Killer waves and the incidence of diabetes

Published in The Hindu on March 2, 2006

People affected by a natural calamity suffer from high intensity psychological stress. Photo: NASA

It has always been known that stress is one of the contributing factors for precipitating diabetes in people even in normal conditions. But stress can play a bigger role when people go through a traumatic experience such as loss of dear ones and loss of property due to a natural calamity. In such situations the intensity of stress is higher and hence its contribution to cause diabetes and cardiovascular diseases can be much higher.

“The contribution of stress in precipitating diabetes in a short span of time is increased when people go through traumatic situations,” said Dr. A. Ramachandran, Managing Director, M.V. Hospital for Diabetes, Chennai. The tsunami that struck India and other countries on 26 December 2004 brought about large-scale destruction of property and loss of human lives. It was one of those perfect settings for people to suffer from high intensity psychological stress.

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The study done by Dr. Ramachandran on people who have suffered heavily by the killer waves has been able to show the role of high intensity stress and the onset of impaired glucose tolerance (IGT) – a precursor to diabetes – and full-blown diabetes.The team led by him studied fishermen living in north Chennai.

Two populations of fishermen living in the same area – one group affected by the tsunami and the other that was not – and belonging to same age group and income level were chosen for the study. The group that lived very close to the shore suffered the most while the other group that lived inland did not.The study done in April-June last year, studied nearly 1400 persons from both groups. Apart from evaluating the prevalence of IGT and diabetes, the team also evaluated mental stress using standard assessment techniques.

Positive correlation

“We found that some individuals’ stress scores did not correlate with diabetes or IGT but as a population the increased stress score in fishermen who suffered from tsunami did correlate with increased incidence of undiagnosed diabetes and IGT,” Dr. Ramachandran said. “So our hypothesis is that heightened stress in the tsunami affected population has led to the increase in undiagnosed diabetes and IGT.”

Individual specific

The possible non-correlation of stress and diabetes on an individual basis, according to him, is because each person would react to stress in a different way. And women were found to undergo more stress compared with men. This is not the first time that a positive correlation between stress and diabetes has been found. A study done on people following the Kobe earthquake in Japan found that glycemic control was aggravated in diabetic patients after the earthquake in Kobe but not in the control group that lived in Osaka, which was not affected by the earthquake. Similar correlation was found in those affected by the Marmara earthquake of 1999 in Turkey.

It is well known that people suffer from cardiovascular disease following stress. “Stress is a precipitant and any form of stress is going to create problems. The symptoms show up when under stress,” said Dr. Mullasari Ajit. S, Senior Consultant Cardiologist, Madras Medical Mission, Chennai. Catecholamine, a natural hormone is responsible for increasing the heartbeat and blood pressure under normal conditions.

“When under severe stress this hormone goes up and it causes an increase in blood pressure and heartbeat and could worsen any underlying heart problems,” noted Dr. Ajit. Following a big calamity, the hormone level goes up many-fold and its effect is seen over a longer period of time and at a heightened level. According to Dr. Ajit, there is very little data to show that stress is a primary risk factor for cardiovascular disease; stress is a contributing factor.

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