Connect with us

Life style

Shifting paradigms in diabetes care

Published

on

Today is World Diabetes Day

The prevalence of diabetes worldwide has nearly doubled since the 1980s. Globally about 422 million people have diabetes according to the World Health Organization and the majority of them live in low and middle-income countries. Around 1.5 million deaths are directly attributed to diabetes each year. A century after the discovery of insulin, millions of people with diabetes around the world still cannot access the care they need.

In this setting the theme for World Diabetes Day 2021-23 has been declared- ‘Access to Diabetes Care.’ The management of diabetes has today taken a shift involving a more holistic approach, points out Consultant Endocrinologist at the Sri Jayewardenepura General Hospital, Dr. Dimuthu Muthukuda. In an interview with the Sunday Island, she throws light on these shifting paradigms which are aimed at enhancing the quality of life of those with diabetes.

by Randima Attygalle

Q: How relevant is this year’s theme ‘Access to Diabetes care’ in a Sri Lankan context?

A: Since the discovery of insulin in 1921, there had been many strides forward in terms of the varieties of insulin – both oral and injectable. Today there are both national and international guidelines pertaining to diabetes care. Despite these, people with diabetes all over the world are challenged in accessing diabetic care. We are at a satisfactory level in delivering diabetic care within our freely accessible and well-structured health care system. Our limiting factor is the non-availability of the ideal device for insulin delivery which is the insulin pen. What we have in the state health sector for cost reasons is still the syringe and the needle. However, we are constantly improving our services for increased accessibility.

Q: What is the current ‘diabetes picture’ here at home?

A: In terms of the numbers, our situation is quite alarming. Recent studies show that the prevalence of diabetes in suburban areas of the island is about 20%. The situation in the rest of the South East Asian countries is no better. The major triggers of diabetes in our part of the world are obesity and being overweight. Today obesity has reached pandemic proportions and is as dangerous as COVID. Worse, there is a sizeable proportion of school children with diabetes.

The accumulation of fat in the abdomen which is called ‘abdominal or central obesity’ is common among South East Asians. This reflects the tendency for a person to develop diabetes. The other major risk factor is insulin resistance. This condition is closely linked to obesity and diabetes and this inter-connectivity leads to a very vicious cycle.

A few decades ago when we talked of a person with diabetes, it was a middle-aged or an older person that we visualized. This is no longer the case. Today many children, adolescents and young adults are diabetics.

Q: What are the most common types of diabetes?

A: Type 1, Type 2 and Gestational diabetes are the common types. In Type 1, the body does not produce any insulin and there is life-long insulin dependency. Very often children under 10 years develop this type although symptoms could occur in adolescence as well.

Type 2 is the most common, where the body does not use insulin which is produced by the pancreas effectively. This insulin resistance is also attributed to obesity where insulin is prevented from working well at tissue-level. Although Type 2 is called ‘adult-onset diabetes,’ today we see many young people developing it giving enough time to develop other complications. After about 10-15 years of having Type 2 Diabetes, the pancreas can get exhausted and it could stop producing insulin. Therefore initially although a person can manage Type 2 with drugs, later he/she may need insulin as well.

Diabetes during pregnancy is what is known as gestational diabetes. The long term consequences of this type could be serious. If a pregnant woman has gestational diabetes, there is a 50% chance of her children getting it. There is also the risk of children being obese. This is why we say that when we manage diabetes of an expectant mother, we also manage the condition in the next generation.

Q: Who are at high risk of developing diabetes?

A: Being a South Asian per se is a risk factor. Besides that, being overweight or obese, appearance of blackish velvety skin behind the neck, having a family history of diabetes (children whose both of whose parents have diabetes have more than 75% chances of developing the disease) and children of mothers with gestational diabetes and people who are on certain drugs such as steroids are at high risk.

Q: Can you throw light on the new interventions in managing diabetes?

A: Today the global trend is to look at the condition from a positive perspective. The traditional understanding was that the moment a person is diagnosed with diabetes, he/she becomes a ‘diabetic’ or a ‘diabetic patient’. Imagine a person being diagnosed at 15 or 20 with diabetes; are we going to call that person a ‘diabetic’ for the rest of his/her life? What will be his/her social and psychological well being in that case? Today diabetes is considered as a condition which you need to manage. Instead of calling ‘diabetics’ or a ‘diabetes patients’ we call them ‘individuals with diabetes’.

