Diabetes

Why number of diabetes patients is increasing in India?

Posted on

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.

If you like this post, please subscribe us so that you can get our latest blogs.

Please share this post with people  around you, especially in age group of 20-50 years who are a greatest risk of developing diabetes.

Also read

Medical practice

4D Ultrasound for sex determination

Posted on

Four-dimensional (4D) ultrasound (real-time volume sonography), a technology, started in developed world for encouraging  bonding of the parents with the fetus. It  is  widely been perceived to be  used for sex determination during pregnancy in India.

4D ultrasound or live 3D ultrasound provides  real lifelike foetal images in real time,  . It help doctors to see  congenital uterine anomalies, the endometrial cavity and  ectopic pregnancy among other things . In during pregnancy , it can be used to asses foetal anomalies involving the face, brain, thorax, heart, spine and limbs.

Issue

The problem statement

In developed world, there is no such issue like selective sex abortion, so the prenatal gender determination( sex determination before birth) is legal. 4D imaging technology offers the option of “Meet the Baby” ultrasound scans, which allow the parents and relatives to watch the intrauterine foetus in a comfortable family environment which is supposed to help in parental – foetal bonding and gender determination.

 4D ultrasound has rapidly spread in India, which most of the ultrasound centers are offering  at a premium price. These 3-D and 4-D ultrasound scans, enable a pregnant woman and her relative/attendant to see the foetus and possibly it’s  genital organs on the TV screen displaying the footage realtime, as the scan is performed.. There are valid concern from different quarters that these machines are been used to disclose the gender of the foetus to the parents, genital organs of the feotus are displayed on large TV  screens, either inadvertently or purposefully.  The major concerning fact is that this new technology does not concur with the Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act. It is well known that sex determination is criminal according to the PCPNDT Act and punishable with imprisonment and a fine .

4D ultrasound known to be safe though valid the risk–benefit studies on acoustic damage to fetus are yet to be reported. 

 

Reasons

Profiteering from the overcharging of the fee seem to be the main driving force for proliferation of these centers, and propagation of this practice. The radiologists performing the scan  are often the mere employees, consequently not in position to resist these practices. 

Conclusion

Four-dimensional (4D) ultrasound (real-time volume sonography), which has been used in the West for the determination of gender as well as for bonding and entertainment of the parents, is  widely available in India. Clearer policy  guidelines to prevent its misuse in sex determination of fetus is the need of the hour.

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

Subscribe to Blog via Email

Do not miss the opportunity to receive best actionable insight on health issues which matter the most. Its absolutely free.

Join 1,365 other subscribers

Retinoblastoma

Retinoblastoma Screening : Indian scenario.  

Posted on

India carries the biggest burden of Retinoblastoma globally, with an estimated 1500 new cases annually, which account for almost 20% of total Retinoblastoma population. Regular screening of the children at risk at is must for early identification and management.

Why should children be screened for Retinoblastoma?

It is a cancer and delayed identification and initiation of treatment causes loss of eyesight, eye or even death. if the disease is identified in early stage, it can be cure and sight as well as life of  child can be saved. At-risk children should be screened very early in life by regular eye examinations so as to diagnose the cancer in its initial stages. It has been scientifically proven that early identification of the disease is associated with less advanced disease and better outcome in terms of saving vision and the eye.

Does every new born child needs to be screened for Retinoblastoma?

No

Who should be screened for Retinoblastoma?

All offspring, twins and siblings of Retinoblastoma patients should  complete retinal examination for earliest identification of the disease. Other relatives need not be screened.

How is screening for Retinoblastoma done?

Complete eye examination is done  by a trained ophthalmologist / eye surgeon with or without anesthesia.

