DIWAS, in collaboration with the Endocrine Society of India, DiDI, the Diwas Integrated Diabetes Initiative, and ETI Services hosted an event titled ‘The Future is Her’ on 20th November 2022 to mark World Diabetes Day.
Diabetes is a serious non-communicable disease, and India, with more than 70 million persons with diabetes one of the highest burdens in the world. Women have the designated role of ‘caregiver’ in the family, which often leads to their health being de-prioritized. This proves to be dangerous in the case of women with diabetes, where data shows that mortality is much higher in women across the globe. It is presumed that India will have more than 100 million people with diabetes by 2025. Discussion on diabetes requires attention to the impact on women & girls, gestational diabetes, and pregnancy as a window to future chronic disease, focusing on obesity and nutrition – particularly during the reproductive years. These discussions should be used to inform policy and build a gender-transformative and personalized approach to diabetes care.
The event kicked off with Dr. Usha Sriram, Founder of DIWAS, and Dr. Chitra Selvan, Associate Professor at Ramaiah Medical College addressing the gathering. Dr Sriram welcomed everyone stating, “We at DIWAS believe in empowering and educating health care providers, patients, caregivers and the community about the nuances of diabetes and diabetes care in girls and women. DIWAS strongly advocates for girls and women by addressing gender as a determinant of health and promoting the need for a life course approach. This event aims to address the critical need for looking at diabetes and NCDs through a gender lens and have important conversations to ensure issues such as gestational diabetes, osteoporosis and eating disorders receive attention. We are honored to have leading national experts as panelists, presenters, and discussants. The only way forward is that we come together and work for a common purpose.”
The first panel focused on type 1 diabetes in girls and women. The panelists highlighted how discussions around weight find a priority and often guide women's lives. It is important that discussions around diabetes are normalized and brought into the mainstream. The panel also discussed studies done by them showcasing the limited information people have on insulin and suggested the need for building awareness regarding the same and ensuring that measures are developed at home and in the workplace to ensure effective and regular use of insulin, without discrimination. During the talk, Dr Priyanka Padhy, Assistant Professor of Psychology, Lady Sri Ram College, said, “In young girls there is often no self-definition beyond the disease(diabetes). This impacts self-image and often gives rise to eating disorders as well. It is important to understand the linkage between eating disorders and diabetes and lots of young women omit insulin intake due to the fear of weight gain. When we are dealing with eating disorders, psychiatric disorders are comorbidities.”
The second panel prioritized the impact of obesity and nutrition on women in their reproductive ages. It talked about the new fad diets regimes often taken up by young girls which have no scientific basis. It is important that young girls are taught to listen to their bodies instead of being into perceptions of what a good body should look like. Dr Rucha Mehta, Endocrinologist, Ahmedabad discussed post- marriage weight gain in diabetes patients saying, “There are certain factors that drive weight gain across the lifespan - especially in women and they further potentiate noncommunicable diseases including type 2 diabetes. These include medications, improper sleep schedule, shift work, emotional stress, smoking cessation and alterations in growth trajectory through adolescence. Women are particularly vulnerable to these factors leading to obesity which in turn results in diabetes development.”
To bring the way forward for developing gender-transformative policies, a panel on advocacy, policy, and activism was also constituted. The panel focused on the need for promoting activism in NCDs especially among women. The panelists highlighted the shortfall of women in the medical space, particularly in leadership positions, and the need to empower women to be change-makers. It also highlighted using various types of media - like social media ensure effective messaging. Dr Ambrish Mithal, Chairman and Head- Endocrinology and Diabetes, Max Super Specialty Hospital, Delhi, emphasized “There is a need to build a strong network of messengers- including school teachers, community health workers, NGOs and hospitals right now. There is an urgent need to build attention on women’s health. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) does not currently have a priority for women. To ensure this becomes a priority we must adopt a non-medical and social approach to this movement for maximum reach.”
Evidence shows that 29.3% women in India had hyperglycemia during pregnancy in 2021. The panel discussed pregnancy as a window to future chronic diseases. While summing up the discussion Dr Hema Divakar, Consultant and Medical Director, Divakars Specialty Hospital, Bengaluru, said, “It is very important to create awareness about how important it is to manage diabetes during pregnancy. Early diagnosis and proper management of diabetes during pregnancy will prevent intergenerational transmission. Timely intervention during pregnancy to effectively manage gestational diabetes (GDM) is pertinent to prevent its cascading effect on the mother and baby in the future. In the medical space, pregnancy must be looked at as the low hanging fruit considering people are often more receptive to doctors' advise during the time.” The last panel of the day discussed complications of diabetes in women - like osteoporosis, cardiovascular diseases (CVD), fractures, and mental health, among others. It discussed how women often have to take care of others, even when they are unwell. The session also focused on the ‘elephant in the room’ that is rarely talked about – psychological and mental health of diabetic patients. Dr. Purvi Chawla, Consultant Diabetologist & Dir Clinical Research - Lina Diabetes Care & Mumbai Diabetes Research Centre mentioned "CVD remains the leading cause of mortality in persons with diabetes. A common perception is that women are relatively protected from CVD prior to menopause. However, this is not true, and women face an increased risk for CVD when they are diabetic.”
Post an open house session, the session ended with a vote of thanks delivered by Dr. Gagan Priya.
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