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Diabetes and cardiovascular diseases: It’s time to act

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Heart

According to International Diabetes Federation’s ‘Diabetes and Cardiovascular Disease report, in 2015, approximately five million were estimated to have died from diabetes, the majority of these as a result of cardiovascular complications. The report adds that populous countries have the largest absolute number of people dying from CVD, and include China, India and the Russian Federation.

While India is ranked at Number 67 in terms of age-standardised CVD mortality rate (306 deaths per 100,000 people per year), it has the second-largest number of people dying from CVD (over two million deaths per year).

One of the significant outcomes of cardiovascular disease is poor circulation in the legs, resulting in heightened risk of foot ulcers and amputations leading to disability. When people with diabetes develop CVD, their probability of survival is lower than those CVD patients without diabetes.

Diabetes can lead to cardiovascular damage in multiple ways. When a person has uncontrolled diabetes, the blood sugar levels are usually higher. And too much sugar in the blood damages blood vessels.

Although diabetes is regarded as the strongest risk factor for CVD, it is not just high blood glucose levels, but a variety of mechanisms that lead to CVD. The blood vessels in people with diabetes are more susceptible to well-established risk factors such as smoking, high cholesterol, high blood pressure and obesity. More than 80 per cent of people with type 2 diabetes are overweight. About 70 per cent of people with diabetes have high blood pressure and 67 per cent of adults with type 2 diabetes have one or more lipid (cholesterol) abnormalities.

Traditionally, the treatment of diabetes has been focused solely on good control of blood sugar levels.

Evidence now suggests that to prevent diabetes-related complications, one needs to look beyond glucose control and focus on other conditions like reducing weight, controlling high blood pressure and abnormal lipid profile.

In short, a person with diabetes needs to take care of the A, B and C of diabetes:

A stands for HbA1C (the test gives average blood glucose for last three months). It should be ideally less than seven per cent and is recommended at least three times a year.

B stands for blood pressure. The goal of blood pressure control is to reduce it to <130/80 mm Hg. Checking blood pressure at every doctor’s visit is essential.

C stands for cholesterol. The cholesterol that needs to be checked is the HDL, LDL and the triglycerides. The three should be within the specified limits. The optimal target is less than 100 milligrams per deciliter (mg/dL) for LDL cholesterol. For HDL cholesterol, the recommended level is more than 50 mg/dL for women and more than 40 mg/dL for men. Lipid profile is recommended at least once in a year.

If blood glucose, blood pressure, and cholesterol levels are not on target, then a person with diabetes needs to reach out to their doctor. Appropriate medicine and few changes in diet and activity can help him/her reach these goals. Here are four things you can do to lower your risk:

* Take medicines as prescribed by the doctor. In some instance, insulin is required for optimal control of diabetes. New-age insulin delivery devices like pens with thin needles have made taking insulin really convenient. Control of blood pressure and cholesterol is as important and you may require medication if they are above target. The doctor, after seeing complete reports, can decide on any change in medication.

Newer and more efficient medicines are being discovered. GLP-1 based therapies represent a latest class of treatment for type 2 diabetes. In addition of blood sugar control, GLP-1 also has other beneficial effects in the body that could be useful in the management of type 2 diabetes and CVD. These include lowering weight and blood pressure and improving lipid profile and heart function, thus reducing cardiovascular risk factors in type 2 diabetes.

* One need not have a special diet. In fact, the traditional Indian thali which includes naturally available nutrients and fibre from whole grains, fruits and vegetables with less oil is best. Eat natural foods that have less salt, less sugar and less fat. Transfats need to be avoided.

* Weight control and ceasing to smoke are two important lifestyle measures that have an impact on preventing CVD.

* Try to get 30 to 60 minutes of physical activity for most days of the week. Physical activity helps you keep a healthy weight and lower blood sugar and blood pressure. If a person with diabetes hasn’t been physically active recently, it is necessary to visit a doctor for a check-up before starting an exercise programme.

In conclusion, be aware, be active and be prompt to save yourself from diabetes and its complications – it’s time to act.

(Dr. C.M. Batra is an endocrinologist ar Indraprastha Apollo Hospitals, New Delhi. The views expressed are personal. He can be contacted at [email protected] )

Health

Health Outreach Services during Covid-19

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Anganwadi Healths Outreach

New Delhi: The Government has been regularly reviewing the situation in consultation with States/UTs. In order to improve the nutritional status of Women and Children, Ministry of Women and Child Development is implementing Supplementary Nutrition Programme under Anganwadi Services and Scheme for Adolescent Girls under the Umbrella Integrated Child Development Services (ICDS) Scheme to children (6 months to 6 years), Pregnant Women, Lactating Mothers and out-of-school Adolescent Girls (11-14 years).

