Which Treatment Is Right For You, Metformin Or New Injectables?

From ndtv.com

As weight loss injectables become more widely available, many people wonder whether metformin is now outdated or whether these injectables are the better option. Diabetes specialists say the answer is not so simple. In this episode of NDTV Lifelines, Dr Anoop Mishra breaks it down for you.

Diabetes has become one of India's biggest public health challenges, affecting millions of families across the country. According to the Indian Council of Medical Research (ICMR), more than 11% of Indian adults, over 100 million people, are living with diabetes, while another 15% have prediabetes, putting them at high risk of developing the chronic condition. What is even more concerning is that nearly four in 10 people with diabetes do not know they have it until serious complications appear.

Diabetes is no longer limited to cities or wealthy households. Rural India is also seeing a sharp rise in cases due to changing diets, physical inactivity and delayed diagnosis. If left poorly controlled, diabetes can increase the risk of heart disease, stroke, kidney failure, vision loss, nerve damage and even amputations, making early diagnosis and the right treatment more important than ever.

For decades, metformin has been the backbone of type 2 diabetes treatment. It is affordable, has a long safety record and remains the first-choice medicine in India as recommended by ICMR and RSSDI guidelines. However, newer weekly injectable medicines such as Ozempic and Mounjaro have gained attention for offering better blood sugar control, significant weight loss and better heart and kidney benefits in selected patients.

As these medicines become more widely available, many people wonder whether metformin is now outdated or whether injectables are the better option. Diabetes specialists say the answer is not so simple. The best treatment depends on each person's age, weight, overall health and medical conditions. Rather than replacing metformin, newer injectables are often used alongside it in carefully selected patients under medical supervision.

Metformin Is Still The Foundation

According to diabetes expert Dr Anoop Mishra, Executive Chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences, metformin continues to be the cornerstone of diabetes management. Around 90% of patients seen in routine clinical practice are still prescribed metformin, while only a smaller group requires injectable medicines.

Metformin has remained the first-line treatment for over four decades because it effectively lowers blood sugar, is inexpensive and has a very low risk of causing dangerously low blood sugar levels. It mainly works by reducing the amount of glucose produced by the liver. It also has beneficial effects on the gut and may offer additional long-term health benefits beyond diabetes control.

Why Are Injectables Becoming Popular?

Injectable medicines like Ozempic and Mounjaro belong to a newer generation of diabetes treatments. Besides lowering blood sugar, they help people lose weight and may reduce the risk of heart and kidney complications.

However, Dr Mishra stresses on the fact that these medicines are not suitable for everyone. They are mainly recommended for people with both type 2 diabetes and obesity, especially those who meet body mass index (BMI) criteria. Since Indians often develop diabetes at lower body weights than Western populations, doctors believe BMI cut-offs may need to be lower for Indian patients. For many people, injectables are not a replacement for metformin but an additional treatment that provides greater overall benefits.

Treatment Must Be Personalised

Diabetes treatment should never follow a one-size-fits-all approach. A young adult with obesity and diabetes may benefit significantly from injectable medicines, while an older person with diabetes but normal body weight may not need weight-loss treatment at all. Dr Mishra points out that nearly 30% of Indians with diabetes are not obese. For such people, reducing weight is not the treatment goal, making injectables less appropriate.

Doctors consider several factors before choosing medicines, including age, weight, existing heart or kidney disease, overall health and treatment goals.

Important Facts Patients Should Know

Although injectable medicines are effective, they are powerful drugs that require careful medical supervision, says Dr Mishra. Patients need to understand possible side effects, gradual dose increases and the commitment to long-term treatment before starting them.

"In people with simple obesity without diabetes, we have to achieve target weight loss, so 10 kg, 15 kg, 20 kg. Whenever we achieve that, we start tapering out these doses. In people with diabetes and obesity, possibly longer because we have to control diabetes very well. And once we control diabetes, the requirement for other drugs comes down," says Dr Mishra.

Patients should also know that stopping treatment may lead to weight regain, making lifestyle changes essential alongside medication. "And this must also be known that once we stop the drug, there's always the possibility of weight regain, for which, a serious conversation with your physician is required right in the beginning and once you're stopping the drug," adds Dr Mishra.

Common Diabetes Myths Debunked

Several myths continue to confuse patients about diabetes treatment.

Metformin is far from outdated. It remains one of the most trusted and well-tested diabetes medicines available. Similarly, injectable medicines are not meant only for weight loss. They also improve blood sugar control, reduce fat accumulation in organs like the liver and may protect the heart and kidneys.

