Diabetes and Indian children - Warning signs

The widespread prevalence of diabetes in India, and in children especially, merits closer look.

Diabetes and Indian children - Warning signs

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• The story: India is colloquially called the diabetes capital of the world. Researchers focused on why diabetes was so common in Indians, and found a tendency towards high glucose in early childhood in many individuals. So a diabetes prevention strategy is needed from early life. This comes close on the heels of a recent recommendation by experts to lower the screening age for diabetes from 30 to 25 years.
• Latest study: At the Diabetes Unit of KEM Hospital, Pune, scientists have been carrying out research for 35 years to understand why diabetes is so common in Indians. In 1993, they embarked on the Pune Maternal Nutrition Study (PMNS) across six villages near Pune, and have followed more than 700 families since. 

1. They have tracked women from before they became pregnant and during their pregnancy, and their children through childhood, puberty and now as adults.
2. The study, ‘Poor In Utero Growth, Reduced b-Cell Compensation and High Fasting Glucose from Childhood are Harbingers of Glucose Intolerance in Young Indians’, by Dr C S Yajnik, was published in Diabetes Care, a journal of the American Diabetes Association.

• Learings: Researchers measured glucose and insulin concentrations and other vital data at ages 6, 12, and 18. At 18 years, 37 per cent of men and 18 per cent of women had elevated glucose levels (prediabetes). This was despite half these participants being underweight (body mass index less than 18.5 kg/sq. m.) Children with sub-optimal growth in the womb carry high levels of risk factors for diabetes from early childhood, including high circulating glucose levels. The tendency towards high glucose was visible even when measured at ages 6 and 12. The researchers concluded that this was driven by a poorly functioning pancreas, which could not cope with the demands of increasing age, and that this very likely reflects poor growth of the pancreas during foetal life as part of general growth failure. When maternal glucose is minimally increased during pregnancy, even this stresses the baby’s pancreas.
• How widespread in India: According to the World Health Organization (WHO), India has an estimated 8.7 per cent diabetic population in the age group 20-70, with around 77 million people with diabetes. A first national nutrition survey (2016-18) by the Union Ministry of Health and Family Welfare, UNICEF and Population Council among children and adolescents, too, found that diabetes is affecting children in a big way. Released in 2019, the survey said that almost 1 in 10 children (ages 5-9) were pre-diabetic, and 1 per cent was already diabetic. The rising prevalence of diabetes is driven by a combination of factors — rapid urbanisation, sedentary lifestyle, unhealthy diet, tobacco use, and increasing life expectancy.
• Current screening strategy: The current recommendation from the government to begin screening for diabetes is at age 30. Diabetes prevention trials still mainly target middle-aged individuals who already have obesity and advanced metabolic abnormalities. An integrated life course approach is required and prevention has to start at the community level and not just in the clinic. What we need are public health experts, not just doctors, to tide over this problem. A new report in Diabetes and Metabolic Syndrome–Clinical Research and Reviews, too, shows a trend of the increasing prevalence of diabetes in younger age groups in the last decade. After analysing data from various diabetes centres, researchers found that 77.6 per cent of those below 30 were either overweight or obese.
• Summary: Comprehensive lifestyle changes and widespread awareness is needed to tackle the menace of the silent killer, diabetes.
• EXAM QUESTIONS: (1) Explain how Indians seem to be more predisposed towards contracting diabetes. (2) What are the ways to manage diabetes well? What are the risks of not doing so?

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