Diabetes

How to assess that you are at risk of type 2 diabetes?

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A recent ICMR research report says that more than half of respondent said no when asked, ” have you ever heard the term Diabetes” . Equally surprising is the fact the even those who said yes, half of them did not know that diabetes can be actually prevented. We are exploring the scientific ways to assess if one is at risk of developing type 2 diabetes , so that appropriate measures can be taken to prevent or delay it.

There is clear scientific evidence  that appropriate changes is  lifestyles and eating habits can reduce the risk of type 2 diabetes by as much as 70 % in patients at risk . It makes all the more sense to assess if one  is at risk of diabetes. if yes, than how serious is the risk.

All this is possible if there is a simple way to assess the risk.

Madras Diabetes Research Foundation-Indian Diabetes Risk Score

Madras Diabetes Research Foundation has developed a simple scoring system based on four parameters which can easily be assessed by any one. 

  • Age
  • Abdominal Obesity
  • Physical activity
  • Family history

All these parameters can be easily assessed without using any  special instrument or equipment. 

Abdominal obesity

It is cool to have six pack abs . Abdominal obesity  ( big tummy ) kills  your cool looks. Surprisingly , current research shows that it can  also increase your risk of  serious disease like type 2 diabetes and heart attack.

We all know how hard it is have six packs abs, but it is simple to assess abdominal obesity. it can be your  first step to get rid of it.

Waist circumference

Measured in the standing position by placing a plastic tape horizontally midway between 12th rib 9 the last rib you can feel) and iliac crest  ( highest point on hip bone ) .

 

Physical activity

It is to assess how active are you.  If you are not doing any exercise and job requires  sitting in office for long , it means the lifestyle is basically sedentary. On the other hand if you regularly go to gym , play sports or your job requires lot of hard physical labour (unlikely) , than you are active. And then there are lots of people in between.

Family history

As inheritance plays an important role in the causing type 2 diabetes, it is important if your parents are also diabetic.  if both the parents are diabetic, higher is the risk.

 Indian Diabetes Risk Score 

Using the values of your age, waist circumference, level of physical activity and  family history of diabetes, you can calculate the Indian Diabetes Risk Score ( IDRS ) . as per the score , risk is been stratified into low, moderate and high .

Risk

Score

High risk

equal to or more than 50

Moderate risk

30-50

Low risk

less than 30

If you are 45 years old with waist size of 92 centimetres and have typical office job which is primarily sedentary and none of your parents is diabetic , your IDRS score is (20+10+30+0) 60. It means you are at high risk of developing diabetes . It would surprising to know that just because your parents are not diabetic and you are not particularly obese ( waist size 92 cm) , does not mean you are not at risk to have  diabetes. In fact , if you are not physically active ( not running or exercising) , you are a high risk of getting diagnosed of type 2 diabetes, down the line.

what can be done to reduce the risk of type 2 diabetes ?

Age and family history are the constant factors. Obviously we can not do much about them.

So we are left with only two options, we can do something about ?

  • Waist size ( Abdominal obesity)
  • Physical activity

We should try to reduce our waist size ( obesity ) and that is more or less directly related to increase in the physical activity. The weight reduction ( causing reduction in waist size) and increase in the physical activity ( running, waling and exercise) are scientifically proven to significantly reduce the risk of developing diabetes even in high risk people. It also help in better blood sugar control and delay the complications resulting from the diabetes.

Some useful links

Concluding: excess weight and sedentary life style are two important risk factors for development of  type 2 diabetes. Weight reduction and adoption of a physically active lifestyle are the best way to avoid diabetes.

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Why number of diabetes patients is increasing in India?

Diabetes

How many Indians are aware of the disease ” Diabetes ” ?

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We have the world’s largest population of diabetes in india. But not many indians know the disease “Diabetes” , let alone knowing the ways to prevent it. We are exploring the level of diabetes awareness in indian population.

These are some startling observations reported in a recent ICMR  research report .

Percentage of Indians who have  never  heard  the term “Diabetes”.