As per the directions issued by Ministry of Home Affairs, under Disaster Management Act, 2005, all the Anganwadi Centres across the country were closed to limit the impact of COVID-19. However, to ensure continuous nutritional support to Anganwadibeneficiaries, Anganwadi Workers and Helpers have been distributing supplementary Nutrition at the doorsteps of the beneficiaries. Further, this Ministry has issued necessary directions to the States/UTs to ensure distribution of food items and nutrition support by Anganwadi workers, once in 15 days, at the doorstep of beneficiaries. In addition, Anganwadi Workers and Anganwadi Helpers have been assisting the local administration in community surveillance, creating awareness or other works assigned to them from time to time.

Ministry of Health and Family Welfare issued the guidance note on “Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition (RMNCAH+N) services during & post COVID-19 Pandemic” with States and UTs which states that campaign mode services such as – mass Vitamin a prophylaxis, campaigns for Intensified Diarrhea Control Fortnight (IDCF), National Deworming Day (NDD) and Anemia can be provided on an alternative mechanism like through home delivery of essential services & commodities etc. based on local situations. The continuation of outreach services through modified VHSNDs and Home visits by health workers was recommended in area beyond buffer zone and green zone. The activities in the containment and buffer zone were recommended through the routine visits of COVID workers. Essential medicine like IFA, ORS, calcium and Zinc are home delivered in containment zones. Specific guidance notes on the provision of the outreach services with all States and UTs to ensure continuity of essential outreach services has been issued and Webinars on implementation of outreach services related to Anemia, Nutrition Rehabilitation Centers (NRCs), Special Newborn Care Units (SNCUs), Diarrhoea prevention, NDD and IYCF practices etc have been organized.

This information was given in a written reply by the Union Minister of Women and Child DevelopmentSmt. Smriti Zubin Irani in Lok Sabha today.

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Mandatory daily antigen test for reporters, Parliament staff

Journalists covering the Monsoon session from press galleries of Lok Sabha and Rajya Sabha also have the option to undergo the RT-PCR test which is valid for 72 hours.

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Parliament

New Delhi: Amid fresh cases of coronavirus among MPs, reporters and parliamentary staff entering the Parliament complex will have to undergo mandatory antigen test on a daily basis, according to a new protocol put in place.

Members of both Houses are undergoing RT-PCR test on regular intervals on a voluntary basis, said a senior Parliament official.

A member of Parliament can undergo RT-PCR test as many times he or she likes.

Journalists covering the Monsoon session from press galleries of Lok Sabha and Rajya Sabha also have the option to undergo the RT-PCR test which is valid for 72 hours.

Since the report of the much reliable RT-PCR takes time, antigen test has been made mandatory on a daily basis.

Government officials accompanying their respective ministers during bill discussions also have to show a negative report of RT-PCR test taken within the last 72 hours of their visit to the complex. – PTI

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Rajya Sabha passes Homoeopathy Bills

The DMK MP T. Siva said, “The government is taking away the powers of the states”, and alleged that its diluting the federalism.

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Homoeopathy

New Delhi, Sep 18 : The Rajya Sabha on Friday passed two Bills — the Indian Medicine Central Council (Amendment) Bill, 2020 and Homoeopathy Central Council (Amendment) Bill, 2020.

Replying during the discussion on the Bills, Health Minister Harsh Vardhan said, “The Ordinance was necessitated as Parliament was not in session.”

The Minister said that Yoga and Naturopathy will also be promoted in due course, as demanded by Rashtriya Janata Dal (RJD) MP Manoj Jha.

During the discussion, Biju Janata Dal (BJD) MP Prasanna Acharya supported the Bill, but questioned the need for the ordinance. He said only in extraordinary situations the ordinance route should be adopted.

Speaking on the Bill, BJP MP Sudhanshu Trivedi said that new things are always opposed first, but during covid times homeopathy medicine was prescribed as an immunity booster.

Samajwadi Party (SP) member Ram Gopal Yadav asked the government not to delay the constitution of the commission as homoeopathy is a necessity for the poor as allopathy is costly and in covid times private hospitals are charging more than Rs one lakh per day.

The DMK MP T. Siva said, “The government is taking away the powers of the states”, and alleged that its diluting the federalism.

The Bill brought by the Centre amends the Homoeopathy Central Council Act, 1973. After becoming an Act, the Central Council of Homoeopathy will regulate homeopathic education and practice.

The Bill replaces the Homoeopathy Central Council (Amendment) Ordinance, 2020 which was promulgated on April 24, 2020. The period for the supersession of the Central Council — The 1973 Act — was amended in 2018 to provide for the supersession of the Central Council of Homoeopathy. The Central Council was required to be reconstituted within one year from the date of its supersession.

This period was amended in 2019 to require the reconstitution of the Central Council in two years. The central government constituted a Board of Governors to exercise the powers of the Central Council.

The Bill amends the Act to increase the period for the supersession of the Central Council from two years to three years.

The resolution moved by K. C. Venugopal, E. Kareem and K. K.Ragesh was defeated. But Ragesh raised a point of order for the right to reply as the mover of the resolution and asked about the role of the state governments in this Bill.

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