Paradiagm shift in diabetes care: to rural, pregnant women. Indian rural diabetic females should also be aimed at

Hetal Pandya, Arti Muley
2017 JIHS The Journal of Integrated Health Sciences Journal of Integrated Health Sciences   unpublished
It is a well known fact that heart diseases affect men more than women. 'Affection by heart disease is equal in post menopausal women and men' is also known to all. However, difference due to gender in incidence of diabetic complications and their prognosis is less talked of. According to International Diabetic Federation (IDF), 1 in 10 women are living with diabetes and 1 in 7 births are affected by gestational diabetes. Hence, the WHO theme for World diabetes day 2017-'Women and diabetes-our
more » ... n and diabetes-our right to a healthy future' was a well thought of and needed theme. 'Diabetes is worse in women on an average, than men.' This inequality was revealed in a study published in 2007 which reported that in the thirty years following 1971 i.e; till 2000, death rates for women with diabetes remained same although they actually reduced for men with diabetes. 1 It also showed that the average life span of men with diabetes was 7.5 years lesser than that of men without diabetes. While among women the difference was of 8.2 years. After this more studies poured in with data on difference in behavior of diabetes in men and women. 1 In later studies it was reported that heart attacks were more often fatal for women with diabetes than they were for men with diabetes. Data also show that women with diabetes are more likely than men with the disease to have poor blood glucose control, obesity, renal involvement, high blood pressure and unhealthy cholesterol levels. 2 Many theories have been proposed as a reason for this gender difference. It is reported that although chest pain or discomfort in the upper body is the commonest sign of myocardial infarction in both males and females, women are more likely than men to experience only nausea, shortness of breath and back or jaw pain during a heart attack. If a woman experiences these but doesn't recognize them as heart attack warning signs, she may not seek treatment, lowering her chances of recovery. It has also been speculated that although HDL cholesterol is normally higher in women than men; with diabetes, the high triglycerides drive down HDL levels in women more and the combination of high triglycerides and low HDL leads to a greater risk of heart disease. 3 Other reasons might be 1) less aggressive treatment and delay in attention to symptoms in females in view of the thought that females are at lesser risk of heart attack. 2) Greater physical inactivity among women as compared to men. (It has been reported that in all WHO regions and across all country income groups 27% of women and 20% of men were insufficiently physically active). 3) Females themselves take lesser care of themselves as compared to other family members. Gestational diabetes mellitus(GDM) is another area of concern in women. The term "Gestational Diabetes" was first used by O'Sullivan in 1961. It is defined as glucose intolerance of varying severity with first recognition during pregnancy. Under this definition, all different categories are included namely-true GDM, pre-existing pre diabetes worsening during pregnancy, previously undiagnosed type 2 and type 1