Context

• India is often referred to as the ‘Diabetes Capital of the World as it accounts for 17%percent of the total number of diabetes patients in the world. There are currently close to 80 million people with diabetes in India and this number is expected to increase to 135 million by 2045. World Diabetes day is observed on 14 November.

What is Diabetes?

• Diabetes is a chronic (long-lasting) health condition that affects how our body turns food into energy.
• Diabetes is a metabolic disorder in which the body has high sugar levels for prolonged periods of time.
• The lack of insulin causes a form of diabetes.
• Type-I Diabetes: It is a medical condition that is caused due to insufficient production and secretion of insulin from the pancreas. Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). This reaction stops your body from making insulin. Approximately 5-10% of the people who have diabetes have type 1
• Type-2 diabetes: With type 2 diabetes, your body doesn’t use insulin well and can’t keep blood sugar at normal levels. About 90-95% of people with diabetes have type 2.

Type-2 diabetes in brief 

• Long term Condition: It is long-term (chronic) condition which results in too much sugar circulating in the bloodstreams and poor response of insulin. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems. Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. It is a defective response of Insulin
• More common in adults: Type 2 is more common in older adults, but the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people.
• Slow signs and symptoms: Signs and symptoms of type 2 diabetes often develop slowly. Symptoms include, Increased thirst, Frequent urination, Increased hunger, Unintended weight loss, Fatigue, Blurred vision, Slow-healing sores, Frequent infections etc. It develops over many years and is usually diagnosed in adults (but more and more in children, teens, and young adults).
• Cure for Type-2: There’s no cure for type 2 diabetes, but losing weight, eating well and exercising can help you manage the disease. If diet and exercise aren’t enough to manage your blood sugar, you may also need diabetes medications or insulin therapy.

What is insulin?

• Insulin is a hormone produced by the pancreas.
• Insulin regulates the movement of sugar into your cells.
• Blood glucose levels tightly controlled by insulin.
• When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level

The prevalence of diabetes in India

• People living with Diabetes in India: 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.
• Rapid increase in younger population: According ICMR report, the prevalence of diabetes in India has increased by 64 percent over the quarter-century. prevalence among the younger population has also increased above 10%.
• Children impacting more: Worryingly, in India, a large number of children are also impacted by diabetes. Children are developing obesity and metabolic syndrome early because of the change in diets to more processed and fast foods.
• Projected Estimation: About 98 million Indians could have diabetes by 2030, these projections come from the International Diabetes Federation and the Global Burden of Disease project.
• Children impacting more: Worryingly, in India, a large number of children are also impacted by diabetes. Children are developing obesity and metabolic syndrome early because of the change in diets to more processed and fast foods.

Why Indians are more prone to diabetes?

• Lifestyle changes: The current exponential rise of diabetes in India is mainly attributed to lifestyle changes. The rapid change in dietary patterns, physical inactivity, and increased body weight, especially the accumulation of abdominal fat, are some of the primary reasons for increased prevalence.
• Ethnically more prone: Ethnically, Indians seem to be more prone to diabetes as compared to the Caucasians, although the precise mechanisms are not well known. we Indians have a greater degree of insulin resistance which means our cells do not respond to the hormone insulin. And when compared to Europeans, our blood insulin levels also tend to rise higher and more persistently when we eat carbohydrates.
• Greater genetic predisposition: The epidemic increase in diabetes in India along with various studies on migrant and native Indians clearly indicate that Indians have an increased predilection to diabetes which could well be due to a greater genetic predisposition to diabetes in Indians.
• Decrease in traditional diets: At the same time, the increased ‘westernization’, especially in the metros and the larger cities, has led to a drastic change in our dietary pattens. Indian diets have always been carbohydrate-heavy and 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.
• Mechanization of day-to-day work: With the increasing availability of machines to do our work, there’s also a substantial drop in day-to-day activities.
• Consumption of high calorie food and lack of physical activities: Obesity, especially central obesity and increased visceral fat due to physical inactivity, and consumption of a high-calorie/high-fat and high sugar diets, thus become major contributing factors.
• Rapid urbanization: Currently, India is undergoing a rapid epidemiological transition with increased urbanization. The current urbanization rate is 35% compared to 15% in the 1950’s and this could have major implications on the present and future disease patterns in India with particular reference to diabetes and coronary artery disease.
• Rural-urban migration: The rural migration to urban areas and associated stress plays a significant role in lifestyle change.

Ways to manage Increasing Diabetes in India

• Aggressive Screening procedures: Indians 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. All Indians above 30 should be screened.
• Timely diagnosis and right management: Medical experts feel that timely detection and right management can go a long way in helping patients lead a normal life.
• Diet discipline for children: For children, Doctors 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 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 and to make it healthy.
• Promoting physical activities: “The overall decline in physical activity has had devastating impacts on our metabolism,” while agreeing with the 30-minute a day exercise and activity schedule, sounds a note of caution. The recent scientific evidence suggests even five minutes of walk after any meal provides some protection.
• Adopting healthy Lifestyle: Though a chronic medical condition, Diabetes can be curbed at the initial level by introducing lifestyle changes. Experts suggests, reduce stress; sleep on time and for minimum of seven hours, maintaining ideal body weight, regular physical activity stop smoking, stopping/ minimum alcohol intake and get early treatment for any pre-existing or co-morbid health condition such as hypertension.
• Regular check-ups: Regular visits to the doctor are important to assess sugar control and assessment/ prevention of complications related to the disease.

Conclusion

• With the country having the highest number of diabetic patients in the world, the sugar disease is posing an enormous health problem to our country today. According to a World Health Organization (WHO) fact sheet on diabetes, an estimated 3.4 million deaths are caused due to high blood sugar in the world.

Mains Question

Q. Diabetes is increasing alarmingly across all age groups in India. Discuss the reasons and suggest measures to manage epidemic of diabetes if it is not curable?

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