbiome of the healthy Indian and non-western population that consumes a diet rich in plant-carbohydrates and fibres, Sharma explained.
"The proportion of P.copri in Indians is 30 per cent and can reach upto 60-70 per cent. Of the more than 1200 species of Prevotella, P.copri is the most abundant in Indian human gut," Sharma told IANS.
On the other hand, the guts of Western population were found to have other Prevotella species such as P. intermedia and P. nigrescens. These bacteria are usually found in the mouth, which points to a mouth-gut axis. These bacterial species are inflammatory and have high virulence and antibiotic resistance genes, making the Western population more susceptible to gut inflammatory diseases.
"Our insights would help in the development of new probiotics and prebiotics for different health-related conditions associated with the gut which is much needed for non-western populations," Sharma said.
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The festive season is around the corner and with sugar-laden sweets, snacks and luncheons, festive eating tends to tip towards an indulgence. The pandemic alongside the festive season gives us double the reason to take care of our health, especially if you are living with a chronic health condition like diabetes. People with diabetes need to find ways to manage their health smartly and effectively to mitigate risks that come with the disease such as kidney problems, heart diseases, nerve issues, foot problems, and so on. Controlling glucose levels, maintaining a healthy lifestyle and regular medical consultations are key to managing this disease effectively.
Dr Jothydev Kesavadev, Diabetologist and MD of Jothydev's Diabetes Research Centres said, "It is imperative for one to always make sure diabetes is being well-managed, but, during the festive season, it is important than usual. Uncontrolled diabetes can heighten the risk of developing severe diseases or complications. Regularly monitoring glucose levels helps you catch spikes or trends that suggest your diabetes may be getting out of control. This also helps you to take timely measures," he explains.
Here are a few tips for better diabetes management during the pandemic:
Scheduling is Key
Diabetic patients need to continue medications without interruption. Apart from continuous monitoring of glucose levels, do plan regular consultations with the doctor. It is also imperative that patients do not ignore high blood glucose levels, HbA1C >10%, or positive urine ketone status.
No Pain, No Gain!
Diet & exercise play a major role in preventing and managing diabetes. Attention to nutrition and adequate protein intake along with exercise helps control weight and lower blood pressure. It also lowers harmful LDL cholesterol and triglycerides, raises healthy HDL cholesterol, strengthens muscles and bones, reduces anxiety, and improves general well-being. Patients with diabetes are encouraged to take up 45 minutes of moderate activity every day.
Wearable Devices for The Win!
Technology advances have led wearable devices, to allow patients to keep a close tab on glucose levels. One such wearable is the Freestyle Libre that go a long way in helping people with diabetes (both type 1 and 2) manage the disease well. Continuous glucose monitoring, through these devices, offers the highest levels of accuracy and performance standards.
Say No to Stress
Stress can be a major barrier to effective glucose control. This has become worse during the pandemic, as health anxieties and long lockdowns have given rise to emotional responses like anxiety, frustration and disappointment. One can opt for healthier life choices such as exercise, yoga and meditation to avoid stress.
The pandemic is still with us. Patients with diabetes need to practice utmost caution to reduce the risk of catching an infection. Along with vaccinations, patients with diabetes need to ensure safe choices such as social distancing, wearing a mask, and frequent hand washing.
This festive season, even those with diabetes can enjoy life to the fullest, provided these simple measures are followed to keep the glucose levels under check. (Agency)
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Until a few years ago heart diseases were common among older people in India. However, in recent years, heart ailments have become more common among the younger population in India. Heart diseases are killing approximately 17 million people in the world, and in India, there million people die each year due to cardiovascular diseases (CVDs) which include heart attack and stroke.
Therefore, it is important to understand what causes heart attacks in younger Indians. Following are a few reasons that cause a heart attack in Indians:
Over Exercising: A recent study that too much exercise may be bad for the heart. While inactivity is also linked to increase in heart diseases by giving rise to obesity and other chronic diseases, the study that was conducted displayed that the people who engage in physical activity that exceeds a recommended amount for them are more at risk of having a heart attack.
Dietary Supplements: There has been no research that shows a clear benefit of supplements. However, it has been said that consuming too many supplements can be harmful. Excessive amounts of calcium and vitamin D are said to be linked to an increased risk of cardiovascular diseases. Although there are studies that are ongoing around this, there has been little evidence that any amount of vitamin D supplement will protect the heart.
Stress and Heart Attack: In today’s fast-paced lives an individual faces a lot of stress due to their personal and professional relationships. Professionally, a lot of work takes place on a desk and the working hours are long. Therefore, this leads to young professionals having less sleep and high stress, which increases their risk of having heart diseases.
Hypertension: With our current dynamic lifestyles, food habits tend to change leading to increased salt consumption. Furthermore, there is increase in the amount of stress and our lifestyles are sedentary. All the factors together have led to an increase in hypertension among younger people. People with high blood pressure are likely to develop coronary diseases because high BP adds pressure on the artery walls and over time this can destroy the arteries.
Unhealthy Eating Habits: A lot of young professionals and students often go to food joints that serve unhealthy food items such as junk food. These foods have a high amount of cholesterol and trans fat which may lead to heart disease among people
Hence, to reduce the number of individuals with heart attacks, drastic steps need to be taken collectively and as individuals. Organisations and healthcare professionals need to spread awareness around the growing burden of heart attacks among younger Indians and individuals need to adapt to a more holistic and healthy approach to life. Even at the slightest indication of heart disease, one must reach out to their primary care consultant to stay safe and healthy.
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