More than 7.1% of the adult population of India is having diabetes
Diabetes mellitus, popularly called diabetes, is a modern epidemic. The prevalence of diabetes has shown an exponential rise in recent years all over the globe. According to World Health Organisation (WHO) 2016 data, there are estimated 422 million adults in the world living with diabetes. India is one of the worst hit nations of the world. Currently there are more than 62 million Indians living with diabetes and by 2025 this number will swell to 70 million. This means more than 7.1% of the adult population of India is having diabetes. ICMR-INDIAB is a recent study conducted in 15 states of India. In the community, 57,117 individuals were sampled. The overall prevalence of diabetes and pre-diabetes were found to be 7.3% and 10.3% respectively. Most importantly, 47.3% of them were not knowing that they have diabetes. They were diagnosed for the first time when their glucose level was checked for the study. Thus, awareness regarding diabetes among community is a need of the hour. According to a survey, the prevalence of diabetes in India varies among people from villages (4.0%), small towns (8.0%) and metros (16.0%). WHO predicts that deaths from diabetes in India will increase by 35% over the next 10 years. Diabetes is the number one cause of kidney failure in the world. Besides this every year it is responsible for 5% (5 million) blindness in adults and one million limb amputations. Diabetes is also an important cause of heart disease, stroke and cataract.
Diabetes mellitus is not a single disease, but a group of diseases, all characterised by a high level of glucose in the blood, that often lead to short-term as well as long-term complications. It is a group of diseases as there are various types of diabetes, caused by different pathological processes. Each type of diabetes behaves differently as far as its response to treatment and complications are concerned. For instance, type 1 diabetes is usually found in children. There is absolute deficiency of insulin in the blood because of selective autoimmune destruction of beta cells (beta cells produce insulin) in the pancreas. These children need external insulin not only for control of their diabetes but also for their survival. Type 2 diabetes is by far the most common type of diabetes-usually found in adults. This type of diabetes is initiated by insulin resistance (inability of insulin to function efficiently) followed after years and decades by beta cell death. That is why this type of diabetes can be controlled successfully by oral anti-diabetes medications for many years. Diabetes induced by drugs and chemicals is another class of diabetes. For instance, glucocorticoids given for many diseases like asthma and rheumatoid arthritis, can lead to diabetes as an adverse effect. Also called steroid-induced diabetes, this is managed in a different manner. Gestational diabetes develops in pregnancy and is treated by a limited number of safe oral medicines and/or by insulin.
THE SILENT THEIF
Majority of patients with type 2 diabetes do not feel symptoms initially for many months and years. This is the reason why diabetes is called silent killer. This is also the reason why the American Diabetes Association (ADA) has advised testing blood glucose after 40 years of age, even if you have no symptoms. And if the result is normal glucose, then blood glucose test is to be repeated after every three years in the absence of symptoms. Usual type 2 diabetes begins as a small increase in fasting blood glucose levels above the lower normal limit of 100 mg/dL. This rise of fasting glucose above the lower normal limit of 100 mg/dL is called pre-diabetes till it reaches 126 mg/dL or above when it is called diabetes. The same slow rise happens in post-prandial (after meals) glucose levels as well as in glycated hemoglobin (HbA1C) levels-the other measures of blood glucose status. This rise is very slow, often taking months and years. The body adapts to the new raised blood glucose levels and the patient does not feel symptoms. This absence of symptoms comes at a cost. The cost is harm to other organs like retina and kidneys. When diabetes is severe and has caused complications, then it causes symptoms. These symptoms include being very thirsty, frequent urination, weight loss, increased hunger, blurry vision, irritability, tingling or numbness in the hands or feet, frequent skin, bladder or gum infections, wounds that don’t heal, unexplained fatigue, and many more.