A few decades ago the most feared thought was going on a ‘diabetic diet’. Today we are talking of a healthy diet for everyone in the family; we are talking about giving advice to the whole family because it has to be essentially a family affair. For instance, you are going to cook a healthy meal for the entire family and not only for the member with diabetes.

The pharmacological management landscape of diabetes has also changed. Instead of the gluco centric approach which looked only at glycemic or sugar control, today a holistic approach is in place which is known as ‘cardio-renal’ approach. This looks at reducing cardio-renal complications (kidney and heart related complications). Although morbidity and mortality due to diabetes is largely heart attacks, the root cause is underestimated because the cause of death goes as ‘heart attack’ and most of these heart attacks can be prevented. To strengthen the cardio-renal management of people with diabetes, our health sector is trying its best to make the latest cardio-protective drugs available in government hospitals.

In diabetes management, we not only address sugar levels but the entire spectrum of micro vascular and macro vascular complications. When diabetes is mismanaged both small (micro) and big (macro) vessels can be damaged. While micro vascular damage will involve the retina of the eye, kidneys and nerves, macro vascular damage will lead to stroke, heart attack and peripheral vascular disease. As Endocrinologists, our ultimate goal is to prevent people from getting micro and macro vascular diseases. To realize this, we encourage people with diabetes to monitor their blood glucose levels at home using glucometers. It is imperative that they have good metabolic control and healthy cholesterol levels. Diseases such as ischemic heart disease and non-alcoholic fatty liver should also be kept at bay. Then only can we prevent amputations and even death. Today we look at the bigger picture.

Another new trend is what we call ‘diabetes remission’. New clinical trials have shown that in case of recent onset of diabetes, if a person is able to lose weight coupled with a healthy diet and exercise and also with the use of drugs such as Metformin, a person can go into a remission for a long period of time with a fully normalized blood sugar levels.

Q: What measures are in place to empower people with diabetes, so that they become independent and can improve their quality of life?

A: Sri Lanka College of Endocrinologists (SLCE) carries out many educational programmes including training of trainers and health care personnel. Guidelines are also developed by the SLCE.

Education and awareness is very much a part of Endocrinology Units of state hospitals today. We look at the entire metabolic picture and deliver a comprehensive diabetic care delivery through our clinics.

Q: What is the role of diet and exercise in preventing and managing diabetes?

A: Eating in moderation is the key and rather than what you eat, you need to be mindful of how you eat. Managing portions is crucial here. Our plate should ideally have 1/4th of rice and the rest should be green leaves, fish, etc. People should also be more creative and intelligent in their food choices. Mixing food which contains more sugar with fibre-rich food for example, can be a smart way of eating. It is not realistic to stay away from delicacies during festive seasons, nor depriving a child of sweets; the key is enjoying what you like in moderation. Eating fruits in between meals is encouraged so that they serve the dual purpose of having a snack as well as fulfilling the daily fruit requirement. Processed food and fast food should be minimal.

In terms of exercise, we encourage at least half an hour of physical activity such as brisk walking, cycling, swimming or aerobics, at least five days a week. Exercising itself can help minimize insulin resistance.

Even people with disabilities are encouraged to exercise their muscles while being seated or lying down.

Q: What challenges do you see for people with diabetes during the pandemic and how can they be mitigated?

A: When a person has poorly controlled diabetes, his/her immunity is compromised and chances of catching infections are very high. So it is essential that people manage their diabetes and take their drugs diligently. Mismanaged diabetes can result in COVID pneumonia. Even during the lockdowns, we ensured that drugs reached people and most clinics operated uninterrupted in the best interest of the public.

We see more people becoming sedentary during the pandemic. Both children and adults are spending a considerable time before computer screens with little or no exercise. This could make them susceptible to obesity which is a precursor to diabetes. Hence, children should be encouraged to indulge in some kind of physical activity and even adults should regularly take breaks from their desks and take a short walk around.

Q: Finally, how important do you think it is to adopt a multidisciplinary approach to combat diabetes instead of making it the sole responsibility of the health sector?

