Most of us know someone with #diabetes, be it in our family, peer, office or in our surrounding. It is quite a common illness yet, not many people are aware about the impact the disease can have. This blog discusses the prevalence of diabetes and why it is so common among Indians – what makes Indians especially prone to the disease.
Global impact
According to the International Diabetic Federation (IDF), by November 2019, an estimated 463 million people between the ages of 20-79 years had diabetes. In other words, one in 11 people in the world has diabetes. Generally, people between the ages of 20 and 79 years are likely to develop diabetes. The average age for onset of diabetes is 42 years.
Approximately, 75% of diabetic people come from the low- and middle-income countries and approximately half the world’s diabetics are from China,
India, US, Brazil, and Indonesia, as per the World Health Organization (WHO). Diabetes is a growing menace worldwide and India seems to be hit very hard.
India and its alarming number of persons with diabetes
India is next only to China in terms of prevalence of diabetes. According to a survey conducted by IDF in 2019, about 77 million Indians have been diagnosed as diabetic and an alarming 43.9 million Indians live with undiagnosed diabetes. This number is set to double in the next 10 years. By 2030, India is likely to have 100.95 million people with diabetes. Studies also indicate that every year there are nearly 1 million deaths caused due to diabetes in India. The disease is twice as common in urban areas as in rural ones and is more prevalent among the higher socio-economic classes than lower class.
A survey, by the Health and Family Welfare ministry of the Indian government, reports 11.8% prevalence of diabetes in India. Men and women seem to be equally affected.
What makes Indians more prone?
Genetics or ethnicity
Several earlier studies have shown that Asians, particularly Indians, are highly susceptible to diabetes and often acquire the disease at a younger age and also at a lower body mass index (BMI) as compared to their European counterparts.
Though the study of genetics of diabetes is limited, some genes have been identified that predispose Indians to diabetes. Also, there are other genes that protect Europeans from diabetes but do not protect Indians.
Genetics is beyond our control. Indians living across the world are more prone to diabetes irrespective how they live their lives.
Increased insulin resistance
Researchers from Mayo Clinic, US say that irrespective of the diabetic status, compared to Europeans, Indians have a greater degree of resistance to insulin, the hormone that regulates the glucose levels in the blood. This means our cells do not respond too well to insulin.
Low birth weight
Low birth weight also contributes to insulin resistance among Indians. Malnutrition of the fetus or the new born child impairs proper development of the pancreas, the organ in the body that produces insulin. Permanent structural and functional impairment of the pancreas impairs insulin secretion and causes diabetes.
Truncal obesity
Indians have a higher burden of truncal obesity and relatively lower muscle mass compared to Caucasians. Truncal or abdominal obesity is a type of obesity where the fat distribution is such that the excessive fat accumulates in the trunk rather than in the limbs. It is considered an important risk factor for heart disease and diabetes. Those with waists of more than 40 inches are at seven-fold higher risk of diabetes.
Lifestyle changes – physical inactivity and altered diet
People with insulin resistance typically have poorly functioning mitochondria. Mitochondria are parts of the cell that convert the energy content of food into adenosine triphosphate (ATP), a chemical form of energy that the body can readily use for its own functions.
However, Indians, even with their higher insulin resistance, actually have higher mitochondrial function than Europeans. This means they produce more energy for same amount of food consumed.
Researchers hypothesize that this could have been an adaptation of the body over generations when the energy content of Indian diets was lower. As Indians moved to a more urbanized lifestyle, they also moved away from a lifestyle of higher physical activity and diets of lower energy content.
Though the adaptation to produce more energy from food was a boon to previous generations of Indians, today, this has become a disadvantage given that the current generation consumes more high-energy foods.
The traditional Indian diet of unrefined wheat, rice, millets etc, and vegetables was rich in fibers. This has been substituted by refined cereals and lower intake of fresh vegetables. With an increased per capita income, the fat, sugar, and calorie intake has also increased.
What can we do to prevent diabetes?
You cannot do much about the genetic factors that predispose Indians to diabetes. However, with proper lifestyle modifications, risk reduction is possible. An early diagnosis and proper management of diabetes can also prevent diabetic complications and improve the quality of life.
* Knowing your body type and what works for you goes a long way.
* Getting yourself diagnosed never hurts, especially if you have a family history of diabetes.
* Go for regular checkups every 6 months.
* Keep your weight in check.
* Go out and engage yourself in physical activities like yoga, cycling, swimming, etc.
* Have a healthy diet.
* Avoid junk food. It is high in refined carbohydrates, saturated fats and deprived of nutrients.
* Don’t take medicines for diabetes without consulting your physician.