Another common misconception is that diabetes is only about high blood sugar. In reality, the disease can damage nearly every major organ, including the eyes, nerves, kidneys, heart and liver if left uncontrolled.

Experts also caution against relying only on HbA1c to judge diabetes. While HbA1c helps monitor long-term sugar control, diagnosis should be confirmed using appropriate blood glucose testing as advised by a doctor. Dr Mishra suggests the oral glucose tolerance test.

Technology Is Improving For Diabetes Care

Modern technology is making diabetes management easier. Insulin pumps can deliver insulin continuously for those who need intensive insulin therapy. Smart insulin pens help track doses and remind users when injections are missed. Continuous glucose monitors (CGMs) provide round-the-clock glucose readings, helping people understand how food, exercise, stress and sleep affect their blood sugar levels.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

https://www.ndtv.com/health/living-healthy/ndtv-lifeline-x-diabetes-which-treatment-is-right-for-you-metformin-or-new-injectables-11727556

85% of amputations due to diabetic foot complications are preventable, says expert

From indianexpress.com/article 

A patient with diabetic foot infection (DFI) spends 50 per cent of his annual income on treatment, and every year 20,0000 patients with diabetes undergo higher-level amputation

Diabetes has assumed epidemic proportions, with India now known as the diabetes capital of the world. The risk of diabetes is increasing rapidly even in young people, with many diagnosed between the ages of 20 and 40. This is unlike Western countries, where diabetes typically manifests after the age of 60. The reasons for this include a genetic predisposition and lifestyle factors like modern-day stress, sedentary routines, reliance on fast food, and lack of regular exercise. One in every four new diabetes patients is below 40 years of age. In Chandigarh, the prevalence of diabetes is 20.4 per cent.

Diabetes is the most common cause of leg amputations

The disease, says Dr Ashu Rastogi, Associate Professor, Department of Endocrinology, PGIMER, can lead to ‘diabetic foot’ complications that include foot ulcers, and gangrene. More than 50 per cent of hospital admissions for diabetes are for diabetic foot ulcers (DFU), which lead to a five-time increase in the cost of diabetes treatment and more importantly cause lower limb amputation, he adds.
A patient with diabetic foot infection (DFI) spends 50 per cent of his annual income on treatment, and every year 20,0000 patients with diabetes undergo higher-level amputation.

“However, the stark reality is that 85 per cent of these amputations are completely preventable. Diabetes is the most common cause of leg amputations in the world and accidental trauma is a distant second. The knowledge about diabetic foot complications is very low even amongst doctors and para-medical, and the need of the hour to focus on this very aspect of diabetes especially the preventive element to empower the patients themselves for foot care,” adds Rastogi.

Power of prevention

The best way to educate patients is one that is in their language, and that’s why Rastogi has conceptualised and written a booklet titled, ‘Pada, Paduka and Aap,’ in Hindi in a simple language and manner for better understanding of this severe condition. The book focuses on the preventive aspect of diabetic foot that details how to take care of feet in diabetes like washing of feet, cutting nails, what should not be done like self-surgeries, and warming feet in front of heater. The type of footwear for the prevention of trauma to foot and foot ulcers is also presented with pictorial representation for a better understanding of the common man.

“The book informs people about various tests that should be performed for early detection of foot abnormalities if a patient has diabetes. And if somebody has blockage in leg arteries, it is an indicator of a high risk of heart attacks and a close evaluation of heart arteries is needed as well. Hence the foot is the mirror of the heart,” explains Rastogi.

According to the experts, one in every five diabetic patients is likely to develop foot ulcers, and in the initial stage, there is a blackening of the feet and swelling in the fingers. If this is not taken care of, there is a risk of ulcers over time. Symptoms like black spots, blisters, abnormal swelling, burning, redness, blue marks and strange smell in the feet are signs of diabetic foot and ulcers, in such a case the doctor must be consulted immediately.

Patients need to take special care of their feet, keep them clean, dry, moisturised, not walk barefoot and protect their feet from injury. The book will be distributed free to all patients of diabetes by Rastogi in the Department of Endocrinology, to educate, empower and enhance the self-care behaviour of people with diabetes to prevent leg amputation.

Rastogi is the recipient of the prestigious Dr Subhash Mukherjee Oration of the Endocrine Society of India, for his work on diabetic foot complications. His novel research in drug development for people with diabetic foot ulcers has resulted in the topical preparation of esmolol, a new and pathbreaking foot gel for patients with foot ulcers.

A study led by Rastogi found that esmolol has a beneficial effect in reducing oxidative stress that may improve wound healing and that esmolol hydrochloride gel was far more effective than standard therapy protocols in use till now.