A: Although management of diabetes has to be customized, it is very crucial that we have a multi modal approach with the participation of schools, policy makers, employers and media to prevent the numbers from escalating. Today we have the traffic light system for certain foods, however there is still a question of consumer literacy. We also see children being the target of advertisers and there is a need for regulation here. Hence it is imperative that all stakeholders get together in preventing diabetes which could take a toll both on individual productivity as well as the health sector.



Continue Reading
Advertisement
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Life style

Tourism gets a World Bank powered boost

Published

on

By Zanita Careem

With Sri Lanka tourism entering a new phase of growth, the Deputy Minister of Foreign Affairs, Foreign Employment and Tourism, Professor Ruwan Ranasinghe outlined the Government’s forward looking approach, stressing that Sri Lanka must move forward, and must move beyond short term promotional efforts and build a tourism industry backed by clear strategy, stronger planning and measurable results. At the recent Press Conference, held at the SLTPB, Sri Lanka Tourism launched two World Bank supported consultancy assignments to develop a national tourism strategy and global promotional campaign road map, as the country seeks to attract high spending visitors and generate greater economic reforms. The National Tourism strategy planning consultancy for 2026-2031 will prepare a five-year framework, covering a forward looking approach, centred on transforming tourism into a more competitive sustainable and high value sector. For Sri Lanka, this initiative marks an important shift towards strategic, sustainable and inclusive tourism development with the aim of giving greater economic opportunities to the people. The Deputy Minister said the country does possess the natural beauty, cultural heritage and hospitality needed to compete globally. What is required now, he emphasised, is a coordinated approach that brings together government, industry stakeholders and international expertise.

For Professor Ranasinghe the way forward is not simply about bringing more tourists to Sri Lanka but about creating greater value from every visitor, diversifying markets, encouraging investment, strengthening the tourism institutions and developing a destination that can complete confidentially on the world stage. His speech reflected a clear message, Sri Lanka has the attraction, diversity and potential to compete with the world’s best destinations, but must be driven by stronger strategy, sharper global marketing and co-ordinated action.

He emphasised that Sri Lanka has not lacked tourism plans in the past. Previous governments and tourism authorities had undertaken considerable work and developed important plans but the challenges was that these efforts had not given the strength, continuity and implementation mechanisms needed to produce the desired results. The new approach, he stressed, is about giving tourism greater teeth through stronger planning, better governance, targeted investment, sustainable development and a much aggressive presence in the international markets.

(Q) Why is the launch of the National Strategies Planning Consultancy a major milestone for Sri Lanka’s tourism industry?

(A) The launch marks a turning point because it introduces a structured, evidence-based framework for tourism development. For years, Sri Lanka focused primarily on increasing visitor numbers, but despite strong arrivals, revenue growth lagged. This consultancy, supported by the World Bank, ensures that future strategies emphasise value creation, sustainability, and inclusivity. It is the first time Sri Lanka’s tourism industry is being aligned with global best practices, institutional reforms, and a clear roadmap for implementation, making it a landmark initiative.

(Q) What are key priorities that the new national tourism strategy will focus on?

(A) The new strategy prioritises enhancing visitor spending and length of stay, reducing revenue leakage by strengthening local supply chains, modernising institutions and regulations, and embedding sustainability across all tourism activities. It also emphasises skills development through curriculum modernisation at SLOTH, digital transformation of tourism data systems, and diversification of tourism products to attract high-value segments such as wellness, eco-tourism, and cultural tourism.

(Q) What major gaps in Sri Lanka’s existing tourism strategy do you hope to address?

(A) Previous strategies were heavily arrival-driven, with limited focus on yield per visitor. There was weak differentiation among destinations, limited integration with local communities, and insufficient institutional coordination. The new plan addresses these gaps by embedding sustainability, strengthening provincial tourism bureaus, diversifying products, and ensuring that tourism revenue benefits local communities more directly.

(Q) What is the vision behind Sri Lanka’s new global promotional campaign road map?

(A) The vision is to reposition Sri Lanka as a premier global destination by highlighting its unique blend of culture, nature, and wellness. The campaign, developed with international expertise, will use data-driven marketing, influencer collaborations, and destination storytelling to reach high-value markets. It aims to move beyond generic promotion and instead create a strong, differentiated brand identity for Sri Lanka.

