Diabetes advice ‘should be culturally responsive’

By Amit Roy

A LEADING diabetes doctor has advised British Asians on how they can reduce their risks from Covid-19 by taking up NHS programmes aimed at dealing with the disease.

The comments from Prof Partha Kar, national speciality adviser for diabetes for NHS England, follow the publication last week of disturbing statistics which showed that more than a quarter of NHS patients who died in hospitals in England af­ter contracting coronavirus had suffered with diabetes.

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Of the 22,332 patients who died in England’s hospitals be­tween March 31, when pre-ex­isting conditions began to be recorded, and last Tuesday (12), some 5,873 – 26 per cent – had either type 1 or type 2 diabetes.

An inquiry by Public Health England (PHE), under Prof Kevin Fenton, national director for health and wellbeing, into BAME deaths is expected to re­port by the end of May.

Prof Kar said: “Data has shown that 26 per cent of the deaths is due to diabetes – a huge number. The next ques­tion is can we now drill into it to find out if there are any obvious areas we need to focus on? Those are the things we need to know for policy reasons.”

In the UK, “the data is not specifically Indian – it is based on ethnicity,” he went on.

“With the southeast Asian population – Indian, Pakistani, Bangladeshi, Sri Lankan – you will very likely see there is a spike so there are more deaths among brown people com­pared to those who are white.”

He expressed regret that Brit­ish Asians appeared to be falling behind as regards their diabe­tes outcomes: “Type 2 diabetes is not ‘one of those things’. It’s a big thing.”

He explained the difference between the two types.

“Type 1 diabetes is some­thing you can’t control. It hap­pens because of an immune problem – nobody knows the reason for it. You lose your abil­ity to produce insulin. At what­ever age it happens, you are dependent on insulin for the rest of your life. It has nothing to do with your lifestyle.”

Type 2 diabetes, on the other hand, which is common among Asians, “is mostly down to life­style. It’s about what you eat, your exercise level. We use cars more, we have TV channels, you don’t have to get up from your sofa. Type 2 diabetes is a bigger risk (to Asians).”

Prof Kar said: “We need the BAME population, es­pecially Indians, Pakistanis, Bangladeshis and Sri Lankans, to join the NHS programmes (on curbing Type 2 dia­betes), whether it be in their care or re­search. We need more Asians in it be­cause that’s where the high risk is.”

He explained: “What Covid-19 has shown starkly is the deaths that you see spread over two or three years we are now seeing it in a far shorter period, which is why it is so noticeable.”

Prof Kar wants NHS cam­paigns to be targeted better. “In the UK, the southeast Asian population needs to also ap­preciate that they need to en­gage with services better. They need to do type 2 diabetes pre­vention programmes.”

But he added that the NHS had a responsibility, too, to en­sure its message on diabetes was getting through to the Asian community.

“Services here need to be re­sponsive to different cultures. You can say to Indian families you should not eat pizzas, but what a lot of them would want is to have better advice about roti, chapati and rice.

“The message has to be tai­lored to the population.”

Prof Kar was born in the UK, where his parents, Deba Prasad Kar and Manju Kar, were both doctors. “My grandfather said he wanted to have his son back. So my father left everything and went back [to India]. I was five, six years old. My father was posted in Darjeeling, then went to Calcutta (now Kolkata).”

He attended Don Bosco, a well-known school in Kolkata, and did his MBBS locally at NRS Medical School & College. “I came back here (to the UK) when I was 25.

“My mother was an anaes­thetist and my father still prac­tises in north Kolkata. At the moment they are both here – they are stuck here. It was their 50th wedding anniversary so we flew them over here to cele­brate. They don’t know when they can go back.”

Prof Kar spoke of some of the cultural issues in Kolkata, which also apply to the UK, where sweet shops in Asian ar­eas of the country do a roaring trade, and not just at weekends.

“If you go to somebody’s house, any function we go to, mishti (sweet) is a big thing. But if you multiply your ceremonies and all your weddings, once-in-a-while mishti becomes a lot. Have it once in a while and en­joy it rather than have it every other night.”