Sixty per cent of patients had wound closure within 12 weeks with esmolol compared to only 41 per cent with existing care routines, suggesting a 2.1 times increase in chances of wound closure with esmolol. More than three-fourths of patients had complete wound healing with esmolol compared to only half with existing treatments. More importantly, esmolol led to wound healing in a certain group of patients with low haemoglobin, renal problems and low albumin, all of which slow down recovery.

https://indianexpress.com/article/cities/chandigarh/diabetic-foot-complications-preventable-9827623/

How added sugar in baby food is pushing children towards diabetes

From indiatoday.in 

Reports of added sugar in Nestlé baby products, such as Cerelac, are a wake-up call for new parents to carefully read packaging labels as well as the government to bring in strict guidelines

For marketing manager Ridhima Bhatnagar, discovering her 10-year-old son to be pre-diabetic last year came as a nasty shock. Bhatnagar, 42, from Delhi, says her child has had a craving for sweet things since he was an infant. A suspected reason could be that unlike her first child, who is now 16, Bhatnagar gave her second born a lot of readymade baby food.

“My mother-in-law was around when my first born was a baby, and she would insist on giving only home-cooked porridge or mashed vegetables when my child was old enough to eat solid food. But for my second baby, there was only a nanny. I would keep very busy at work, so opted for convenience at the time,” says Bhatnagar.

She now faces deep regret because she feels it was the added sugar in readymade baby food that might have triggered a constant craving for all things sweet in the boy. Indeed, several medical studies over the years have pointed out that too much added sugar creates an addiction for it. A study published in the Nutritional Neuroscience journal in 2005 theorised sugar’s impact to be the same as drug addiction—the more you have, the more you want.

Reports of added sugar in commercial baby products has been a wake-up call for parents; (Representative image: Getty Images)

The past few years, endocrinologists are noticing a worrying pattern of increasing childhood diabetes in India. In 2015, a pan-India survey of 17,000 children conducted over three years by Fortis SRL Labs found 66.11 per cent of children with abnormal levels of sugar.

Experts say this is largely due to the huge amounts of added sugar in packaged foods given by parents to their children. “The body needs glucose to function. But pumping glucose into your system is harmful. It is stored away as fat and increases the risk of obesity. Also, constantly high blood sugar levels decrease your insulin sensitivity and puts a lot of pressure on the pancreas—a step towards diabetes,” says noted diabetologist Dr S.K. Mishra.

While most foods have naturally-occurring sugar, it is the free or added sugar that is a problem. And it is no longer just white sugar that is a cause for concern because honey, corn syrup, jaggery, brown sugar and other caloric sweeteners have the same effect on the body’s blood sugar. “Unrefined sugars have some health benefits but end of the day, they are still added sugar. You can’t have them in huge amounts,” says Ritika Samaddar, regional head, department of clinical nutrition and dietetics, Max Healthcare.

Developing diabetes in childhood is a lifelong scar that will impact the overall quality of life, warn experts. Diabetes not only limits the kind and amount of food you can eat but substantially increases the risk for heart disease and liver, kidney and pancreatic issues. It also affects vision and hearing and triggers skin problems. “The earlier you develop it, the more the chances of starting to face its consequences at mid-age,” says Dr Mishra.

With the sources of added sugar surprising, doctors say new parents need a lot of awareness on how to read packaging labels. Recently Public Eye, a Swiss organisation that undertakes investigations, public advocacy and campaigns, published a report in collaboration with the International Baby Foods Action Network. It was based on tests on Nestlé products and found them to have more added sugar in Asian markets than in European ones. Most specifically, India’s most popular baby cereal brand Cerelac averaged nearly 3 grams of added sugar per serving.

“Convenience is good, but if people became aware of how packaged/processed foods impact a child or baby’s wellbeing, they would put in the effort to make the food themselves. Added sugar is not good for anyone under two years of age, and even after that should be given in limited amounts,” says Pune-based child nutritionist Anita Dhar.

Although official guidelines don’t ban added sugar in products for infants or children, the recent revelation of free sugars in baby food is an eye-opener on the need to bring in such norms.

https://www.indiatoday.in/india-today-insight/story/how-added-sugar-in-baby-food-is-pushing-children-towards-diabetes-2529882-2024-04-21

Minor tweaks to daily diet can check diabetes, finds study

From thehindu.com

The findings favour increasing the percentage of proteins and fats and cutting down on carbohydrates

Diabetologists have shown that reducing carbohydrate intake could result in remission of diabetes.