58.5%

Among those who  are aware of diabetes 

Percentage of Indians who know that more and more people are getting affected with diabetes now days.

80.7%

Percentage of Indians who know that Diabetes can actually be prevented .

56%

Percentage of Indians who know that diabetes can damage their organs.

51.4%

Among those who know that diabetes can damage their end organ.

Eyes

Percentage of Indians who know that diabetes can damage their eyes and can cause blindness.

52.3%

Heart

Percentage of Indians who know that diabetes can damage their heart and can heart attack.

36.3%

Kidney

Percentage of Indians who know that diabetes can damage their kidney and can cause kidney failure.

36.6%

Feet

Percentage of Indians who know that diabetes can damage their feet and which can lead to amputations.

54 %

Nerves

Percentage of Indians who know that diabetes can damage their nerves and which can lead to paralysis.

18.7 %

The study further reported that the the awareness about diabetes is far more in urban population than their rural counterpart. furthermore, males are more aware than the females. Those who are diabetic know more about diabetes and its complications than the general population.

Some useful links

Concluding: A significant segment of Indian populations is not aware of diabetes, its complications and prevention. It  none the less explain why more and more people in India are  are getting diabetic.

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Why number of diabetes patients is increasing in India?

Diabetes

Why number of diabetes patients is increasing in India?

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India is diabetes capital of the world with projected population 80 millions diabetic by 2030. We are exploring current scientific research , why number of diabetic patients is rising in India.

India : The diabetes capital of the world.

Current scenario

Current studies  shows that 9.1 percent of India population is diabetic. It i s more that the world average of 8.3 percent. Since we have a large population ( 1.3 billion) we have an equally large population of diabetics. In 2013, there were 65.1 million people between 20 and 79 years of age with diabetes and this number is predicted to rise to 79.4  million by 2030. So problem is not only that we have a large population base, we are getting diabetes at a rate faster than rest of the world.

The rise in incidence of diabetes cases is attribute to multiple causes which include genetics factors with contribution from environmental  causes.

Inheritance of abnormal genes are responsible for some cases of diabetes especially type 1 diabetes ( seen in young patients , usually need insulin) . Even in these patients , it is the food and other life style factors which decide the occurrence and course of disease. The type 2 diabetes ( seen in middle aged, usually obese adult which take tablets to control blood sugar) is predominantly because of environmental factors ( food and life style ).

The important question is “what exactly are these so called life style factors.”the more important issue is “what exactly should we do about that.”

Obesity

There is clear scientific evidence that the rates of obesity and type 2 diabetes are constantly increasing in India, every year and they are very much related to each other.

Studies show that Indian overweight and obesity prevalence (percent adults 24–65 with BMI≥25 kg/m2) would be expected to increase from 39% to 49% by the year 2024.  A similar pattern is been witnessed for type 2 diabetes incidence which  would rise in parallel with cases of obesity. By year 2024 there will be 319 to 336 diabetic cases per 100,000 population.

Basu S, Vellakkal S, Agrawal S, Stuckler D, Popkin B, Ebrahim S. Averting Obesity and Type 2 Diabetes in India through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study. Blakely T, ed. PLoS Medicine. 2014;11(1)
Basu S, Vellakkal S, Agrawal S, Stuckler D, Popkin B, Ebrahim S. Averting Obesity and Type 2 Diabetes in India through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study. Blakely T, ed. PLoS Medicine. 2014;11(1)

As compared with their western counterparts, Indian have lesser prevalence of obesity and overweight. But the incidence of diabetes is higher in Indian that what we see in western countries. It is suggested that Indian are at higher risk of developing diabetes if they are obese ( BMI > 30)  or over weight ( BMI 25-30).

 

Surprisingly , many Indians are known to have diabetes have weight with in the normal limits ( BMI < 25). So just because you are lean and young does not mean you are not at risk of having the diabetes. Even the slight gain in weight is a bad sign. The average age of an Indian  developing  diabetes  is at least a decade earlier that their western counterpart.