Current recommendations  for Retinoblastoma screening:

  • At-risk children should undergo genetic testing
  • The child’s age and risk level should determine the frequency of serial dilated fundus exams, which should be performed by a physician
  • Newborns at high risk should be screened every 2 to 4 weeks during their first 2 months of life, whereas newborns with intermediate or low risk should be screened monthly.
  • high risk means
    • Bilateral Retinoblastoma diagnosed in any of the parents.
  • intermediate risk means
    • siblings of a patient diagnosed with bilateral Retinoblastoma
    • children of a person whose one of the siblings has Bilateral Retinoblastoma
    • children of a patient of Unilateral Retinoblastoma
  • low risk means
    • siblings of a patient diagnosed with Unilateral  Retinoblastoma
    • children of a person whose one of the siblings has Unilateral Retinoblastoma
    • children of a person whose one of the siblings had a children with  Bilateral Retinoblastoma
  • Necessary exam frequency declines as the child ages and may be discontinued at age 7 for children without an RB1 mutation
  • Children who carry an RB1 mutation should be screened indefinitely, every 1 to 2 years.

Genetic testing of Retinoblastoma.

The test which can predict the occurrence of Retinoblastoma in future, can help to save the vision of the patient  and avoid unnecessary (and invasive) eye examinations for first person who develop disease (proband) in a facility and their close relatives.  The disease exhibits a hereditary and a non-hereditary occurrence.

One third of all children which have retinoblastoma had a heritable tendency to develop tumors. The mutation in retinoblastoma gene RB1   predisposes the retinal cells to undergo to malignant transformation, resulting in the disease occurrence. A child born to a parent with mutation in retinoblastoma gene RB1 has a 45% chance of developing retinoblastoma. These patients, multiple tumors and often in both the eyes.  15% of the patients, who have tumor in one eye, are also heritable. Siblings (brother and sister of patients with bilateral or unilateral Retinoblastoma have a risk of 3% and 0.5%, respectively, to have Retinoblastoma.

Genetic testing services of Retinoblastoma, available in India.

There are many hospitals which are offering the genetic testing for Retinoblastoma. At Shankar netralaya, this test cost around 12000 INR for a family of four (parents and two children). There are few private labs, which are also offering at price of about 30,000 INR per person. Genetic screening  cost one sixth of the cost of clinical testing to rule out Retinoblastoma in a person.

Related articles

Blindness

Blindness : Common conditions leading to blindness in India

Posted on

Credit : Pixabay

However well prepared one is to face adversity, getting blind is a tragedy which devastates not just the individual but the  whole family. People go blind in their primes, often by the mistakes which could have been avoided by simple precautions. Some useful tips which can make people are extra cautious so as to keep their eye safe.

A usual story in a hospital emergency:

A school teacher brought his six years old son with penetrating injury in the eye by needle of a discarded syringe .  The boy was playing with other children and got hold of a discarded syringe with sharp needle from somewhere. It’s no surprise to see people casually discarding the used syringes in household waste. While playing with it, he got himself injured .

The child presented in emergency with infection in the eyeball (endophthalmitis) resulting from the penetration of that contaminated needle. With everything said and done, child went blind in that eye, for rest of his life. And it was irreversible.

Why did it happen?

Out of 1.4 million blind children in the world, two thirds are living in the developing countries. Unfortunately 50% of the blindness is due to causes that are currently not treatable or preventable. But rest half is due to reasons which are absolutely preventable. What is more surprising is the fact the precautionary measures do not cost anything significant.

One sixth of the childhood blindness is due to eye injuries. Injury to eye affects one in 25 people in urban population in India, and one in 167 people in this population are estimated to be blind in at least one eye due to injuries. The majority of the injuries resulting in blindness occurs during childhood and young adulthood, and slightly more than half occurs while playing.

Injuries in children occur either because of unsafe domestic environment or employment of children in agriculture and other industries. Unattended access of children to sharp objects like knives, needles, bow and arrows , pointed stationary items etc. are the reason for that. Mothers are often busy in domestic chorus to attend children.

Fire cracker injuries

In spite of clear government regulations prohibiting the access of the fire crackers to children less than 18 years of age, the most common age group of receive fire cracker injury in eyes , are children between 10-15 yrs. Age. This is because parents can spare money to purchase firecrackers but not the time to attend to children when they are playing with it.

One third of the children go blind due to lack of  spectacles for refractive errors which is  easily avoidable. All that parents have to do is to be cautious of any problem child has in seeing while playing with toys or reading, or if eyes are not straight. If they find anything suspicious, consult a eye doctor. A pair of spectacle cost around 400-500 INR.

