A study backed by the Indian Council of Medical Research has estimated that in India, 136 million people (which is more than the population of Maharashtra) or 15.3% of the population are likely to be pre-diabetic.
There is almost no urban-rural divide when it comes to pre-diabetes with 15.4% of the urban population and 15.2% of rural India in the pre-diabetic stage.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation, according to the World Health Organization.
Pre-diabetes is a condition in which a person's blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes.
“When you check a person’s blood sugar levels after an overnight fast, it should be less than 100 mg. This is normal. If the number crosses 125 mg, then that person has type 2 diabetes. The rest who fall between 100 mg and 125 mg are pre-diabetic,” Dr Rajeev Jayadevan, physician and co-chairman of National Indian Medical Association COVID Task Force, told Boom.
The study’s estimation is based on an analysis of the prevalence of hypertension, generalised and abdominal obesity and dyslipidemia or abnormally elevated cholesterol or fats (lipids) in the blood.
“It is a ticking time bomb,” said M Anjana, lead author of the study and managing director at Dr Mohan’s Diabetes Specialities Centre. She said that pre-diabetes levels were higher in states in which the current prevalence of diabetes was low.
“If you have pre-diabetes, conversion to diabetes is very, very fast in our population; more than 60% of people with pre-diabetes end up converting to diabetes in the next five years.” said Anjana.
But what does this study mean to a layperson?
To know why India has a pre-diabetes burden, it is helpful to understand the demographics of diabetes. Different countries have different demographic profiles. The median age of India’s population is 28 years. This means that 50% of the population is below the age of 28. This makes an average Indian 20 years younger than the average Japanese person whose median age is around 48 years. Thus, India’s population pyramid has a broad base, and a significant proportion of the young adult population in India, which are placed in the bottom of the pyramid, are likely to turn diabetic in the future, explained Dr Jayadevan.
The rise in pre-diabetes cases comes as no surprise given the lifestyle changes in recent years, which historically parallel economic growth. Sedentary lifestyle, overload of carbs in everyday diet, sugary beverages/juices, intake of sweets and processed food are a few. Hence we see a rise in the number of people with pre-diabetes and diabetes every year, he said.
Who should get tested for pre-diabetes or diabetes?
Testing should be considered in adults who are overweight, obese or physically inactive, Those with a family history of diabetes and cardiovascular diseases are at risk developing the disease. Further, those with high levels of cholesterol, hypertension, women with polycystic ovary syndrome and other clinical conditions associated with insulin resistance are also at risk.
Pre-diabetes is usually asymptomatic. However, if a person shows symptoms of excessive thirst, tiredness, frequent urination, blurred vision or unintended weight loss, they are most likely to have moved to the type 2 diabetes stage.
Once diagnosed with pre-diabetes, a person must get their blood sugar levels checked at least once a year, Dr Rahul Baxi, Consultant Diabetologist at Bombay Hospital in Mumbai wrote in a tweet. For others, testing should begin at the age of 45, he tweeted.
Interventions for pre-diabetic persons
“Pre-diabetes needs a sustained intervention,” said Dr Jayadevan. Major lifestyle changes such as increased physical activity, dietary interventions which include having smaller portions of carbohydrates, cutting sugars and processed foods, increasing fibre intake and avoiding habitual feasting during late hours. “Big changes are impossible to sustain, so start small,” said Dr Jayadevan.
Further, getting enough sleep plays an important role as lack of it is associated with diabetes. “If we don’t get enough sleep our body’s insulin resistance goes up, which means our cells are starving for energy,” the physician said. Energy is all around in our bodies but if insulin does not work then our cells cannot burn energy. This increases insulin resistance, aggravating pre-diabetes.
“Lastly, if a person is already diagnosed with pre-diabetes and they have a family history of the disease, then they should avoid smoking as it will worsen it,” Dr Jayadevan concluded.