Some useful links

Steady urban migration

There is a steady migration of rural population to cities in search of  better living and employment  opportunities. Diabetes is reported to be about four times commoner in urban Indian  population than in their rural counterpart. More over it has a higher  incidence among the norther states than in southern states of India. 

Studies have  found that living in  urban areas  is a strong risk to develop  diabetes in India . it is explained through the lack of  physical activity  and changes in the eating habits, both associated with an urban lifestyle. 

 

In urban areas , people mostly engage in white collar professions associated with long duration of sitting or minimal physical activity. Traditional  physically vigorous jobs like agricultural work and manual labour intensive manufacturing are simply going out of fashion in a typical  Indian  urban setting.

Moreover , richer you are, minimal you work manually. Car parking has to be in basement of the building, basement has to be connected with an elevator. Staircase are usually meant for servants , cleaner and other lower order staff.

 

 Plus  the eating habits are rapidly shifting to high carbohydrate, high fat and low fiber diet, typically of what is served in any fast food restaurant. Wealthier you are , more frequent you eat outside . Now , the apps can deliver gourmet food , right on your dining table. You  save your time and also the calories , you would have burned while walking to the restaurant. 

lifestyle changes

Physical inactivity

Modern urban life style has reduced the requirement of manual labour as a precondition of employment.  Most of us has a routine  which involves little or no physical activity.  A recent report from Stanford shows that countries where people show lesser physical activity have a higher incidence of obesity and diabetes. The physical activity data for research was provided by a mobile company which recorded the steps walked by each mobile user in 170 different countries.

The question is why people live a sedentary life and do not do  the required amount of physical activity required.

Recent research has shown that often people have incorrect perception about physical activity and sedentary life style. Majority of of people have  a view that they must be active as they have a busy work schedule and a hectic life. Moreover there are certain perceived barriers which prevent people to involve in exercise. The most common ones are the lack of comfortable walking shoes, concern about their looks while doing the exercise and having other more pressing daily commitments which are given priority over the exercise.

One of the largest studies conducted by Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, on this issue has some startling observations.

Nearly half of Indian population is physically inactive which increases risk of diabetes. It is far more common in urban areas than rural, and males are more inactive than females. What ever little physical activity males do , it is at their work place only. More than 90 percent of people do not engage in any type of sports or  recreational physical activity.  Even those who claim, that they are active, the amount of physical activity is 20 min per day which half of what is recommenced.

Current recommendation are 30 minutes of brisk walking which at the speed of 5.6 km per hours.

It is not difficult to understand why people are becoming so inactive.  The household income in urban areas is steadily rising. Larger number of people are getting jobs which are  less and less physically demanding. Almost universal access to personal  mechanized transport and household appliances among urban dwellers further contributes to this inactivity.

High fat intake

in last two decade, there is rapid shift in the dietary habits of whole of the Indian population. The oil and fat consumption is rapidly rising in our society.  The National Sample Survey Organization (NSSO) survey results indicate that the fat intake of rural Indian populations has risen one and a half folds within last one decade. The incidence of obesity and diabetes  have shown almost similar pattern.

High oil and fat consumption leads to a medical condition known as   metabolic syndrome (MS). it is refer to a constellation of metabolic abnormalities characterized by abdominal obesity( big tummy , dyslipidemia, high  blood pressure, impaired fasting glucose , and insulin resistance.

Abdominal obesity
Dyslipidemia
 High  blood pressure
Impaired fasting glucose 
Insulin resistance.

The increased fat intake is primarily because of changes eating habits of people acquiring financial prosperity. The amount of cooking oil used is  increasing and also the frequency of eating out, where the there food is usually fat rich. The shifting of cooking to sunflower based refined oil has partially been blamed for this.