One in every sixth children going blind is due to vitamin A deficiency. If you are reading this post, it’s unlikely you have any children in your family who is at risk of vitamin A Deficiency. But it is very much likely that that your servant or driver has a child who is at risk. Vitamin A deficiency is sign of malnutrition which is in turn common in people living in poverty. Ask them to ensure that child has received vitamin A supplementation offered free in government hospital to all children.

What should be done?

  1. Always keeps sharp and pointed items away from children.
  2. Keep an eye on children when they are playing.
  3. No fire crackers.
  4. Observe the children eyes and his/her ability to see the common things around.
  5. Educate poor and underprivileged around you, regarding protection and vitamin A supplementation.

Another usual story

Twenty years old young guy working as laborer in a sugar mill presented in emergency with one of eye injured with an iron rod. He was bleeding profusely and his father was in tears. Father was cursing the sugar mill administrators for spoiling his son’s life. When asked whether he was wearing any protective glasses while working, he said, he has no idea about any such glasses. These are available at hardware stores for 90 rupees.

The damaged eye has to be removed to prevent infection and bleeding. He was left permanently blind with one eye and a disfigured face with an empty eye socket .

Why did it happen?

Unsafe work environments

Eye Injury while working in unsafe working environment is another major cause of blindness acquired in youth. Usual story is some sharp object or a splinter penetrates in the unprotected eye, as the person is not wearing  protective glasses.

Why do they don’t wear it? Of course there are government regulations, but who has time to enforce them. Most of the people engaged in these jobs are poor and less educated, are in informal sectors. Employers have no interest in their protection. Victims are often young and stupid

Road traffic accidents:

Use of a two wheeler is very common, but not so the use of hamlets. The road traffic accidents are commonly associated with head injury, and injuries to the eyes are associated with it.

Sport related injuries.

Injury with the fast moving balls in sports like cricket and lawn tennis is another reason young adults present with injuries in eyes. Absence of protective eye gears is the main reason.

What can we do?

  1. Educate about vitamin A supplementation.  If you are reading this blog, again you neither engage in these sight threatening jobs, nor need eye protection gears. But you must be out sourcing these jobs to people who are too dumb to see that they can injure themselves, or smart enough to use protective eye gears. You can ask them to do so, make it a precondition that they will wear it if they have to work on your contract or premises.

  2. Helmet and other eye protection gears

Still another usual story?

56 yrs old legal practitioner presents with sudden loss of vision in one eye for last one week. He had diabetes for 11 years. He could barely see his way with his better eye. When asked about the treatment, he said he was on and off homeopathy drugs. There was nothing like control of blood sugar, and is usually in range of 300-350 mg%. when asked why was he so casual in his treatment, he said, its because he never had any problem with high blood sugar.

He had a bad form of diabetic eye disease in both the eyes, with one eye totally destroyed. After best treatment he could barely see at one meter from him, with his better eye. Every time he comes, he pleads to do something about his eyes so that he can read. His family is in financial mess as could not practice.

Diabetes

The sedentary lifestyle and changed eating habits have increased the incidence of the diabetes and consequently the cases of people losing their sight due to eye disease due to diabetes. The access to the treatment of diabetes is definitely a challenge in the society. Ignorance of the fact that the long standing uncontrolled disease will cause failure of many organ systems in the body, only adds to this burden. People are not careful as diabetes per say does not cause much physical discomfort.

Glaucoma glaucoma is another silent predator. it is of two types. Painless and painful. One that is painless is often diagnosed late often during the routine examination of eyes by an eye doctor.

What can be done?

  1. If you are not a diabetic, do not be one.
  2. Strict diabetes control. You must realize that drugs only control the sugar levels, if you restrict your sugar intake and exercise regularly. if you think taking pill is all you have to do, than you are seriously mistaken.
  3. Regular eye checkup. If you are above forty, you should see an ophthalmologist once a year. If you have diabetes, and a regular eye examination is even more important, to catch the diabetic eye disease as early as possible.

These are few simple precautions everybody should follow. please comment on the issues which can also be included in the list.

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

Subscribe to Blog via Email

Do not miss the opportunity to receive best actionable insight on health issues which matter the most. Its absolutely free.

Join 1,365 other subscribers