A recent study using the Indian Council of Medical Research-Indian Diabetes (ICMR-INDIAB) data has shown that by reducing carbohydrate and increasing protein and fat in the daily diet, diabetes progression can be controlled.

R.M. Anjana, Vice-President of Mohan Diabetes Research Foundation (MDRF), led the study that is based on the food habits of 18,090 adults across the country.

The Indian diet comprises 65-70% carbohydrates, 10% proteins and 20% fats. The carbohydrates could be rice or wheat-based items. The composition of food could be slightly altered to prevent the progression from pre-diabetes to diabetes, Dr. Anjana said. This could be achieved by maintaining the carbohydrate content at 54%-57%; protein at 16%-20% and fats at 20%-24%, she said.

She suggested the ‘plate concept’ to change the proportions: “You have a round plate. Draw a vertical line across the plate. Fill one half with green, leafy vegetables. Draw a horizontal line across the other half and make it two quarters. One is for carbohydrates and the other for proteins, such as chickpea, legume and such.”

This is in contrast to the normal pattern of having more rotis and just a small cup of vegetables, she pointed out. The rest of the carbohydrates would come from tea, coffee, milk and fruits, she added. Since proteins offer satiety, it is good to focus on them, she explained. For the study, the researchers asked every fifth person about their dietary habits, thus preventing bias in the sample, Dr. Anjana said.

V. Mohan, director and chief of diabetes research at the MDRF, said a recommendation to the population to alter the diet composition was necessary, as in another 20 years, the diabetic population could reach around 130 million. Currently, it stands at 74 million. As many as 80 million are in the pre-diabetic stage, he said. “We need to prevent people moving from pre-diabetes to diabetes. If possible, even make them normal,” Dr. Mohan added.

“Even a 10%-20% reduction in carbohydrate intake can do wonders. Increasing protein slightly and eating healthy monounsaturated fats such as nuts, fish or natural vegetable oils, will ensure a healthy balanced diet,” he explained.

“For the first time, we are seeing that even modest changes can reduce the diabetes epidemic, help to slow it down and even prevent it. It can lead to the remission of the condition,” Dr. Mohan added.

The study Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study was recently published in Diabetes Care.

Seshadri Srinivasan of Kalasalingam Academy of Research and Education, who did the quadratic programming problem, said the ICMR-INDAB data was used for mathematical modelling, enabling the prediction of remission and prevention of diabetes at the population-level.

Sudha Vasudevan, head, Department of Foods and Nutrition Research, MDRF, said the recommendations would vary based on age, sex, body weight, urban and rural areas and activity levels. The study has called for “new dietary guidelines that recommend appropriate changes in macronutrient composition” to reduce the burden of diabetes across South Asia.

https://www.thehindu.com/news/national/tamil-nadu/minor-tweaks-to-daily-diet-can-check-diabetes-finds-study/article65815416.ece

The Diabetes Risk: Know all about prediabetes & how to reverse it

From financialexpress.com

In certain individuals with more than two risk factors, more frequent screening may be considered

How big is the pre-diabetic pandemic among the Indian population?
The prevalence of prediabetes in India is often under-estimated. Based on the research studies done in India, among the population that has been tested, the prevalence of prediabetes in India is estimated to be around 15%. Given that almost one in six of Indian adults have prediabetes, no wonder it is considered as an epidemic.

Is there any particular age group or demographic profile that is at risk?
Here are the risk factors for prediabetes:
– Being overweight
– Age 45 years or older
– Having a parent, brother or sister with type 2 diabetes
– Inadequate physically activity (less than thrice a week)
– History of gestational diabetes
(diabetes during pregnancy)
– History of polycystic ovary syndrome.
Please advise on screening and frequency to check pre-diabetes.
Screening is necessary in the following group of people
– Age=45 years without other risk factors
– Family history of type 2 diabetes
– Overweight or obese
– Sedentary lifestyle
– Low good cholesterol or high triglycerides
– Polycystic ovary syndrome
– Fatty liver disease
– History of gestational diabetes or delivery of a baby weighing over 4 kg.

Screening can be done with fasting glucose and HbA1c (8 week average blood sugar level) or oral glucose tolerance test. In the event of normal results, repeat testing is recommended at least every 3 years. In certain individuals with more than two risk factors, more frequent screening may be considered.

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Prediabetes will progress to overt type 2 diabetes in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop overt diabetes within their lifetime

Is prediabetes reversible?
Yes, absolutely. Prediabetes and type 2 diabetes mellitus are lifestyle-related diseases and, therefore, dietary changes, adequate physical activity and a moderate amount of weight loss can prevent and reverse prediabetes. Regular physical activity of 150 minutes of walking is considered adequate. A moderate weight loss of about 6 to 10% can achieve reversal of prediabetes.