(Q) How will this campaign change the way Sri Lanka is positioned and marketed internationally?

Professor Ruwan Ranasinghe: New international narrative for Sri Lanka

(A) Sri Lanka will be marketed not just as a tropical island but as a destination offering diverse, high-value experiences. The campaign will highlight wellness retreats, heritage tourism, eco-adventures, and community-based experiences. This repositioning will attract discerning travellers who seek authenticity and are willing to spend more, thereby increasing tourism’s contribution to the economy.

(Q) How will the Ministry ensure that the strategy does not remain another document, but is actually implemented?

(A) The consultancy includes costed action plans, institutional reforms, and monitoring mechanisms to ensure accountability. Stakeholder workshops and validation sessions will embed ownership across government, private sector, and communities. The Ministry is committed to ensuring that this strategy translates into tangible outcomes through structured implementation and regular progress reviews.

(Q) Are we ready to market Sri Lanka to the world at a much bigger level or do you first need to fix the gaps in the visitor experience before spending heavily on promotion?

(A) Both aspects must go hand in hand. While global promotion is essential to reposition Sri Lanka, the visitor experience must be strengthened to ensure repeat visitation and positive word-of-mouth. The strategy priorities service standards, infrastructure, and product diversification so that promotional spending translates into genuine value for visitors and communities alike.

(Q) What does the World Bank’s involvement bring to Sri Lanka’s tourism strategy that was missing from previous initiatives?

(A) The World Bank brings international expertise, credibility, and funding support. Its involvement ensures that Sri Lanka’s strategy is benchmarked against global best practices, with stronger institutional frameworks and better data systems. Unlike past initiatives, this partnership emphasizes sustainability, inclusivity, and value-driven growth, ensuring long-term resilience for the industry.

(Q) Will the World Bank’s expertise help Sri Lanka move from simply increasing tourist arrivals to attracting high-value tourists?

(A) Yes, the World Bank’s guidance is focused on shifting from volume-driven growth to yield-driven growth. By strengthening product development, diversifying markets, and embedding sustainability, Sri Lanka will attract high-value tourists who spend more, stay longer, and contribute positively to local communities and conservation efforts.

(Q) Will the new strategy place greater emphasis on sustainable and responsible tourism?

(A) Absolutely. Sustainability is at the heart of the new strategy. ECT-tourism, community-based tourism, and conservation initiatives will be scaled up to protect Sri Lanka’s fragile ecosystems and heritage. Responsible tourism practices will be embedded across the industry to ensure that growth does not come at the expense of the environment or local communities.

(Q) With the World Bank bringing international expertise to Sri Lanka’s tourism strategy, what is the one major transformation for the world to see in Sri Lanka as a tourism destination?

(A) The major transformation will be Sri Lanka’s repositioning as a high-value, sustainable destination. The world will see Sri Lanka move beyond being a volume-driven market to becoming a model of responsible tourism, where visitors enjoy authentic experiences while contributing to local prosperity and environmental conservation. This shift will redefine Sri Lanka’s global image and ensure long-term competitiveness.

Continue Reading

Life style

When food becomes the language of connection for Chef Sajesh Nair

Published

on

Royal medley of Indian flavours-at Nair’s Navaratne

By Zanita Careem

Behind every memorable dining experience is a chef whose passion transforms ingredients into something extraordinary. At Taj Samudra Colombo, the hotel’s Executive Chef, Sajesh Nair brings culinary artistry, precision and a deep understanding of flavours, curating dishes that are as refined as they are memorable.

With his passion for quality ingredients, attention to details and commitment to culinary excellence, Chef Nair continues to create flavours, turning the finest ingredients into culinary masterpieces, and transforming the dining table into a stage of indulgence.

Behind every memorable dining experience is a Chef who understands that food is more than what appears on a plate. For Chef Sajesh Nair cooking has been a lifelong journey, shaped by tradition, discipline, curiosity and a passion for authentic flavours.

With an impressive 30 years in the culinary tradition, including 17 years with Taj Hotels, Chef Sajesh Nair has built a career round creating a distinctive dining experience, while remaining deeply connected to the heritage of the cuisines he represented.

