151 V. SUMMARY AND CONCLUSION Diabetes is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycemia) resulting from insufficient levels of the hormone insulin. A rapid alarming rate of prevalence of diabetes is noticed in the entire globe. Diabetes pandemic reaches its peak in India with the highest prevalence. Once it was considered as a disease of the affluent and elderly, but now there is a transition from affluent to ordinary and elderly to young and middle aged people with severe morbidity and mortality. Around 70% Indians residing in rural areas are without basic amenities. Lack of quality healthcare and awareness, minimum facilities and increasing disease related complications in these areas facilitate the Type-2 diabetes as a more violent one. Further, most of the population based diabetes studies in the globe centre around the urban population. Such studies in the rural agrarian communities are very scarce to evaluate the level of metabolic syndrome, prediabetes, diabetes and its damage control mode. The present study opens up the possibility for the onset of diabetes in an agrarian, physically active, non-vegetarian, endogamous, forward caste group. The main objectives are: i) directly a better understanding on the impact of socioeconomic factors on diabetes in the survey group. ii) indirectly an understanding on the functions of various biomarkers in the diseased group.
152 The present population based epidemiological study in an agrarian group reveals the following major findings: 1. The study covers a population of 5000 subjects including 2561 (51.22%) men and 2439 (48.78%) women in 37 villages with a spread of more than 40 km on road and settled near the sea coast, plain and hilly areas. 2. The overall disease prevalence is 8.12%, among males it is around 9.84%, while in females it is about 6.31%. 3. The reported minimum and the maximum age of the Type-2 diabetic subjects are 19 and 75 years respectively. 4. It is well known from the study that, males are highly susceptible to diabetes than their female counterparts. 5. It is obvious to note that the percentage disease prevalence is less both in the villages which are located near the coastal area and the base of the Western Ghats. But, it is more in the villages which are located in the plain especially near the city (Nagercoil, the district headquarters). 6. The prevalence of diabetes is more with regard to the progress of age and 40 plus aged people are found as the highly vulnerable groups. There are no Type-1 diabetic cases in the present study. 7. Though, the study group is basically, a physically active, hard working agrarian group, around 46.8% of diabetics are found as farmers and agricultural coolies.
153 8. It is also well documented from the study that, around 6.86% housewives are afflicted with diabetes. 9. The transition of royal disease (diabetes) from affluent to ordinary people is well noticed in the present study. 10. It is well evidenced from the study that, the transition of diabetes from affluent to ordinary people has already reached its peak. Around 85% of diabetic victims seem to be poor and middle class people. 11. The study reveals that around 68% of the diabetics are with either primary education or illiterates. Lack of knowledge about diabetes is one of the prime concern and also it handicaps this innocent agrarian rural population against diabetes. 12. It is quiet interesting to note that, above 70% diabetics are either 1 st, 2 nd or 3 rd order by birth. 13. A great majority (i.e) around 65% diabetic subjects are afflicted by this disease for more than 6 years to 25 years period and with notable clinical problems such as retinopathy, neuropathy, and nephropathy as well as generalized symptoms pertaining to diabetes. 14. The study also highlights the significance of food on diabetes. Above 94% diabetic victims prefer rice as a staple food and only 6% prefer wheat. 15. The study also focuses on the inheritance of diabetes. It is evident from the study that, the disease transmission percentage is 43.65 in males and 68.83 in females.
154 16. Compared to alcoholics, smokers and people with alcohol plus smoking habits, teetotallers are having less risk of diabetes. 17. The study also emphasizes the need of physical activities to evade from diabetes. It highlights the ill effects (prevalence of diabetes) of sedentarianism and the importance of physical activities as an escaping device from this notorious killer. 18. The study also pinpoints the impact of BP on the incidence of diabetes among the study subjects. 19. The direct impact of metabolic syndromes such as BMI, waist-hip ratio on diabetes is well understood by this study. 20. The role of chemotherapy in diabetes control is also clearly observed from the study subjects. 21. The percentage incidence of diabetes (Type-2) among the ABO blood group subjects are screened and found that more patients are with A and O blood groups, sizeable numbers are with B group and least number of diabetics are with AB group. But, numberwise O group occupies the first place, followed by B, A and AB comes second, third and fourth places respectively. Bio-chemical analysis of certain specific biomarkers reveal the extent of damage on these agents and the various pathological manifestations associated with diabetes. Some of the major findings are:
155 1. A remarkable level of increase of certain enzyme biomarkers related to liver function like AST, ALT, GGT, ALP and LDH shows the extent of damage caused by diabetes in patients than the respective control subjects. 2. The elevated levels of serum total bilirubin, direct bilirubin and indirect bilirubin implies the malfunctioning of the liver in the patients. 3. A significant increase in the levels of certain specific enzymes such as ACP, ChE, amylase and creatine kinase in the diabetic subjects reveals the derailment of various metabolic activities in diabetics. 4. High values of HbA1C and ferritin in diabetics is an alarm call to control over the disease. 5. Increased levels of serum (fasting) biomarkers in relation to kidney function such as BUN, creatinine and electrolytes like Na +, K +, and Cl - and chemical element Ca ++ reveals the ill-effects of diabetes on kidney function. 6. A significant increase of protein, albumin, urea and uric acid in the urine samples of diabetics reveals the extent of kidney damage by diabetes. 7. Enhanced levels of total cholesterol, LDL, VLDL, TG and decline of HDL in diabetics urges the need for better glycemic control to avoid diabetes and related ailments. 8. An elevated level of thyroid profile is an indication of the antagonistic role of diabetes on thyroid gland function.
156 9. Elevated levels of fasting, postprandial sugar and C-peptide and decreased level of insulin reveals the poor glycemic control in diabetic subjects. 10. Changes in serum protein, albumin, globulin levels and A/G ratio is also noticed in the diabetics. 11. Reduction of WBCs, RBCs, and enhancement of prothrombin time and ESR showed immune dysfunction in diabetic subjects. In conclusion the major share of the population (i.e) rural has been ignored in all aspects including health. Epidemiological studies on health provides vital statistics to formulate and implement health care programmes, but such studies in the rural population are very scarce which is a sorry state of affair. Large scale epidemiological studies on diabetes are imminent to curb this dreaded killer. The tri-way hypothesis, the outcome of this current study, highlights the prime reasons for the onset of diabetes. If we are able to surpass these factors, we can bid farewell to diabetes, the modern killer. The study recommends the following approaches to the local people to avoid diabetes, the dreaded killer. 1. Say no to alcohol, if you are a drinker. 2. Quit smoking, if you are a smoker. 3. Try to avoid cholesterol enriched diet. 4. Go for vegetarian diet, try to avoid meat. 5. Enrich your physical activities.
157 6. People with family history of diabetes should be more alert to evade from the onset of diabetes. 7. If you are diabetic go for routine medical checkup. 8. Always maintain your body fit. 9. Always keep your mind and soul happy. 10. Be a good follower, not a preacher of good ideals. The surge of diabetes in the present study population (i.e) physically active, agrarian community is a warning signal to other people (groups) with moderate or no physical activities. We can say No to diabetes by proper awareness, routine healthcare checkups, healthy lifestyles and avoiding metabolic syndrome to make a diabetes free world.