In what cases can it advance to diabetes?
Prediabetes will progress to overt type 2 diabetes in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop overt diabetes within their lifetime. If the above reversible risk factors are not addressed (inadequate physical activity, progressive weight gain), then such individuals can progress to develop overt diabetes.

Are lifestyle changes enough to reverse early diabetes?
Research has showed that people with early type 2 diabetes can reverse it through diet and lifestyle modifications alone. A study that had people aim for 10,000 steps a day and at least 2 1/2 hours of moderate exercise a week — along with cutting 500-750 calories a day showed that many patients with early type 2 diabetes can bring their blood glucose into normal range without medications. However, this may not be achievable in every individual with type 2 diabetes.

Five points to keep diabetes at bay:
(i) Lose extra weight: Achieve ideal body weight; in people who are overweight or obese, losing at least 6 to 10% of the current body weight
(ii) Be physically more active: Thirty minutes or more of moderate to vigorous aerobic exercise (walking, cycling, swimming); resistance exercises two to three times a week (weightlifting, yoga)
(iii) Follow healthy eating habits: Avoid high carbohydrate diet, avoid refined sugars, increase fibre intake, regular consumption of fresh fruits and vegetables
(iv) Quit smoking: This has been shown to be a risk factor for developing type 2 diabetes
(v) Screening early in at-risk population and taking necessary preventive actions if any parameters suggest progression towards diabetes (for instance, impaired fasting glucose levels, low level of good cholesterol, high triglycerides).

https://www.financialexpress.com/lifestyle/health/the-diabetes-risk-know-all-about-prediabetes-how-to-reverse-it/2533296/

 

What Explains Rural India’s Diabetes Problem?

From science.thewire.in

South India has a higher rate of diabetes compared to North India, possibly due to its partiality towards white rice, which has a high glycaemic index. Photo: Total Health

At a healthcare clinic in Thodathara, a village in the Thavanampalle mandal near Chittoor, Andhra Pradesh, Dr Vijay Kumar calls in his next patient. “He is the most disciplined man I know,” Dr Kumar says with a hint of pride.

Reddyappa Reddy walks in and takes the seat opposite Dr Kumar. “Ten years ago I found out I have diabetes. I took Dr Kumar’s advice. Today, I walk up and down the lengths of a mango farm every day after dinner,” says Reddyappa, who is in his sixties. Dr Kumar adds that Reddy is an inspiration to the other patients at the clinic.

The numbers game

In 2013, Apollo Foundation's Total Health initiative conducted a household survey of 195 villages and 32 gram panchayats in the Thavanampalle mandal. We screened 31,453 people for health data and found that 6.2 percent had diabetes. In addition, 16.7 percent of men and 12.2 percent of women were obese, a risk factor for diabetes.

Today, the numbers in the mandal have shot up, with 10.1 percent of the people suffering from diabetes. This is still less than the national average; diabetes in rural and urban India grew from 2.4 percent and 3.3 percent respectively in 1972 to 15 percent and 19 percent in 2015, according to a 2021 meta-analysis published in Annals of Epidemiology.

At 74.7 million people living with the disease, India is home to the second largest population of people with diabetes (after China). While the prevalence of diabetes is twice as high in urban India as compared to rural areas, Total Health has chalked it out to be one of the biggest causes of concern in Thavanampalle mandal, where its work primarily lies.

“I saw 600 people last month, of whom 200 had diabetes,” says Dr V Bhargav, who heads a mobile clinic unit. Most people who get diabetes are above the age of 50. Compare this to the national numbers: A 2009 study found that of the people living with diabetes, 54 percent develop it before reaching 50 years of age. The same study says that the onset of diabetes among Indians is about a decade earlier than their Western counterparts.

Change in rural diet 

“The environment in rural India is changing, starting from what we eat,” says Dr T Swarna, who heads a satellite clinic in Thavanampalle.

In 2016, the authors of a study conducted in Krishnagiri in Northwest Tamil Nadu identified the primary factors that “have catalysed dietary changes leading to rising prevalence of diabetes”. Of course, there is the increased availability of ‘city foods’ such as sugar-laden sodas and sweets, as well as trans-fat-laced chips and bakery goods. But, more significantly, the availability of free polished rice at ration shops through the public distribution system (PDS) makes it the staple food of the region.