His journey with Taj has taken him through some of the group’s most prestigious properties. He was the Executive Chef at the celebrated Taj Falakruma, in Hyderabad, where he became particularly recognised for his expertise in Hyderabad and Nizami cuisine. “My philosophy was rooted in preserving traditional techniques while presenting them with refinement and creativity.” My passion for cooking began at an early age, “My journey was shaped by an early and lasting influence of my father.’’ It was through him that Sajesh developed an appreciation for food, discipline and dedication behind creating something truly special.

Turning ingredients into memorable experiences

His culinary credentials also came into spotlight when he led the team preparing an elaborate royal inspired menu for a high profile dinner at Taj Falakuma Palace, attended by Prime Minister Narendra Modi and Ivanka Trump.

At Taj Samudra Colombo, Chef Sajesh brought his wealth of experience to Sri Lanka’s hospitality scene. His culinary leadership extended to many restaurents, including the revamped Indian Restaurant Navaratne where he has created an experience, centred around cuisines from all parts of India. Adding depth to this culinary journey, Chef Sajesh philosophy fits naturally into the restaurant’s identity, offering guests an introduction to India’s culinary traditions while maintaining the standard of Taj hospitality. Navaratne has become more than an Indian restaurant, it’s a culinary passage to India with Sajesh Nair’s experience in helping bringing its flavours, traditions and stories to the table. Chef Sajesh Nair has a long Taj Hotel career and in Sri Lanka, as the Executive Chef of Golden Dragon – one of the hotel’s specialist restaurant, where he has brought his expertise and creativity to the kitchen, creating flavours that have delighted diners from all walks of life. His association with Golden Dragon, the Chinese restaurant, began in India where he worked at the restaurant as part of his early Taj Samudra hotel’s career. That experience gave him the exposure to the Chinese wider culinary techniques at the Golden Dragon Colombo.

Chef Sajesh Nair: Executive Chef, Taj Samudra, Colombo. Maestro behind flavours

At Taj Samudra Colombo, the Yumi Japanese restaurant is one of the hotel’s speciality dining outlets, His strength lies in creating dishes that balance authentic flavours with contemporary presentation, while his attention to detail and understanding of ingredients gave each creation its distinctive character. He embraced a wider gastronomic repertoire, mastering flavours and techniques from across the world. Chef Sajesh Nair’s culinary canvas extended beyond Indian cuisine. Nair’s role was not simply about mastering one cuisine but about creating different dining experience to suit different tastes. He curated extensive festive menus at Ports of Call and worked across the hotel’s speciality restaurants .

Chef Sajesh Nair’s journey extends beyond the restaurant kitchen with his career giving him opportunities to prepare food for celebrations, distinguished personalities and high profile guests in Sri Lanka and abroad. His work at the Golden Dragon and at the Yumi restaurent further reflect his versatility as a executive. Chef Nair led the culinary team at Taj Falaknuma Palace when a dinner was hosted for Narendra Modi.

Chef Nair and his team prepared the elaborate five-course royal Hyderabad/Nizami menu for Ivanka Trump during her Hyderabad visit. Mukesh Ambani and Ratan Tata both were among the prominent. Indian business leaders who attended the gala dinner. Among the distinguished personalities to experience Chef’s culinary artistry was Cherie Blair, who was among the guests at the glittering banquet at Taj Falaknuma Palace in Hyderbad during the 2017 Global Entrepreneurship Summit. He also curated menus for Mohamed Azharuddin’s wedding reception at Taj Mahal Palace. At this wedding he worked as a young Chef de Partie at the hotel where he won rave reviews. Later he steadily worked his way through the demanding hierachy of professional kitchens.

In Sri Lanka he has created menus for cricketers, both Sri Lankans and Indians. He was also the part of the team when he created various menus during PM Narendra Modi’s visit to Sri Lanka when he stayed at the Taj Samudra. He has also curated menus for all the higher profile personalities, like corporate clients and political figureheads, including the PM of Sri Lanka, Harini Amarasuriya.

