Diabetes can be vaguely classified into Type 1 (insulin deficient-noticed in younger age groups), Type 2 (insulin resistance-generally above forty years of age) and other minor varieties. India’s diabetic load is expected to increase to over 100 million by 2030.

However, available data suggests that the prevalence of Type 2 diabetes mellitus (t2dm) is not only increasing, but there is also a shift of age at the onset of t2dm towards younger age groups.

Why Is The Trend Changing?

Indians have higher percentage of body fat and increased waist to hip ratio, for any given body mass index. Which predisposes us to diabetes and other metabolic syndromes.

Insulin resistance is one of the most important factors contributing towards type 2 dm in Indians. It is mainly attributed to low birth weight, and it is hypothesized that smaller viscera and lower muscle mass but preserved body fat which increases the insulin resistance. Lower birth weight coupled with obesity in childhood/adolescence leads to a very high risk of diabetes

Genetic and environmental factors go hand in hand. Familial aggregation of type 2 diabetes is noticed with high prevalence among 1st degree relatives. Studies in India has shown that children of diabetic parents (both parents being type2 diabetic) have 50% chance of developing diabetes which is very high compared to European counterparts. This clearly establishes a link between the Indian gene and diabetes.

Environmental Factors

Urbanization – India’s dramatic development over the past fifty years with lifestyle changes among Indians resulting in a sedentary lifestyle and mental stress has also lead to the earlier onset of type2 diabetes. Consumption of high fat sugary caloric diet has its roots to urbanization.

Physical Inactivity

Most important reason for low prevalence of young type2 diabetes among the rural population compared to urban population is because the former leads a physically active lifestyle. Risk of t2dm in sedentary people is three times higher than physically active people

Diet

Increased consumption of fat, high caloric diet and saturated fats when compared to the western diet which has more of protein as the main constituent is also a significant reason for young diabetics in India.

In general, one should seek help from a doctor in case you have familial history of diabetes, undue fatigue, central obesity, acanthosis nigricans (dry, dark patches of skin that usually appear in the armpit, neck or groin), polycystic ovarian syndrome (pcos), binge eating habits and lack of physical activity. It is wise to screen yourself for diabetes and its complications at timely intervals and start primary prevention.

Dr. Sivaram Kannan S, MD. (GEN. MED). F.C. DIAB, General Medicine & Diabetology, Senior Consultant @ Kauvery Hospital

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