Geo Data Institute, University of Southampton

1. Prevention of Diabetes and the Care of People with Diabetes M G Sayyad, KEM Hospital and Research Centre, Pune, India. A L Searle, School of Mathematics, University of Southampton, UK. A K Shahani, School of Mathematics and GeoData Institue, University of Southampton, UK. J A Shirodkar, KEM Hospital and Research Centre, Pune, India. C S Yajnik, KEM Hospital and Research Centre, Pune, India. Geo Data Institute, University of Southampton

2. Prevention of Diabetes and the Care of People with Diabetes • Outline of Presentation • Diabetes • History of diabetes • Western and Indian Ayurvedic classifications • Data Analysis and Modelling for control of diabetes • Concluding remarks

3. Diabetes Problems with body’s carbohydrates metabolism Excess glucose in blood Damage to body’s systems specially blood vessels and nerves Many serious consequences. e.g. Kidney failure, blindness Geo Data Institute, University of Southampton

4. A History of Diabetes Ancient Indian scriptures (Rig and Athrava vedas) mention health and diseases including20 types of “obstinate urinary disorders” (Prameha). Pra = Abundance Meha = Urine Prameha= Passing of excessive urine 5000 BC About 1000 BC Ayurvedic texts of Indian physicians Charak and Sushruta discuss classification, causes,prevention, and treatment of Prameha. 2nd Century AD The word Diabetes is used to describe passing of excessive urine Geo Data Institute, University of Southampton

5. A History of Diabetes 19th Century • Discovery that damaged pancreas, and in • particular damage to a cluster of cells called • Islets of Langerhanscauses diabetes. • Mellitus is added to the word diabetes to distinguish the condition of excess glucose in urine from other urinary disorders. Insulin is discovered. Injection of manufactured Insulin becomes a major advance for controlling diabetes. 1922 Geo Data Institute, University of Southampton

6. Diabetes • Diabetes is a major, and a growing, health problem • In year 2000, 3.2 million deaths due to diabetes. • About 194 million people worldwide have diabetes. • India had about 31.7 million people with diabetes in 2000. • There could be about 80 million people with diabetes by 2030. • World’s diabetic population is estimated to double • from 110 million in 1994 to 220 million by 2010. Geo Data Institute, University of Southampton

7. Classification of Diabetes • Type 1 Diabetes Mellitus (Insulin dependent, IDDM) • Type 2 Diabetes Mellitus(Non insulin dependent, NIDDM) • Gestational Diabetes Mellitus(GDM) • Pancreatic Diabetes Mellitus (FCPD, PDDM) • Malnutrition Related Diabetes Mellitus (MRDM) • Other Geo Data Institute, University of Southampton

8. Classification of Diabetes Type 1 Diabetes (IDDM) Type 2 Diabetes (NIDDM) • Usually in children and young adults • Severe symptoms, Sudden onset • Life long insulin treatment • 5% to 10% of all diabetic cases • Usually in adults • Mild symptoms, chronic course • Various complications • Treated with diet, exercise, tablets and insulin • 90% to 95% of all diabetic cases

9. Ayurvedic Classification of Prameha Sahaja (Acquired) Over-eating Lack of exercise Prameha Vataja Uncurable Prameha Apathyanimittaja (Inherited) defect in genetic substance in mother or father Pittaja Maintainable Prameha Kaphaja Curable Prameha Sthula Obese body krisha Lean body Note correspondence with the “modern” Classification of Type 1 and Type 2 diabetes

10. Causes of Type 2 Diabetes • Wisdom of Sushruta:Oversleeping, lack of exercise, overeating, • especially sweet and fatty things, are the • primary causes of prameha. • Modern knowledge: Obesity, smoking, and lack of exercise are • risk factors for developing diabetes Geo Data Institute, University of Southampton

11. Diagnosis of Diabetes • Commonest symptom is ‘no symptom’ • Rapid weight change • General weakness • Recurrent infections • Excess urine • Excess thirst • Excess hunger • Delivering large weight babies Level of glucose in blood has to be measured for detecting Diabetes Geo Data Institute, University of Southampton

12. Diagnosis of Prameha • In the absence of measurement of blood glucose levels, • signs and symptoms for diagnosing Prameha include: • Colour, taste, smell, and other characteristics of urine • Family history of Prameha • Coating on teeth • Secretion from eyes/nose, • burning/cracked palms and soles • thirst Geo Data Institute, University of Southampton

13. Obesity • Obesity is a major risk factor for diabetes and Prameha • Body Mass Index (BMI) = Weight / Height2 is used to define obesity. • Underweight: BMI <18.5 • Normal weight: BMI in range 18.5–24.9 • Overweight: BMI in range 25.0–29.9 • Obese: BMI >30.0 Geo Data Institute, University of Southampton

14. Obesity • Indians have more body fat for a given BMI • “Normal” BMI range for Indians = 20-23 kg/m2 • BMI of obese Indians >23 kg/m2 • Dr Yajnik and his colleagues have demonstrated that • central obesity, measured by Waist to Hip Ratio (WHR), • is a good measure of risk of diabetes. WHR = Waist circumference / Hip circumference Obese Men: WHR > 0.95 Obese Women: WHR > 0.85 Geo Data Institute, University of Southampton

15. Obesity • Obesity is a major and a growing health problem in • many countries. • Obesity in England has increased by about 400% • in the past 25 years. • At present about 2/3 of the population in England • are overweight or obese. • Diet and life style changes are major challenges for many • obese people. • Effectiveness of Ayurveda for controlling obesity?

16. Control of Diabetes Diet Exercise Medication Diabetes Control Education Regular monitoring Geo Data Institute, University of Southampton

17. A Model for Preventing and Treating Type 2 Diabetes Normal Glucose Tolerance Risk factors Risk factors Normal Glucose Tolerance Type 2 Diabetes Diabetic complications Death Risk factors

18. Wellcome Diabetes Study Geo Data Institute, University of Southampton

19. Wellcome Diabetes Study Geo Data Institute, University of Southampton

20. Wellcome Diabetes Study Geo Data Institute, University of Southampton

21. Wellcome Diabetes Study Geo Data Institute, University of Southampton

22. Model Results for Effects of Treatments

23. Modelling Nephropathy G

24. Transition Probabilities and Transition Times • Analysis of the Wellcome Diabetes Study provided estimates • of the probabilities of transitions between the various states • of the “Nephropathy” model • Transition times were assumed to be Weibull variates. • Analysis of the Wellcome Diabetes Study provided estimates • the parameters of the various Weibull distributions. Geo Data Institute, University of Southampton

25. Selected Interventions • Control of blood glucose • Control of high blood pressure Geo Data Institute, University of Southampton

26. Risk Groups for Nephropathy Geo Data Institute, University of Southampton

27. Model Results for Effects of Treatments Geo Data Institute, University of Southampton

28. High Blood Pressure Treatment: Deaths over time Geo Data Institute, University of Southampton

29. Concluding Remarks • Diabetes is a major threat to the health of many nations • Control of blood glucose, blood pressure, and obesity • will control diabetes. • Side effects of the western drugs? • Combination of the Eastern wisdom of Ayurveda • and western Science is likely to be a powerful combination • for controlling diabetes. Geo Data Institute, University of Southampton