From royal banquests in India to distinguished tables in Sri Lanka, Chef Sajesh Nair’s culinary journey is one marked by experience, versatility and an enduring passion for creating memorable dining experiences. His career reflects a Chef who has continually evolved with the times, while remaining rooted in the craft.

He quipped “For me food is more than what is served on a plate it is a way of connecting people.”

Continue Reading

Life style

CCWE National Workshop calls for collective action

Published

on

Yassas Hewage, Chairman, Industrial Development Board, with Amélie July, Deputy Director for Sri Lanka AFD, and Dr Ayanthi Gurusinghe

The Ceylon Chamber of Women Entrepreneurs (CCWE), in collaboration with the University of Kelaniya, brought together policymakers, development partners, private-sector leaders, academics, civil society organisations and women entrepreneurs at the National Workshop “Advocating for Change: Women’s Economic Empowerment through Collective Action.”

The workshop formed part of the FAME – Feminism: Action and Mobilisation for an Inclusive Economy Project, supported by the Agence Française de Développement (AFD), and focused on identifying practical pathways to create a more inclusive and enabling entrepreneurial ecosystem for women in Sri Lanka.

The national dialogue provided a platform to bring together policy-level perspectives with the experiences of women entrepreneurs and grassroots organisations, while presenting research evidence on the barriers, opportunities and institutional changes required to strengthen women’s participation in entrepreneurship and economic development.

Welcoming participants, Dr. Ayanthi Gurusinghe, President of the Ceylon Chamber of Women Entrepreneurs, emphasised that women’s economic empowerment cannot be achieved through isolated interventions or training programmes alone. She highlighted the importance of connecting women entrepreneurs with finance, technology, markets, knowledge, networks and policy-making institutions, while ensuring that the voices of women, at community level, are represented in national discussions. She noted that the purpose of “Advocating for Change” is to bring these different voices together and move from identifying challenges towards practical and sustainable solutions.

Dr. Gurusinghe further stressed the importance of collective action among government institutions, development partners, academia, the private sector, women’s chambers and community organisations to create meaningful economic opportunities for women across Sri Lanka.

Partnerships for Progress:

France’s Continued Support for Women’s Economic Empowerment, Matthieu John, Deputy Ambassador of the Embassy of France, highlighted the importance of partnerships in advancing inclusive economic development and reflected on the contribution of the FAME partnership in Sri Lanka.

Together we rise: power of collective action

He emphasised the value of strengthening women’s participation in economic decision-making and creating opportunities that enable women not only to establish enterprises but also to build sustainable businesses capable of contributing to employment, innovation and economic growth.The participation of France and AFD in the programme reinforced the importance of international development partnerships that support locally led initiatives, research, advocacy and collective action for women’s economic empowerment.

Creating an Enabling Ecosystem for Women Entrepreneurs:

Delivering the keynote address, Yasas Hewage, Chairman of the Industrial Development Board (IDB), focused on the importance of creating an enabling ecosystem in which women entrepreneurs can move beyond micro and livelihood-based enterprises towards sustainable, growth-oriented businesses. He highlighted the role of enterprise-development institutions in providing entrepreneurs with access to technical knowledge, technology, productivity improvement, business-development services, finance and markets.

Hewage also emphasised that strengthening women-owned enterprises should be viewed not merely as a gender or social-development intervention, but as an important component of Sri Lanka’s wider industrial and economic development

The National Workshop concluded with a call for stronger coordination and continued collective action among government, development partners, financial institutions, academia, the private sector, women’s organisations and entrepreneurs.

Among the broader priorities emerging from the dialogue were the need to strengthen access to finance and markets; improve technology, digital and business-development support; create stronger pathways from micro-enterprise to sustainable business growth; strengthen institutional coordination; improve access to opportunities for women outside Colombo; and ensure that women entrepreneurs have a stronger voice in policy and economic decision-making.

CCWE emphasised that the dialogue is intended to contribute to a wider process of evidence-based advocacy for women’s economic empowerment, ensuring that recommendations are informed not only by research and institutional perspectives but also by the lived experiences of women entrepreneurs themselves.

The workshop reaffirmed a central message: Women’s economic empowerment is not solely a women’s issue—it is fundamental to Sri Lanka’s inclusive economic growth, industrial development and long-term prosperity.

Continue Reading

Trending