Less than 150 km from Krishnagiri, in Thavanampalle, doctors have observed a similar shift to rice as the staple. South India has a higher rate of diabetes compared to North India, possibly due to its partiality towards white rice, which has a high glycaemic index. When eaten as kanji (rice porridge) with the water it is cooked in, the starchy rice meal spikes blood sugar levels. “The local feeling is that you are not full until you have had a rice meal,” says Dr M Gayathri, who heads our AYUSH clinic in Aragonda. The main aim is to keep hunger at bay, because not many people have the luxury of eating meat and fruit. Seasonal vegetables are affordable, but most plates are filled with rice and just a small portion of vegetables. A rice meal is filling and cheap. “Farm labourers who leave for work at eight in the morning want a heavy meal that lasts through the day,” says Dr Bhargav. Wheat is not locally grown, so rotis are not commonly eaten. Dr Swarna adds, “People believe chapatis cause heat in the body when had in the morning.”

Rice is replacing millets such as ragi, which used to be popular in Thavanampalle. “We still make ragi balls, but the ratio of ragi to rice flour (2:1) has reversed because of changing tastes,” says Dr Bhargav. Reddy is conscious of this. He says, “I include as many green, leafy vegetables in my meals as possible and have completely cut down on tea (most villages sweeten tea heavily).” However, he still depends on the PDS and can’t afford brown rice or red rice that were once regular traditional foods but have now become trendy ‘urban foods’, which has pushed up their prices.

“Before the Green Revolution in India, there were a hundred different varieties of rice in our diet,” says Jayanthi Somasundaram, head of Spirit of the Earth in Chennai (which promotes heritage rice), pointing to varieties such as thooyamalli, kaatuyanam, and mapillai champa. “Until the 1950s to ‘60s, there was a conception that white rice, consumed by the elite, was superior. For the middle class, who would have millets, white rice became aspirational,” she says. Krishna Prasad, founder of the Karnataka-based Sahaja Samrudha, adds that as milling technology improved, the more polished rice became, and the more aromatic and of higher quality it seemed to people. He recalls the Rayalaseema area of Andhra Pradesh in the 1960s: “Before it became popular for cash crops such as cotton and groundnut, the area, with its saline soil, used to grow many varieties of red rice.”

Over the years, diet isn’t the only thing that has changed, says R Indrani, another Thodathara resident living with diabetes. “I think the change in the crops we grow has also affected our lifestyle,” she says. Thavanampalle has traditionally been famous for its sugarcane fields and the jaggery it produced. She adds, “We used to have a sugarcane field as well. But now there are very few of them left. Like most farmers here, we shifted to cultivating 10 acres of mango. Unlike sugarcane, which requires constant water and labour, the work in mango fields is seasonal and less intensive.” The doctors at Total Health suspect that this reduction in physical activity combined with changing diets could be one of the contributing factors to diabetes. “I can’t eat the mangoes I grow,” Indrani says with an ironic laugh.

Screening for diabetes

Indrani found out she has diabetes only a year ago when she attended an eye screening camp. “People here are not that keen on regular testing. Unless they can physically see that there is a problem, such as frequent urination, they won’t come. Their attitude is not preventative,” says Dr Gayathri.

“Often, when they first come to us, their blood glucose level is already at 11 percent (the normal level is 6.5 percent). They could have had diabetes for many years but they may have just not known it,” says Dr Swarna.

In fact, about one in every two Indians in the 15–49 age group living with diabetes is unaware of their condition, according to a study conducted by the Public Health Foundation of India in 2019. Of those aware, only a quarter have it under control. The study also found that rural men are more susceptible to diabetes.

“One fear we see among people is the idea that once they start medication, they will have to continue taking it for a lifetime. People here don’t like becoming dependent on medicines,” says Dr Gayathri.

Doctors are unanimous in their view that the focus must be on pre-diabetes—its prevention and control. On the preventive health front, a traditional kitchen revival, where a more diverse diet is practised, and rice does not form the centrepiece, may help.

The more difficult challenge is the attitudinal shift towards movement. In Thavanampalle, as in many rural and urban areas in India, physical work is linked with class hierarchy. The more prosperous a family gets, the more help they can afford and the less functional their movements become.

Additionally, it is important to manage low- to moderate-risk diabetes in people to prevent it from turning into something more serious. As seen in the results of the national NCD survey conducted this year, adequate screening, conducting regular health camps, and increasing awareness about diabetes as a lifestyle disease is how people who have not yet got the disease can prevent it.

Sweta Akundi is a content writer for Apollo Foundation, where she brings out stories from the villages of Andhra Pradesh and Telangana. 

https://science.thewire.in/health/what-explains-rural-indias-diabetes-problem/ 

What to know about diabetes in India

From medicalnewstoday.com

Diabetes in India is a growing health concern, with over half the population at risk of developing the condition at some point in their lives

According to one 2021 review, people who live in cities and metropolitan areas in India are more likely to develop diabetes than ever before. This is due, in part, to cities promoting a lifestyle that can increase a person’s body mass index (BMI). Having a higher BMI is a diabetes risk factor.

