High prediabetes makes future tense
HEALTH CHALLENGE The prevalence of impaired glucose tolerance is 1.4 times higher than diabetes prevalence of 7.3% in India, where nearly half of 70 million diabetics are undiagnosed
reduced by 30% with healthy lifestyle changes) compared to 5–11% in white Europeans, reported a UK study in Lancet Diabetes Endocrinology abstract.
“Indians get diabetes at a lower body weight, with around 20–25% people (diabetics) not being overweight,” said Dr Anoop Misra, chairman, Fortis Centre of Diabetes, Metabolic Diseases and Endocrinology, New Delhi.
He pointed out that another distinctive feature among Indians is abdominal fat — excess fat under the skin and inside the abdomen — which hampers blood glucose control, as does a fatty liver and excess fat in the pancreas, which produces insulin.
Since Asians have a 2–4-times higher risk of type 2 diabetes than white Europeans — roughly four times higher in Bangladeshis and about two times higher in Indians — independent of weight, and develop diabetes on 5–10 years earlier than them, the WHO recommends diabetes screening at a lower body weight (BMI, which is a ratio of weight to height, ideal being 23 kg/m2) for people at risk.
RISING COSTS
Indians get more complications because the disease is often diagnosed after irreversible complications, such as retinopathy, kidney damage, heart disease or slow-healing wounds, have developed.
“Since infections in India are higher in general, people with diabetes in India often develop complications from lifethreatening infections, such a tuberculosis and flu,” said Dr Misra.
An estimated 12% of the global health expenditure is spent on treating diabetes and its related complications (US$ 673 billion), estimates the International Diabetes Federation.
Going by current treatment costs, India’s total bill for treating diabetes would be US$30 billion by 2025, estimates a report by Pricewaterhousecoopers.
But with economic growth and standards of care improving, treatment costs are likely to rise, and it has estimated the same cost to go up to US$79.7 billion.
Preventing 10% of the population from developing diabetes would save nearly US$8 billion a year.
“Prevention and early diagnosis are undoubtedly the way forward. People with prediabetes, a family history and more than two risk factors must be screened regularly every six months to one year,” stressed Dr Kaur.
Apart from high body weight and race, people can get diabetes due to low physical activity, unhealthy diet high in fat, refined carbohydrates and sugars, a waist size larger than 90 cm (35.4 inches) for men and 80 cm (31.5 inches) for women, and gestational diabetes, both for mother and child.