More young people now get deadlier version of diabetes
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
NEW DELHI: Type-2 diabetes that normally afflicts older adults is striking young Indians and it’s striking them harder.
Though young people with type-2 diabetes do not need insulin to survive, they are at greater risk of life-threatening complications, such as kidney damage and heart disease, than people with insulin-dependent diabetes.
One in every four (25.3%) people under 25 with diabetes in India has adult-onset type-2 diabetes, which, by definition, should strike only older adults with a family history of diabetes, obesity, and unhealthy diets, data from the Indian Council of Medical Research’s (ICMR’s) youth diabetes registry shows.
“Youth-onset type-2 diabetes is no longer rare. Family history is strong and obesity, metabolic syndrome and acanthosis nigricans (dark, velvety skin patches) are usually seen in young patients with type-2 diabetes,” says Dr Tanvir Kaur, deputy director general, ICMR.
Type-2 diabetes in the young is more aggressive than in adults, the registry shows. “In the young, it is a different beast altogether. The risk of complications for younger persons with type-2 diabetes is twofold to threefold higher than type-1 diabetes,” says Dr Nikhil Tandon, professor and head of endocrinology and metabolism, All India Institute of Medical Sciences, which is partnering in the registry.
There are 70 million adults in India with diabetes, which affects 422 million people worldwide. Type-1 diabetes is an autoimmune disease where the immune system destroys the cells producing insulin.
With a prediabetes prevalence of 10.3% among adults, people with diabetes in India are likely to more than double in the next decade from the current 70 million, a study by the country’s apex research organisation has estimated.
The prevalence of prediabetes — also known as “impaired glucose tolerance” and a precursor to diabetes — is 1.4 times higher than the diabetes prevalence of 7.3%, according to the Indian Council of Medical Research-IndiaB study of 57,117 adults over 20 years from 14 states and the Union territory (UT) of Chandigarh.
Around 47.3% of India’s 70 million diabetics are undiagnosed and do not know they have high blood glucose levels that, if left untreated, lead to complications such as blindness, kidney failure, heart disease, stroke and foot amputation, the study found.
Diabetes emerged as India’s seventh biggest cause of early death in 2016, up from 11th in 2005, shows data from Institute of Health Metrics & Evaluation .
Diabetes prevalence is higher in affluent states and UTs like Chandigarh, Maharashtra and Tamil Nadu, but prediabetes prevalence, which ranged from 6% in Mizoram to 14.7% in Tripura, was high across states irrespective of income.
Even a state like Bihar with a low diabetes prevalence of 4.3% had 10% people with prediabetes, indicating that diabetes cases would shoot up in the state over the next decade.
HIGHER RISK
Diabetes is also rising among the urban poor in affluent states.
“There is evidence of an epidemiological transition, with diabetes prevalence being higher in low socio-economic groups of urban areas in more economically developed states,” said Dr Tanvir Kaur, deputy director general, Indian Council of Medical Research, who was part of the research team doing India’s largest community-based diabetes study.
Training for the third leg of the study to track prevalence in Delhi, Uttar Pradesh, Madhya Pradesh and Rajasthan began in September 2017.
“Since diabetes is a chronic disease that needs lifelong management, its spread to the economically disadvantaged sections is a matter of great concern, and need urgent policy and lifestyle interventions,” said Dr Kaur.
Several studies have shown south Asians develop diabetes a decade earlier than Europeans at a lower weight, and those with prediabetes progress to overt diabetes at a faster rate.
The progression in south Asians happens at 12–18% per year (which can be 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.