Start a national and cultural campaign to eat healthily.  Avoid sodas, candies, processed foods and instead support local small farmers and the fruits and vegetables they grow.  We need to change the culture of urban areas and rural areas (they should not copy the bad habits of the urbanites).

Awareness program in rural area required to be conducted about Glycemic index and the food calorie requirement VS. value of food they are taking. The difference between previous life style and Now. What Is and why diabetes?Solve the problem to some extent.

I thank both Dr. Wolff & Dr. Kumar for their responses. National campaign on healthy diet & life style is very much needed in rural areas as part of primary prevention. We need to find out some suitable mechanism for effective dissemination of life style modification messages. Simultaneously strengthening of existing health system is necessary that is tuned for early detection at community level & initiation of treatment as a part of secondary prevention. This is really a big challenge as it requires huge resources.

Assuming that your question is pertaining to Type 2 diabetes (diabetes that is implicated by lifestyle habits), I would also suggest using the natural environment for your setting, that is the rural area of India. Physical activities within the natural environment can be used as a mechanism to manage the risk factors of this type of diabetes. Along with physical activities, other preventive approaches such as healthy eating can be used as part of the overall strategy, particularly when these interventions have been consistently proven to be effective and cost-effective. Hope this helps.

What could be very useful is to enlist the active support of Bollywood.  If they would add 'public service' messages into their films and include good health information as part of their 'story' it could go a long way to educate people.  Do the rural people in India have the opportunity to view movies at least occasionally?

Dear Dr. Robert,

We have television set in many rural families, rural youth clubs, rural women association's office etc. So, it is possible that messages reach to many of them through TV, if some popular film star becomes the Brand Ambassador of it. 

That would be great - get a 'Brand Ambassador of Health" to help get simple but effective messages into the popular media.  Could have hugely positive effect.

Yeah; Ministry of Health & Family Welfare, Govt. of India, is needed to take initiative towards that for the sake of entire country.

Alongside all the suggestions mentioned in earlier comments, I feel that there is a need to explore major factors that make the rural population more prone to diabetes. Subsequently, interventions should be customized to target those areas where gaps are identified to have a more impact of the initiatives.   

Dear Mr. Khan, 

A community based study already done that identified many epidemiological factors.  Dietary habits n sedentary life appear to be mostly responsible apart from other variables.  

It doesn't surprise me that the same factors affecting urbanites also affect those from rural communities, poor diet and lack of activity.  It does seem like the rural people should be a little more active, or are there factors that prevent activity?  Either way, the focus should now be on how to change those factors, and begin to lower the rate of Diabetes type 2.

Speaking as someone who had a surprise diagnosis of diabetes in my 30s despite not being very overweight, the testing should be straightforward?  One would just use urine or pinpricks and the results will come back immediately.  Thereafter, Metformin should be affordable for a few cents a month in India.  (I pay about $4 a month in the USA).  There could be education seminars on eating less starchy foods.  It should not cost too much money all around.

Also, if you're dealing with a less educated audience, do not confuse them by talking about how the pancreas, liver, and kidneys work.  Just show them graphic pictures of diabetes complications and emphasize the importance of taking pills daily.

Dr. Robertson - you are very correct about keeping the message simple.  Always remember K.I.S.S. (keep it simple, stupid) so the audience is not distracted by unnecessary information.  What is critical to get across to the audience?  Then keep it simple.  Graphics can be used very advantageously.

I just published a paper where I analyzed the results of an educational workshop for Spanish-speaking women in the United States.  There were people who hardly had any schooling and didn't know a heart from a lung.  They benefited from very basic information about diabetes.

Dr. Robertson - there may be an underlying genetic predisposition (my family seems to have this 'gene'), but there may also be those who respond to the overuse of sugar (starches included) to develop insulin resistance easier.  But also, do not ever diagnose diabetes with a simple blood or urine test.  They must be done correctly (fasting for blood sugar), and repeated several times (different days) to make sure the one test result was not a fluke.  But a hemoglobin A1c is a much better test as it shows variation in the blood glucose over time. 

You're correct that is how we would do things in a wealthy nation.  I'm thinking that in a place with limited budgets where they may not be able to afford complete testing, there's no real harm from prescribing people Metformin at whatever stage of pre- or real diabetes they have.  It is sometimes prescribed to non-diabetic obese people.

Yes; I do agree with the suggestions given both by Mr. Robertson & Mr. Wolff. Information need to be simple but target oriented, which is culturally acceptable in the community. Similarly foods causing chronic inflammation & that help in developing insulin resistance should be avoided.

I would also add education that there is no evidence herbal potions or powders cure diabetes; at best, they help just a little bit.  Even in Western nations, there is a whole industry of scammers selling fake cures.  Metformin originally comes from lily flowers, but was modified synthetically to make them less toxic.

Just adding to Dr. Henry, curcumin (turmeric) is said to have anti-Diabetic, anti-inflammatory, anti-cancer and anti-arthritic properties. I believe that it needs to be studied further in depth about its potential to cure Diabetes, which may lead to new drug discovery by modifying the active ingredient/s. Indian Institute of Chemical Biology, Kolkata, has already confirmed by their study that curcumin has anti-cancer property & gastric ulcer healing properties in rat. 

Yes curcumin/turmeric has many beneficial uses, but how effective is it?  For diabetes I am not sure.  There also is cinnamon which does seem to help slow/lower the blood glucose levels and thus may reduce the risk for diabetes, but it is certainly not a cure.

Those seasonings may have some effect, but until there is definitive clinical evidence of its efficacy (probably a synthetic variant will work better), I would not emphasize them too much in an education program.

Dear Kamalesh Sarkar

Diabetes in rural area you can use health volunteer , head community , key man person in community , personal in local administration , health volunteer in family everyone can help you for provide knowledge attitude and good practice for change behavior of your patient to reduce diabetes by there participation

   The question is whether you have some assessment of the magnitude of the problem. Whatever data is available it is better to start with that. We know that there are cost effective prevention measures. There is no "one size fits all" solution. It all have to depend on the magnitude of the problem and the resources you have at your disposal . Priority setting is important. With the resources you have you can do health promotion and screening of suspected  cases. That has to be matched by supply side initiatives.

1.School: Increase awareness among students about exercise, healthy diet and test for blood sugar, regular health check up. They are the change agents.

2. Training housewives in villages through SHG about healthy diet because it is the kitchen where ignorant mothers nurture  behaviour among  family members to adopt unhealthy diet.

3.Strengthen BCC component at PHC/CHC level.

4.Involve PRI members

5. Villages who adopt exercise, healthy diet and  village with  lowest annual mean blood sugar, mean BMI  in a  panchayat/block wust be rewarded.