Although China recently overtook India as the ‘Diabetes Capital of the World’, there are two startling statistics about India’s relationship with diabetes which are worrisome: 57% of adults with type 2 diabetes don’t know they have it, and over the past three decades, the number of type 1 diabetes patients in India has increased by 150%. I believe that the combination of diabetes and obesity will result in “diabesity” which is probably going to be the biggest epidemic in human history. This is because, diabetes continues to be the biggest silent killer and the most significantly underappreciated public health concern, while the majority of us worry about COVID 19, cancer malignancies, respiratory ailments, and other conditions.

According to the International Diabetes Federation, nearly 134 million Indians will develop diabetes by 2045; as a result, these people are more likely to experience heart attacks, strokes, kidney failure, organ damage, and comas. But there are myriad ways, in my opinion, that India can stop becoming the nation with the second-highest proportion of diabetes patients. Although diabetes is a condition that can be managed on an individual basis, community involvement, better laws, and increased knowledge are crucial for slowing the development of this disease.

Why are Indians more susceptible to diabetes?

We are experiencing several environmental and lifestyle changes because of industrialization, migration to urban areas, rising per capita spending, and a culture of eating out. This has resulted in consumption of food items with high-calorie/high-fat and high-sugar. Further, due to inactivity, these lifestyles have caused obesity and an increase in visceral fat. Additionally, there is mounting evidence that Indians have higher levels of insulin resistance and a stronger predisposition for diabetes.

Despite all of this, if appropriate steps are taken to promote physical activity and lower the obesity rates in both children and adults, several risk factors for diabetes can be changed and reduced.

Now let’s examine these top three factors, Insulin resistance, Genetic predisposition and a rapid Epidemiological transition, which can contribute to an increase in diabetes incidence in India.

1. Insulin resistance: Indians have higher levels of insulin resistance than Caucasians, which is a significant reason for increased prevalence of type 2 diabetes in this population. Hyperinsulinemia, which refers to greater insulin levels to glucose load, has been demonstrated more often in Indians than in Europeans and so according to a study, Indians have higher levels of insulin resistance than Europeans with the same age, sex, and body mass index.

The top three ways to minimise insulin resistance are to increase physical activity, follow a strict diet to lose weight, and take diabetic drugs like metformin and thiazolidinediones, which are insulin sensitizers and can lower blood sugar by reducing insulin resistance.

2. Genetic predisposition: Genetic susceptibility plays a key role in occurrence of Type 2 diabetes. The disease seems to develop at a younger age in Indian, at least a decade or two earlier than in Europeans.

A Chennai Urban Population Study (CUPS) in the city of Chennai, found that respondents with a family history of diabetes had a higher risk of developing the condition (18.2% versus 10.6%) than subjects without a history. Additionally, the likelihood of developing diabetes shot up to 55% 3 if both parents had diabetes.

However, not all hereditary factors are beyond our control. Due to the complex, multifactorial disease that type 2 diabetes is, there is a considerable interaction between genetic and environmental factors, which may in turn influence a number of intermediate traits. As a result, lifestyle changes can still significantly control genetic factors like insulin secretion, insulin action, fat distribution, and obesity to better manage this disease.

3. Environmental factors: Perhaps the most important factor contributing to the rise in diabetes incidence in India today. India is undergoing what we call an Epidemiological Transition. According to this, the patterns of population distribution in terms of fertility, mortality, life expectancy, and leading causes of death are shifting.

In India, the rate of urbanisation has increased from 15% in the 1950s to 35% as of the present. This will undoubtedly have a significant impact on current and future disease trends with regard to two major diseases, diabetes and coronary artery disease. As mentioned previously, socioeconomic and technological advancement have led to physical inactivity, affluent lifestyles have led to consumption of diets rich in fat, sugar, and calories, and finally long working hours have resulted in a lot of mental stress. Each of these factors significantly impact insulin sensitivity.

In conclusion, reduction in incidence of diabetes will require measures to promote physical activity and reduce obesity in adults and children, alongside programs to increase healthy infant and foetal growth. A simple trick would be to keep eating traditional, high-fibre meals and fully adopt Indian practises like yoga and meditation for reducing stress. Such an endeavour would assure us that the epidemic of diabetes is addressed and that our burden of disease is significantly reduced.

This article was first published in the Voices, India, Lifestyle, TOI Blogs on 14^th November 2022