(An interview with Professor Prasad Katulanda
MBBS, MD, FRCP (Lon), FCCP, FACE, DPhil (oxon)
Professor & Head, Department of Clinical Medicine, University of Colombo
Consultant Endocrinologist and Diabetologist, National Hospital of Sri Lanka
Immediate Past President, Colombo Medical School Alumni Association (COMSAA))
We draw attention to Sri Lanka‘s growing diabetes epidemic on the World Diabetes Day. Sri Lanka has one of the highest incidences of diabetes in South Asia with more than 20% of the population currently afflicted, according to recent studies. In this insightful conversation, renowned diabetes specialist Professor Prasad Katulanda discusses challenges, risk factors, and new developments in diabetes care.
A Global Epidemic
According to the International Diabetes Federation, there are currently over 537 million individuals with diabetes worldwide, making the condition an epidemic. As Professor Katulanda points out, “Sri Lanka has one of the highest prevalence of diabetes in South Asia and the world, with the disease rapidly increasing and surpassing 20%.” Although the worrying rise is consistent with the global trend, Sri Lanka’s predicament is made worse by particular regional challenges and changes in lifestyle.
Contributing Factors
The rapid increase in diabetes cases in Sri Lanka is multifaceted. “The reasons,” Professor Katulanda explains, “include the rising prevalence of obesity and decreasing physical activity in the population.” Other contributing factors include an aging population, urbanization, and possible influences from mental stress, sleep deprivation, and epigenetic factors.
Sri Lanka’s Position in the Regional and Global Context
Compared to other countries, Professor Katulanda added that Sri Lanka stands out for its rapidly increasing diabetes prevalence, outpaced only by Pakistan within South Asia. This high prevalence not only strains the healthcare system but also calls for urgent intervention and prevention strategies.
Advancements in Diabetes Management
Professor Katulanda highlights a number of recent developments in Sri Lanka, such as the diabetic remission program for those with type 2 diabetes who have just received a diagnosis. This treatment can help people become non-diabetic by emphasising severe weight loss and metabolic rehabilitation. Furthermore, “new treatments like SGLT2 inhibitors and GLP-1 analogue-based treatments offer multiple benefits beyond blood glucose control, such as reducing heart attack, kidney failure risks, and promoting weight loss,” he adds.
Promising Research and Technologies
Numerous studies highlight the advantages of leading a healthy lifestyle in lowering the risk of diabetes, making prevention efforts essential. While cutting-edge technologies like insulin pumps, flash glucose monitoring, continuous glucose monitoring (CGM), and hybrid closed-loop systems provide new opportunities for patient care, surgical treatments like bariatric surgery have the ability to reverse diabetes. “These technologies mimic artificial pancreases and improve diabetes management outcomes,” says Professor Katulanda.
Challenges in Combating Diabetes
Professor Katulanda notes that the magnitude of the situation is the main obstacle. “The vast numbers of patients are overwhelming the healthcare system,” he says, emphasizing the strain not only in diabetes management but also in addressing complications like diabetic kidney disease, eye disease, and heart conditions.
Diabetes in Children
Childhood obesity, physical inactivity, and excessive screen time are the main causes of the rise in childhood diabetes. Professor Katulanda emphasises the significance of early warning indicators for parents, such as hunger, physical weakness, weight loss, and frequent urination. “Managing diabetes in children, especially type 1, requires regular glucose monitoring, careful meal planning, and insulin treatment from the onset,” he explains.
Prevention through Lifestyle Changes
Professor Katulanda recommends focusing on diet and physical activity to manage and prevent diabetes. “Controlling meals to prevent obesity, reducing high-carb foods, and increasing green leafy vegetables and fruits are essential,” he advises. Physical activities like walking, jogging, swimming, and cycling also improve insulin sensitivity, which is beneficial for managing blood glucose.
Dispelling Common Misconceptions
One major misconception Professor Katulanda addresses is the belief that diabetes medications cause kidney failure. “Diabetes medications like metformin, along with blood pressure and cholesterol-reducing drugs, actually help people live longer,” he clarifies.
A Message on Diabetes Day
Professor Katulanda urges people to adopt healthy eating and exercise habits, monitor glucose levels, and regularly screen for diabetes. “Everyone should screen for diabetes periodically,” he emphasizes. “From age 35, this should be done annually; from age 20, every five years unless there’s a family history of early-onset diabetes.”
People and the healthcare system in Sri Lanka must work together to address the growing diabetes epidemic. Let’s take action on this Diabetes Day to manage and prevent diabetes for a healthier future.
