Diabetes is no longer a disease of elderly people. It has changed its status from being mild disorder to one of the major causes of morbidity and mortality irrespective of the age. Diabetes is now supposed to be a major concern even for the children as young as 15 years. The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. Although there is an increase in the prevalence of type 1 diabetes also, but the major driver of the epidemic is the more common form of diabetes, namely type 2 diabetes, which accounts for more than 90 per cent of all diabetes cases. The prevalence of diabetes seems to be more or less the same in both genders.
However, India leads the world with largest number of diabetic people earning the dubious distinction of being termed the “diabetes capital of the world”. The number of people with diabetes in India currently is around 40.9 million, which is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken.
This is a disturbing finding as the earlier age of onset combined with increasing prevalence of diabetes could have adverse effects on nation’s health and economy. A study from Delhi reports a high prevalence of insulin resistance in post pubertal children, which was associated with excess body fat and abdominal adiposity. This is of great concern because if the epidemic shifts to children it could have serious consequences on the health of the nation.
It is important to note that the studies that have shown an increase in prevalence of diabetes have also reported a very high prevalence of undiagnosed diabetes in the community. Urban rural differences in the prevalence of diabetes have consistently been reported from India. Study showed that the prevalence was three times higher among the urban (8.2%) population compared to the rural population (2.4%).
According to study,prediabetes state is the harbinger of future diabetes. Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) collectively called as prediabetic states, have a high risk of conversion to diabetes. The data on IGT and IFG are also equally important to analyze, as they are indicators of future diabetes prevalence and burden on the nation.
Several studies on migrant Indians across the globe have shown that Asian Indians have an increased risk for developing type 2 diabetes and related metabolic abnormalities compared to other ethnic groups. Although the exact reasons are still not clear, certain unique clinical and biochemical characteristics of this ethnic group collectively called as the “Asian Indian phenotype” is considered to be one of the major factors contributing to the increased predilection towards diabetes.
Despite having lower prevalence of obesity as defined by body mass index (BMI), Asian Indians tend to have greater waist circumference and waist to hip ratios thus having a greater degree of central obesity. Again, Asian Indians have more total abdominal and visceral fat for any given BMI and for any given body fat they have increased insulin resistance.
Studies on neonates suggested that Indian babies are born smaller but relatively fatter compared to Caucasian babies and are referred to as “the thin fat Indian baby”. A recent study confirmed this finding and suggested that the “thin fat phenotype” in neonates persisted in childhood and could be a forerunner of the diabetogenic adult phenotype. These findings suggest that Asian Indians are more prone to diabetes and related metabolic abnormalities.
However, the primary driver of the epidemic of diabetes is the rapid epidemiological transition associated with changes in dietary patterns and decreased physical activity as evident from the higher prevalence of diabetes in the urban population.
The fact that there is a shift in age of onset to younger age groups is alarming as this could have adverse effects on the nation’s economy. Hence, the early identification of at risk individuals and appropriate intervention in the form of weight reduction, changes in dietary habits and increased physical activity could greatly help to prevent, or at least delay, the onset of diabetes. Or else if the situation allowed to persist, as it is now, the time bomb of diabetes is bound to explode in massive proportion causing great damage to the people as well as nation.