The single best predictor of type 2 diabetes is being obese or overweight. The most widely used measure for obesity is body mass index (BMI). BMI is a ratio, and can be determined by dividing weight in kilograms by height in meter squared. A BMI of 23.0 – 24.9 is considered overweight. A BMI of >25 defines obesity. Furthermore, it is not only the BMI that is risky, but also the distribution of fat in the body. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs. Ethnic background is also important as a risk factor for developing diabetes. Asians are more prone to central obesity and hence are more prone to diabetes. Hypertension, or high blood pressure, is also a major risk factor for diabetes. High blood pressure is generally defined as 140/80mm Hg or higher. Sedentary lifestyle and being inactive also makes you prone to type 2 diabetes. Having a family history of diabetes increases your risk of developing type 2 diabetes.
A healthy lifestyle can delay and even prevent type 2 diabetes. A healthy lifestyle consists of two components-physical activity and dietary pattern. Regular physical activity like brisk walk, jogging, cycling, etc., helps in maintaining normal weight. Exercise is beneficial to metabolic health independent of weight loss. That means if you are obese and you exercise regularly, even if you do not lose weight, you still are benefiting your body. Healthy dietary pattern means consuming a balanced diet. A diet that is high in fibre and low in refined carbohydrates and fats. Avoid fast and junk foods like sugary beverages, fruit juices, ice-creams, deep fried foods, chips and pizzas. Cut back on refined carbohydrates like white bread, white rice, white pasta and potatoes. Consume diet that is rich in fruits, vegetables, beans, whole grains, nuts and seeds. Use mike and milk-products. Reduce consumption of red meat and instead use chicken and fish. If you are overweight, every kilogram you lose can improve your health. A successful weight-loss programme consists of sustained dietary changes and regular exercise regimens. Sustained weight loss brings great benefits both biologically as well as psychologically. In one study, overweight adults reduced their diabetes risk by 16% for every kilogram of weight lost. Also, those who lost a modest amount of weight — at least 5 to 10 percent of initial body weight — and exercised regularly reduced the risk of developing diabetes by almost 60 percent over three years. Maintaining normal weight boosts ones self-esteem.
Diagnosis of diabetes is simple. A blood sample is taken after an overnight fast. A fasting blood sugar level between 100 and 125 mg/dL is considered pre-diabetes. If it is 126 mg/dL or higher on two separate tests, you have diabetes. After the fasting blood sample for glucose, 75 grams of glucose dissolved in water is consumed. After 2 hours, blood glucose is again measured. If the reading is between 140 – 199 mg/dL, it is pre-diabetes. But if the reading is 200 mg/dL or more, then it is diabetes. If you have symptoms of diabetes and random blood glucose is more than 200 mg/dL, then it is also diabetes. Another test that can be used for diagnosis of diabetes is HbA1C, that indicates your average blood glucose level for the past 2-3 months. An HbA1C level of 6.5 percent or higher indicates that you have diabetes.
Life-style measures, consisting of healthy dietary patterns (in medicine, known as medical nutritional therapy) and physical activity is an essential part of diabetes management programme. It also includes stress management by engaging in healthy habits like walking, gardening, yoga, music, community services, religious activities, etc. When life-style measures are not adequate for keeping your glucose levels in desired levels, then medicines are prescribed by experts. Experts can be physicians dealing with diabetes (diabetologists) or endocrinologists. Diabetes is a chronic condition and needs life-long measures. In recent times, diabetes is treated by ‘individualised approach’. That means out of many lifestyle measures and medicines, a particular set of advices and medicines are prescribed to a particular patient, that is supposed to work best for that individual, based on the current scientific knowledge of mechanisms of diabetes. The best way to obtain sustained results is to teach the patients about the disease, its complications, life-style measures and about diabetes medicines. This is called ‘patient empowerment programme’ (PEP), as this will help them in the long run to manage diabetes on scientific and evidence-based lines. There are a number of well-studied medicines for the management of diabetes. Some of these medicines have a safety profile of more than five decades. Always discuss your diabetes with your doctor and manage your diabetes in the best possible way.
Dr. M Shafi Kuchay is a Kashmiri Endocrinologist, presently working as consultant at Medanta The Medicity, Gurugram, India.