Diabetes is now not just about epidemic proportions in the country, it is worrisome that the younger generations are reporting a higher incidence. “It would be wrong to say the burden is increasing in the cities, it is exploding. Now 20 per cent of the younger population between 35 and 40 have diabetes. Most worryingly, Type 2 diabetes, which is mostly an adult disease, is now being reported by teenagers,” says Dr Ambrish Mithal, Chairman and Head, Endocrinology and Diabetes, Max Healthcare.
“There are an estimated 77 million people with diabetes in India. Which means one in every 10 adults in India has diabetes. Half of those who have high blood sugar levels are unaware. Even among those who have been diagnosed with diabetes, only half of them have their blood sugar level under control,” says public health expert Dr Chandrakant Lahariya, who specialises in diabetes, hypertension and thyroid disorders.
Why is diabetes increasing among the younger population so rapidly?
There’s no comfort in the theory that Indians are genetically more pre-disposed to diabetes. “It is not yet proven that genes make us vulnerable. But there is a very clear link between economic development, our lifestyle and diet choices that have upped the risk among Indians. Indian diets have always been carbohydrate-heavy. Now the reliance on refined sugars, processed food in the form of quick bites and fuss-free cooking and trans fatty acids are creating havoc. Aspirational eating, binging and a sedentary lifestyle have made weight management a tall order with most Indians, even the thin ones, accumulating visceral fat around their bellies,” says Dr Mithal.
“High levels of stress, smoking, excess use of alcohol are other factors contributing to diabetic burden. Diabetes increases the risk of developing heart, kidney and neurological complications by two to three-fold, all of which means high cost of care,” says Dr Lahariya.
Do all Indians need early screening?
Indians, feels Dr Mithal, need an upstream approach or prioritizing protection of the population as a whole, beginning with women and children. This can be done with aggressive screening procedures. “Anybody above 18, with a clear-cut risk like family history, weight issues and young women with
polycystic ovarian syndrome (PCOS) should be tested. If found normal, mind you not borderline and in the absence of other signs and symptoms, one can space out their testing by up to five years. All Indians above 30 should be screened and depending on readings, should go for an annual test at least. Pregnant women should get their blood glucose tested on their first visit to the doctor as gestational diabetes is an indicator,” advises Dr Mithal. And once detected, accessing a customized regime is not difficult as most trained physicians are well-versed in diabetes management protocols.
“High risk individuals need to undergo plasma sugar levels done at more regular intervals, as advised by the physician on the basis of risk assessment,” says Dr Lahariya.
How can Indians manage their diet?
One of the reasons for excessive carbohydrate build-up in our diet is because we still do not have enough proteins. “Our meal timings are highly irregular and we do not have a culture of eating the right food when the body demands, even at the workplace. To kill our cravings, we reach out for fast food and mind you, Indian fast food is just as bad. Dinner, we believe, should be had at home, no matter how late you get there,” says Dr Mithal. He again stresses on both maternal and child nutrition. He feels pregnant women do not eat right at all, being either overfed, depending on one’s privileged status in life, or underfed and hence malnourished. “What we need to understand is that both overweight and underweight children are at a risk of developing diabetes, the latter because the body is not used to handling sugar loads early on,” adds Dr Mithal.
For children, Dr Mithal recommends a serious diet discipline. “Only healthy meals are the option that remains. Tutor the tastebuds of the young and stop their access to fast foods. There can be supportive policy measures like taxing fast foods and colas while making healthy fruits and vegetables accessible in a cost-effective manner to all instead of plain carbs. The mid-day meal or tiffin needs to be looked at thoughtfully as it is largely unhealthy,” says he. Dr Lahariya advocates a simple formula of “taking five servings of fruits and vegetables.”
What should our exercise patterns be like?
As far as practicable, children should be encouraged to walk to school or the playground, feels Dr Mithal. This childhood discipline helped a generation while growing up to keep diabetes away. “The overall decline in physical activity has had devastating impacts on our metabolism,” says he. Dr Lahariya, while agreeing with the 30-minute a day exercise and activity schedule, sounds a note of caution. “Do not keep sitting or lie down after any meal. Go for a walk. The recent scientific evidence suggest even five minutes of walk after any meal provides some protection. Reduce stress; sleep on time and for minimum of seven hours; stop smoking; get early treatment for any pre-existing or co-morbid health condition such as hypertension,” he adds.
What about availability of drugs and costs?
Thankfully, most drugs are available and affordable in India. “Insulin drugs are still not that high. Given the challenge that diabetes poses today and the continuous follow-ups required, the real issue that should concern us is about insurance for OPD treatment. You have insurance for kidney transplants but no incentive for prevention of chronic diseases and stopping people from progressing to the transplant phase in the first place,” argues Dr Mithal.
“Metformin is one of the most commonly oral hypoglycemia agents. In other categories of drugs, there has been better understanding and a new generation of drugs have been developed. For example, the earliest sulfonylureas have gone out of use because of adverse effects and now, second and third generation sulfonylureas (Glipizide and Glipalamide) are preferred. Even insulin is not one type. In the last five decades, different types of insulin, their analogues, short and long activin insulins, basal and bolus formulations and pre-mixed insulin have become available,” says Dr Lahariya.
What are the common myths that Indians believe in?
The commonest myth is that diabetes is reversible and we can go off medication once our levels are in the normal range. “Let me first state that some patients of Type 2 diabetes can go off medication and remain fine for years. It’s not called cure or reversal, which implies permanency. Rather, the term remission is used, since we don’t know if it is permanent. Type 2 diabetes is an ongoing, progressive disease and it is expected to make a comeback at some point. Clearly, however, several years of postponement of diabetes is possible. This has tremendous benefits for our long-term health and well-being,” explains Dr Mithal.
The most common myth, according to Dr Lahariya, is that diabetes means insulin treatment. “While it is needed for Type 1 diabetes, those diagnosed with Type 2 diabetes are prescribed oral hypoglycemic agents. Insulin is required for only a small proportion of Type 2 diabetics.”
The silver lining is that much of diabetes progression depends on modifiable factors. And the sooner we re-adjust our way of life, the faster we can rid ourselves of the disease burden.
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