High free sugar intake 

Before the Roman Emperor, Alexander the Great came to India in 327 BC, honey was the only thing they knew that could sweeten the food. Roman Emperor was pleasantly  surprised to see “” Sugar ” as another alternative to honey , and described it as a “reed that gives honey without bees” 

Not only did we  invent it , we also use it liberally. We do not know a celebration without sweets, and we have some reason to celebrate almost daily. Sugar sweetened beverages (cold drinks) is available even  in the most remote locations an Indian can reside. A 200 ml bottle of any cold drink cost around 10 rs and every body can have it.

 

Surprisingly polio vaccine is distributed free of cost. In-spite of government’s best efforts, it  never achieve more than 40-50  percent  coverage of targeted population

 On an average, every Indian drinks  11 liters of cold drinks in a year and is rising  . It is a multi-billion dollar industry , coming third after tea packaging and biscuits.

Gulati S, Misra A. Sugar Intake, Obesity, and Diabetes in India. Nutrients. 2014;6(12):5955-5974. doi:10.3390/nu6125955.

The harmful effects of excessive sugar intake are easy to understand. Excess sugar  is converted into fat, in the body, This fat gets deposited at different places in our body causing obesity, diabetes and heart attack, besides a score of other diseases.

Some useful links

Non vegetarian diet

A vegetarian diet , by definition means that it is based on plant foods such as cereals, legumes, fruits, leafy vegetables, nuts, seeds, and sea vegetables. It does not include food originating from animals , including milk and egg.

There is strong scientific evidence that vegetarian diet protects you from diabetes. It does so partly by keeping your weight and BMI down.  Vegans are also found to have lesser insulin resistance  and a better lipid profile than the non vegan . 

Studies have reported that those non-vegetarian diabetics which switch to vegetarian diet once diagnosed of diabetes , are found to have better blood sugar and lipid control, than those which continue to take non vegetarian diet. If you are taking milk, egg and fish, you have higher risk of developing diabetes than one who is pure vegan but still lower than those who are frankly non vegetarian. 

India is witnessing a nutritional transition  in which the population is shifting its dietary preferences. people are leaving the diet rich in cereals , legumes , vegetable and fruits and slowly switching to a diet rich in sugar, fat and animal origin food like milk, egg and meat.

You will be surprised to know that , from year 1975 to 1995 , the total per-capita consumption of cereals had shown a gradual reduction. In the same duration , consumption of sugar, fat and meat had dramatically risen. And so also the incidence of diabetes and obesity.

Its not difficult to explain that people are opting for a “western diet” (high intake of meat, high-fat dairy, refined grains, and fast food) . It looks like a chicken barger. 

Some useful links

Concluding:

Diabetes is nothing but the result of increasing physical inactivity and shift  to western diet rich in fat sugar and meat. We can address this issue by increasing physical activity and sticking to old fashion  Indian vegan diet.

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Diabetes

Diabetes : Does excessive sugar intake causes diabetes ?

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It is a common misunderstanding  that  free sugars or sweet tasting  food can rapidly elevate the blood glucose and is responsible for diabetes. we discuss the recent scientific evidence which says that weight gain not free sugar, which is the main culprit.

Content

Diabetes: presentation

Elevated blood glucose in diabetes may cause signs and symptom

Thirst 

Excess urination (polyuria). 

Fatigue

Cardiovascular diseases.

Renal disorders

T2DM arises as a function of age and of fatness, in individuals predisposed by genetic and environmental factors that promote ‘ectopic’ fat storage within the abdomen and in muscle, liver and pancreas.

Some useful links

Diabetes is  part of the metabolic syndrome spectrum with has following pathological disorder.

Large waist circumference.

High blood pressure

Dyslipidaemia

Fatty liver.

Type 2 diabetes and obesity

The global trends of  T2DM is closely closely following  the epidemic of overweight and obesity.

It is very uncommon in people with  BMI less than 22 kg/m2, the risk of having the diabetes rapidly rises as a person gains the weight and acquires a higher  BMI. 2 particularly among Asians.

Recent scientific evidence shows that the diabetes can go in remission if the person reduces the weight substantially (10-15 kg)  and bring the BMI between between 22-25 kg/m2. Studies show that the metabolic abnormalities like dyslipidemia and fatty liver can also  be reversed.

