A three-decade study that followed more than 700 Pune families, now entering the third generation, has sought to understand why diabetes is so common in Indians and has found a trend towards high glucose in early childhood. in many people. The authors have called for a diabetes prevention strategy from the first years of life. This comes on the heels of a recent recommendation from experts to lower the age of detection for diabetes from 30 to 25 years.
How were these families traced?
At the Diabetes Unit of KEM Hospital, Pune, scientists have been conducting research for 35 years to understand why diabetes is so common in Indians. In 1993, they embarked on the Pune Maternal Nutrition Study (PMNS) in six villages near Pune, and have since followed more than 700 families. They have tracked women from before they became pregnant and during their pregnancy, and their children during infancy, puberty, and now as adults.
The study, ‘Poor growth in the uterus, reduced cell compensation b and high fasting glucose from infancy are precursors of glucose intolerance in young Indians’, by Dr. CS Yajnik, director of the unit of diabetes at KEM hospital, and co-authors, has published in Diabetes Care, a journal of the American Diabetes Association.
What are the findings?
Researchers measured glucose and insulin concentrations and other vital data at the ages of 6, 12, and 18. By age 18, 37 percent of the men and 18 percent of the women had elevated glucose levels (prediabetes ). This was despite the fact that half of these participants were underweight (body mass index less than 18.5 kg / m2).
Children with suboptimal growth in the womb have high levels of risk factors for diabetes from early childhood, including high levels of circulating glucose.
The trend toward high glucose was visible even when measured at 6 and 12 years. The researchers concluded that this was driven by a malfunctioning pancreas, which could not cope with the demands of old age, and that this most likely reflects poor growth of the pancreas. pancreas during fetal life as part of general growth retardation. When maternal glucose increases minimally during pregnancy, this even stresses the baby’s pancreas.
How widespread is diabetes in India?
According to the World Health Organization (WHO), India has 8.7% diabetic population in the 20-70 age group, with around 77 million people with diabetes.
A first national nutrition survey (2016-18) conducted by the Union Ministry of Health and Family Welfare, UNICEF and the Population Council among children and adolescents also found that diabetes is affecting children significantly. Released in 2019, the survey said that nearly 1 in 10 children (ages 5 to 9) were prediabetic and 1% were already diabetic.
The increasing prevalence of diabetes is due to a combination of factors: rapid urbanization, sedentary lifestyle, unhealthy diet, tobacco use, and increased life expectancy.
What is the current detection strategy?
The current government recommendation to begin screening for diabetes is at age 30.
Diabetes prevention trials are still primarily targeting middle-aged people who already have obesity and advanced metabolic abnormalities, Dr. Yajnik said.
“An integrated life cycle approach is required and prevention must start at the community level and not just in the clinic. What we need are public health experts, not just doctors, to overcome this problem, ”said Dr. Yajnik. “Building such evidence is beyond the reach of physicians and will take a long time. We need to act sooner rather than later, ”he said.
Dr Shashank Joshi, President of the International Diabetes Federation, Southeast Asia, said: “This is predominantly in the field of research. We don’t have enough data to translate into the public health domain, especially in a country with limited resources like India. We need strong translational research that is reproducible, affordable, and has strong public health evidence. “
A new report published in the journal Diabetes and Metabolic Syndrome – Clinical Research and Reviews also shows a trend in the increasing prevalence of diabetes in younger age groups in the last decade. After analyzing data from various diabetes centers, the researchers found that 77.6 percent of those under the age of 30 were overweight or obese.
The lead author of the report, Dr. Anoop Misra, had said that the government should lower the age of detection.
Dr Joshi said: “This is a nationwide study and several others have recommended screening above age 25 in countries with limited resources, including India. The focus is also on the health of women and children. Maternal nutrition during pregnancy should be approached as a preventive measure ”.