Rural areas in India are also experiencing a surge in type 2 diabetes cases, but more studies are necessary to fully understand how and why this is happening.

Keep reading to learn more about diabetes in India, including prevalence, some reasons it is so common, and more.

How prevalent is diabetes in India?

Dhiraj Singh/Bloomberg via Getty Images

In India, more than 77 million adults are living with diabetes. Researchers predict that this will increase to 134 million by 2045.

Overall, females have a higher risk of developing diabetes than males, but as both groups get older, this risk decreases.

Although diabetes figures are high, researchers estimate that 57% of cases remain undiagnosed. This is particularly concerning, as the risk of serious complications increases when people do not take medication to control their blood sugar.

Why is diabetes common in India?

There are several theories that attempt to explain why diabetes cases are rapidly increasing in India. The sections below look at some of these in more detail.

Physiological differences

People of South Asian ancestry tend to have a higher fat to muscle ratio than people of European ancestry. When people have less muscle than fat, insulin stays in the body for longer.

Because typical Western diets and fast foods are growing in popularity, especially in urban environments, so is fat and sugar consumption.

When the body cannot efficiently clear glucose, this increases metabolic load and insulin resistance and puts a person at risk of developing diabetes.

Perception of diabetes

People tend to view diabetes as a “new” condition in rural areas, and general awareness of the condition is low.

In a small qualitative study from 2017, people said that health check-ups were too short and that this put them off asking questions about their health and diabetes.

Because people typically view doctors as the best sources of diabetes information, and because they may not have access to other resources, these short consultations have a significant effect on the number of complications that people experience.

Changes in farming practices

Government shops, or fair price shops, are a type of public distribution system that offers rural communities low cost food to improve people’s nutritional health. These foods include white rice, wheat, sugar, and pulses.

However, some research suggests that fair price shops are unintentionally encouraging farmers to grow more commercially viable crops that are denser in calories and contain fewer nutrients.

In place of traditional foods, people are now consuming more polished white rice and refined sugar, the consumption of which causes spikes in blood glucose levels.

Sweet cuisines

The consumption of sugary sweets is a staple of Indian culture and an integral part of ancient traditions and religious festivals.

According to one study from 2014, due to increasing urbanization, people are adopting more sedentary lifestyles as well as consuming more calorie dense sugary foods and drinks.

In cities, sugary drinks and sweetened foods are cheap and readily available, which is increasing people’s risk of developing obesity and type 2 diabetes.

Social stress

Many people report that stress or tension was the cause of their diabetes.

A qualitative study from 2012 found that people in middle-to-high-earning economic groups reported that social stress, such as saving for a dowry, contributed to their diabetes. However, those with lower incomes tended not to share this belief.

As Indian doctors talk more about social stress as a risk factor for diabetes than those in the United States, these beliefs likely originate from information that people receive at healthcare consultations.

Because lower income groups typically have less access to healthcare, this could explain why they do not think that social stress causes diabetes.

Increased availability of processed foods

Like big cities, rural villages are now selling cheaper processed foods. Due to recent changes in imports and economic policies, the variety and availability of processed foods have expanded, and people’s preferences are shifting toward fatty sugary snacks and meals. This trend is particularly noticeable in younger people and children.

Diabetes symptoms

Symptoms of diabetes include:

• regularly urinating at night
• feeling thirsty all the time
• losing weight without trying
• feeling hungry all the time
• feeling tired all the time
• having sores that take a while to heal
• experiencing more infections than usual

Diabetes treatments

Treatment varies depending on the type of diabetes a person has. The following sections look at some treatment options for both type 1 and type 2 diabetes.

Type 1 diabetes

When a person has type 1 diabetes, their pancreas stops producing insulin. To treat this condition, a doctor prescribes an artificial form of insulin that a person takes several times per day and with meals.

People take insulin using a needle and syringe, or an insulin pen. If someone needs a steady supply of insulin throughout the day, they may prefer using an insulin pump.

Insulin does not come in tablet form because stomach acid destroys it.

Type 2 diabetes

Many people with type 2 diabetes need to take medication and insulin to control their symptoms. Some treatments come in tablet form, and a person may take a combination of different medications to keep their blood sugar levels stable.

Summary

Diabetes is an escalating health problem in India. One recent review suggests that the lifetime risk of males developing diabetes from the age of 20 years is 55.5.%. In females, the figure is 64.6%. However, lifetime risk does decrease as people get older.

