An editorial from the Lancet 2011 and some work from our centre quoted in Heart Asia 2011 have both highlighted the fact that pre-diabetes, as documented as a fasting blood sugar of more than 100mg/dl is present in 20% or more of high school children. They have a greater amount of subcutaneous fat (thicker skin) than their peers who do not have blood sugar or cholesterol problems. This is a strong signal that school programmes are of primary importance in preventing obesity, diabetes and abnormalities of cholesterol, which will wreck havoc on the individual and society later on as these kids become adults.Both at the central and State government levels, educational regulatory bodies should highlight the importance of compulsory physical training and games during school hours. There should be a compulsory assessment of physical fitness and period for self-assessment of physical abilities, weight and flexibility as a pre-requisite to pass before going to the next academic level. Radical thinking no doubt, but what if it were to help in preventing 80 million people or more from falling sick in the ensuing 40 years from now?No doubt the growing number of endocrinologists and diabetologists appear to be a promising factor on the horizon. However, are they the ultimate solution for a disease that is going to affect one in 10 of the population of the country and one in six above the age of 20 years? Attempting to train large numbers of endocrinologists and diabetologists would be a time consuming, economically demanding and by and large difficult to achieve solution for such a common disorder - an estimated 30,000 of them would be needed in our country - there are hardly 1,000 present at this point of time, almost all of them concentrated in urban areas. The concept of a competent family physician who has a better understanding of problems like diabetes, obesity, hypertension and other non-communicable problems is the way forward in tackling the problems of numerous clients with diabetes and pre-diabetes.The role of councilors and educators who could be nurses, dieticians, physiotherapists and even school teachers in large numbers would be important in disseminating information and supporting the role of public health physicians and family physicians in handling this pandemic. However, to sort out the problem of diabetes on a large scale basis will require a megalithic vision spear-headed and encouraged by the government to develop teams to enhance physical activity and discourage unhealthy eating habits. It should involve a public health policy targeting schools, with primary health care givers playing an important supplementary role.
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