Why Is The Rate Of Diabetes High In India?

Why Is The Rate Of Diabetes High In India?

         
    1. Age-specific Diabetes Prevalence   
    2. Prevalence Of Diabetes In Obesity 
    3. Gender Specific Diabetes Prevalence  
    4. Individual-Level Risk Factors
    5. Environmental Risk Factors

Introduction

Diabetes Is A Global Public Health Problem Affecting 463 Million Individuals And Projected To Affect 700 Million By 2045. Diabetes Burden Is Increasing At A Faster Pace In Low- To Middle Income Countries Than In High-Income Countries. 77 Million Adults In India Have Diabetes And By 2045 This Number Will Double To 134 Million. In High Income Countries Individuals Over 50 Years Of Age Are Primarily Affected By Diabetes & In Middle Income Countries The Prevalence Is Higher In Young Individuals.  

According to World Health Organization there are 24 million cases of diabetic neuropathy, 5 million cases of retinopathy, and 6 million cases of amputation due to diabetes. Cardiac complications are the main cause of the mortality in individuals with diabetes. 

Genetic and environmental factors, such as heredity, change in lifestyle, age, smoking habits, increased alcohol consumption, screen time, parental conflicts, improper sleep, education, and stress, predispose young adults to diabetes, which is exacerbated with diabetic comorbid conditions. Obesity is the main risk factor that accounts for 80%–85% of the risks of developing type2 diabetes.   

In young adults diabetes can be managed by doing routine physical activity and adopting a healthy and balanced diet, which focuses on the increased intake of dietary fiber.   


Age-specific Diabetes Prevalence   


The incidence of diabetes increases with age until about age 65 years, older adults with diabetes may have incident disease diagnosed after 65 years of age or long-standing diabetes with onset in middle age or earlier. 

Older-age–onset diabetes which is characterized by lower mean A1C and lower likelihood of insulin is more common in non-Hispanic whites than is middle-age–onset diabetes. History of retinopathy is significantly more common in older adults with middle-age–onset diabetes than those with older-age onset. Older adults with diabetes have the highest rates of major lower-extremity amputation.   

There are higher rates of complications in adults aged greater than 75 years than those aged between 65–74 years.Deaths from hyperglycemic crises also are significantly higher in older adults.

Adults aged greater than 75 years also have double the rate of emergency department visits for hypoglycemia than the general population with diabetes .Due to the combined effects of increasing insulin resistance and impaired pancreatic islet function with aging older adults are at high risk for the development of type 2 diabetes. Age-related insulin resistance appears to be primarily associated with adiposity, sarcopenia, and physical inactivity.

Prevalence of Diabetes in obesity  


The prevalence of diabetes is 2.9 times higher in overweight adults than in normal weight adults. According to the studies of National institute of health consensus, 1985 along with BMI, individuals with upper body obesity or adiposity are at high risk for hyperinsulinaemia, insulin resistance and type 2 diabetes.   

In 2000, Studies conducted by Lahti-Koski et al. reported that abdominal adiposity, measured by an elevated waist to hip ratio is shown to be a strong risk factor for type 2 diabetes mellitus. Earlier reports suggest that abdominal adiposity is an independent predictor of alteration in the plasma lipid, lipoprotein and plasma glucose concentrations.  

Abate et al. in 1995 and Goodpaster et al. in 2000 reported that high proportion of upper body fat or abdominal fat, independent of overall obesity, is recognized as an important component in the insulin resistance linked to obesity and type 2 diabetes mellitus.   

In 1994, Despres revealed that insulin resistance and hyperinsulinaemia are associated with lipoprotein lipase (LPL) deficiency, which causes elevation in the level of free fatty acids and a reduction in high-density lipoprotein cholesterol levels. These elevated levels of free fatty acids induce insulin resistance in the peripheral tissues and liver. Insulin resistance eventually produces sufficient glucose intolerance to results in diabetes. 



Gender Specific Diabetes prevalence  


Gender and biological sex impact the pathogenesis of metabolic disorders like diabetes. In middle-aged populations diabetes is more prevalent in men than in women. Many aspects of energy balance and glucose metabolism are regulated differently in males and females and influence their predisposition to type 2 diabetes.  

During reproductive life, women exhibit specificities in energy partitioning as compared with men, with carbohydrate and lipid utilisation as fuel sources that favour energy storage in subcutaneous adipose tissues and preserve them from visceral and ectopic fat accumulation. 

Insulin sensitivity is higher in women, who are characterised by higher capacities for insulin secretion and incretin responses than men; although, these sex advantages all disappear when glucose tolerance deteriorates towards diabetes.  

Individual-level risk factors

The rise in a population’s prevalence of diabetes could be attributed to increases in that population’s prevalence of individual-level risk factors for the condition. Increase in the prevalence of prediabetes increases the prevalence of obesity, hypertension, alcohol consumption, and immigration over the same period of time. Population was aging and that the prevalence of consumption of fruits and vegetables decreased.

However, the proportion of people reporting a physically active lifestyle, sedentary behaviours, tobacco smoking, having completed high school and university education, and being of low income evolved in directions that were opposite to the direction expected to be considered as a factor contributing to the increasing prevalence of diabetes.

Environmental risk factors

Environmental risk factors such as the presence of environmental pollutants (such as nitrogen dioxide (NO2), particulate matter (PM), organic persistent pollutants and non-persistent pesticides), urbanization and rapid socioeconomic development increase the prevalence of diabetes. 

Sources 

1. Nagarathna R, Bali P, Anand A, et al. Prevalence of diabetes and its determinants in the young adults Indian population-call for yoga intervention. Front Endocrinol (Lausanne). 2020;11:507064.
2. Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650-2664.
3. Sharma S, Jain S. Prevalence of obesity among type-2 diabetics. J Hum Ecol. 2009;25(1):31-35.
4. Tramunt B, Smati S, Grandgeorge N, et al. Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia. 2020;63(3):453-461.
5. Thibault V, Bélanger M, LeBlanc E, et al. Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis. Diabetol Metab Syndr. 2016;8(1):71.

Rural Practitioners Jatinder Kumar Mokta

Dr Jatinder Kumar Mokta Professor of Medicine at Indira Gandhi Medical College and Hospital Shimla, a lecturer in rural school, has presented a similar example. Mokta has been honored with the prestigious Oscar E Edward Award in the USA. Dr. Mokta is presently at IGMC Are serving their services in the Madison Department. The thing about pride is that IGMC Dr. Jatinder Kumar Mokta is the first Indian to be nominated for this award. The special thing for Dr. Jatinder Kumar Mokta is that he is the first physician of India who has been selected for the honor of Oscar E Edward Memorial of the prestigious college of physicians of America.

 More FAQs by Dr. Jatinder Kumar Mokta