Diabetes cases are increasing because the country is undergoing a period of urbanization, meaning that more people are moving to bigger cities for employment. Urbanized areas and cities promote lifestyle habits that are more sedentary, which is a risk factor for both obesity and diabetes.

The bodies of people of South Asian ancestry respond differently to sugary and fatty foods than the bodies of people of European ancestry, and because processed Western foods are growing in popularity in India, so is the risk of diabetes.

https://www.medicalnewstoday.com/articles/diabetes-in-india

Diabetes is set to devastate India's metropolitan cities, and what to do about it

From eurekalert.org

More than half of men and two thirds of women currently aged 20 years are projected to develop the condition in their lifetime

Disturbing new research published in Diabetologia (the journal of the European Association for the Study of Diabetes) shows that more than half of men (55%) and some two thirds (65%) of women currently aged 20 years in India will likely develop diabetes in their life time, with most of those cases (around 95%) likely to be type 2 diabetes (T2D). The research is from a team of authors in India, the UK and the USA, led by Dr Shammi Luhar, Department of Public Health and Primary Care, University of Cambridge, UK.

India already has a significant health burden caused by diabetes: estimates suggest 77 million adults currently have diabetes and this number is expected to almost double to 134 million by 2045. Urbanisation, decreasing diet quality and decreased levels of physical activity are all contributing to this hidden epidemic. Since urban centres are continuing to grow rapidly across the country, the authors, in this new research, aimed to estimate the probability of a metropolitan (urban-based) Indian of any age or body mass index (BMI) developing diabetes in their lifetime.

The data for the study came from using age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research INdia DIABetes study (2008-2015).

The authors estimate that lifetime risk of developing diabetes in 20-year-old men and women free of diabetes today is 56% and 65%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk of developing diabetes declined with age: the authors estimated that for those currently aged 60 years and currently free of diabetes, around 38% of women and 28% of men would go on to develop diabetes.

Obesity had a substantial impact on these projections. Lifetime risk was highest among obese metropolitan Indians: 86% among 20-year-old women and 87% among men. People with lower BMI had considerably higher diabetes-free life expectancy: obese 20-year-olds were estimated to have around half (46-52%) of their remaining life years free from diabetes. However, those with normal or underweight BMI were projected to live out most of their remaining years (80-85%) diabetes-free.

The authors say: "The remarkably high lifetime risk of developing diabetes and the low diabetes-free life expectancy in India's metropolitan cities, especially for individuals with high BMI, implies that interventions targeting the incidence of diabetes may be of paramount importance moving forward."

They note that metropolitan Indians at every age and BMI have an alarmingly high probability of developing diabetes compared with results from high income countries, and that proactive efforts to prevent diabetes in metropolitan cities are urgently needed, given the rapid increase in urban obesogenic environments across the country. In addition to these risk factors, Indians and other South Asian populations already have a relatively high predisposition to developing diabetes at both lower ages (up to a decade earlier) and lower BMIs when compared with white European populations.

One study from the USA, using data from 2000-2011, reported a lifetime risk diabetes of 40% among men and women aged 20 years from the general population. The authors say: "Our new estimates from India are much closer to estimates of lifetime risk of diabetes of 20-year olds among the black and Hispanic populations in the USA (above 50%), groups considered at a higher risk of developing diabetes than the general population."

Dr Luhar says: "Such high probabilities of developing diabetes will have severely negative implications for India's already strained health system and also out-of-pocket expenditure on diabetes treatment by patients, unless diabetes is immediately acknowledged for what it is: one of the most important threats to public health in India."

Professor Viswanathan Mohan of the Madras Diabetes Research Foundation in Chennai and co-author of the paper added: "Despite these very high predicted lifetime risks of diabetes, it is possible to prevent or postpone diabetes by effective lifestyle modification, such as following a healthy diet, by increasing physical activity and reducing body weight in those who are obese or overweight."

Professor Nikhil Tandon from the Department of Endocrinology and Metabolism, All India Institute of Medical Sciences in New Delhi, and co-author of the paper also added: "We need policy and investment with clearly spelt out targets and commitments to meet by 2030. Perhaps an aspirational target of '90-90-90' (90% of people with diabetes detected, 90% of those detected treated, and 90% of those treated controlled), is imminently needed. Such a target could operate in the same way as the 90-90-90 targets introduced some years ago for HIV, which has since been replaced by even more ambitious 95-95-95 targets."

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

https://www.eurekalert.org/pub_releases/2020-11/d-dst112020.php