View from India: India is world’s diabetes capital

As reported by the media last week, at least 136 million people or 15.3 per cent of the population have pre-diabetes. A pre-diabetic is a person who has higher-than-normal blood sugar level but not high enough to fall into the category of type 2 diabetes. Pre-diabetic individuals need not become diabetic, provided they follow a healthy diet and exercise routine. Hypertension, high cholesterol levels and obesity are other determining factors that could lead to cardiac arrest, stroke and kidney disease. The survey indicates that at least 35.5 per cent of the population has hypertension and 81.2 per cent have abnormal levels of cholesterol or dyslipidemia. Around 28.6 per cent have generalised obesity and 39.5 per cent were found to have abdominal obesity.

In normal situations, the blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. Both women and men are susceptible to diabetes and can develop diabetes at any age. Type 1 and type 2 are the main types of diabetes and a third type is the gestational diabetes that happens during pregnancy. When the production and secretion of insulin from the pancreas is insufficient, it leads to type 1 diabetes. The defective response of insulin leads to type 2 diabetes.

The study, conducted by the Indian Council of Medical Research, has urged us to think about the increasing number of diabetic patients after 2019. Could there be a relation between Covid-19 and diabetes? Perhaps, yes. Covid-led lockdowns compelled people to stay indoors, which resulted in a sedentary lifestyle. Staying indoors, with or without a job, has led to depression, stress and sleep disorders. All these unhealthy conditions have given scope for people to become diabetic. Medical reports have revealed that the SARS-COV-2 virus can attack the pancreas. Consequently, this can impair the beta cells that produce and regulate insulin and thereby cause diabetes. Also, those Covid victims who were put on steroids to lower lung inflammation were probably susceptible to diabetes. A combination of such factors has added to a diabetes situation and India is now the diabetes capital of the world.

Diabetes is also known as the 'sugar disease'. High calorie, high fat and high sugar consumption makes people lethargic, causes obesity and increases visceral fat. Diabetes is a silent killer. Still, regular exercise and a high-fibre diet with fewer refined carbohydrates could prevent further deterioration. With medical assistance, the condition of the diabetic can improve over a period of time.  

Proverbially, it is hoped that every problem has a solution. At the government level, the National Health Mission (NHM) has launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. As per the programme, a population-based initiative for prevention, control and screening for common Non-Communicable Diseases – i.e. diabetes, hypertension and common cancers – has been rolled out in the country. This is under the gamut of NHM and is also part of the Comprehensive Primary Health Care. Individuals over 30 years of age can undergo screening for the three common cancers – oral, breast and cervical. Screening of these common cancers is an integral part of service delivery under Ayushman Bharat – Health and Wellness Centres.

Institute of Diabetes, Endocrinology and Adiposity (IDEA Clinics) is a national organisation providing specialist care in the fields of Diabetes, Endocrinology and obesity. This is India’s first digitally networked Endocrinology Clinic Chain on a data-driven technology platform. IDEA Clinics supports the National Health Mission and works towards 'One India – One Data for Health'. It has a proactive and continuous care model which combines human interface with process automation and precision healthcare technology. Data and health updates are passed onto the patient through in-house technology and precision healthcare; mobile apps and health analytics engines facilitate the process. With this, the required personalised patient care is executed through specialists. This is healthcare outside of a medical setting and is achieved through tech-enabled Omni channel care delivery. Being both physical and digital, it is known as a ‘Phygital’ model.

India is home to several diabetes startups and companies, many of which leverage the smartphone and apps to monitor diabetes. Diabetic retinopathy or the cause of visual impairment is alarming. Artificial intelligence (AI) with its deep-learning tools could help the medical fraternity to detect and monitor the occurrence of diabetic retinopathy. AI-based screening solutions can spot and identify retina-related complications, while predictive AI tools can be tapped for self-monitoring and management of diabetes. Though technology is an enabler here, one hopes that diabetic community doesn’t increase and the condition of diabetics improves with time.