 

Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.

Studies have found evidence that the weight control is a dominant factor in the management of type 2 diabetes.

Some useful links

Sugar intake in diabetes

Types of dietary sugar that could influence T2DM either directly or indirectly

lactose in milk

Sucrose in fruits and vegetables.

Commercial ‘sugar

Sugar consumption in our body

Sugar in the body and blood is almost exclusively glucose . It is mostly derived from digestion  of lactose, sucrose and commercial ‘sugar’ and little bit from proteins.

It is a common misunderstanding  that blood glucose is derived directly from the diet, and that free sugars or sweet tasting  food can rapidly elevate the blood glucose. it is only the pure glucose which can cause a rapid rise in blood glucose (high glycemic index) . Other types of sugars and food sources does not cause rapid rise . The rise in blood sugar by a food depends upon its glycemic index. Most of the food we consume have moderate to low glycemic indices.

The Glycemic Index (GI) is a relative ranking of carbohydrate in foods according to how they affect blood glucose levels. Carbohydrates with a low GI value (55 or less) are more slowly digested, absorbed and metabolised and cause a lower and slower rise in blood glucose and, therefore usually, insulin level

Recent scientific publications report that majority of clinical studies do not  provide any consistent evidence of an association between dietary sugars and diabetes incidence. In other words , clinical evidence which proves that excessive intake of sugar can lead to diabetes is missing. Studies report that consumption  of energy-dense foods containing sugars are typically associated with excessive weight gain and obesity which is in turn associated with physical inactivity. The current hypothesis is that type 2 diabetes is part of the disease syndrome which have obesity , dyslipidemia  and hypertension as other disorders. Diabetes is presumed to be result of gain in weight and physical inactivity, with excessive sugar intake contributing to weight gain.

Does excessive sugar intake cause diabetes ?

Sugar does not cause diabetes , but extra calories from any source will lead to weight gain, promoting or worsening diabetes. Larger number of calories, even from a non sugar source will result in weight gain, and worsening of diabetes. 

 

Should people who are  at risk  having diabetes,  avoid taking  sugar?

Current  recommendation is to limit sugar intake to <10% of total calories intake .  It is wise to restrict the free sugar intake as it will help in restricting total calories intake which will in turn control the weight. Restricting of total calories intake is more important.

Does sugar intake increases the blood sugar levels in a diabetic patient.  

Present scientific evidence do not show that sugar consumption causes the rise in blood sugar level in the diabetic patients. It is total calories intake in a day which is more important.

Does sugar intake increases the risk of cardiovascular disease ( heart attack or MI)  in patients of diabetes

There is credible  evidence that excess intake of  33 dietary sugars causes rise in  serum triglycerides and total cholesterolHigh sugar intake is also known to increases blood pressure in patients of diabetes. 

Rise in  serum triglycerides and total cholesterol  along with elevated  blood pressure, are serious risk factors for cardiovascular disease.

These adverse effects are besides the increase in the  body weight resulting from excess calories intake.

Does reduction sugar intake will reduce the  risk of cardiovascular disease ( heart attack or MI)  in patients of diabetes ?

The current scientific evidence supports recommendation that free sugar intake should be limited  to 10% of total calories intake to reduce the risk of cardiovascular abnormalities ( heart attack) in patients with type 2 diabetes.

Does sugar intake increases the risk of renal complications ( kidney disease ) in patients of diabetes.

There is weak but positive scientific evidence that say dietary sugars accelerate chronic kidney disease in patients with type 2 diabetes. Some studies suggest that  Caramel coloring and phosphoric acid  used in different cola drinks may also promote kidney disease. 

Should people with diabetes avoid sugar for this reason?

Yes, it is always better to avoid excess sugar and sweetened cola drinks in diabetic patients.

Links to some useful books on this issue.

Conclusion: Excessive sugar intake may not be responsible for causing diabetes, but it is wise to restrict sugar intake as it causes obesity , lipid abnormalities cardiovascular and kidney abnormalities.

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