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INDIANS ARE MORE PRONE TO DIABETES-BUT Why Are We Still Not Pro-Active In Our Approach Towards Screening For Pre-Diabetes?

We the people of India have survived through centuries, with the help of a set of genes ,which ensured our survival against all odds, including long years of famine and scarcity of food! Meaning that the present population is stuffed with all the necessary genes needed for conservation of food.


At the same time Pancreas we have is equipped with a limited power in terms of production of Insulin by Beta cells. These are special cells which can produce Insulin NO OTHER CELL CAN PRODUCE INSULIN.


When a child is unborn in mothers uterus and Pancreas is developing in the fetus ,factors which can negatively influence the develpoment of Pancreas are Maternal Mal nutrition and Maternal Diabetes .A child born to such a mother will be more prone to have a "weak"Pancreas !


Our Genetic pool has some Genes which permit conditions favorable for Diabetes development.


- Our Genes are designed to avidly store fats.


- Storage of fats is predominantly different from our western counterparts , we tend to store fats, whenever available in plenty, within our abdominal cavity, within the muscles & also in Liver and thus create wrong depots!


The Fact that You have Wrong Depots is Easily recognized by Central Obesity-Waist line more than 90 cms in males and 80 cms in females.


- All these fat depots create a situation which make us not only readily “Centrally Obese” but also make us Insulin Resistant! which means more than normal Insulin is required for even normal rates of Glucose transport.


( Readers may note that Insulin is the only Hormone in the body which helps in utilization of Glucose and Glucose is the final product of our food which body uses for survival,repairs and growth.)


- It is a proven fact that an Indian, Obese or even Non-Obese, needs more Insulin Units to deal with any amount of Glucose load when compared to Caucasians/Whites counterparts.


- The situation becomes even more complex because of the fact that Indians have more fat in their body for each Gram of Muscle mass, again, as compared to whites!


More Fat-Less Muscle


- In fact even Infants in India have more fat and less muscle when compared to an Infant with the same body weight but from a "White" mother!


- Indian Infant has to produce more Insulin for each gram of Glucose when compared to Whites. That means Indians are somewhat Insulin Resistant and Hyperinsulinemic right after Birth!


--Aging is another factor which sees every hormone producing system in our body going down hill with each passing year.This happens to Pancreas and Beta cells as well.With every passing decade Beta cell function goes down and down.


- If this Insulin Resistant and genetically predisposed system is subjected to repeated and frequent surges of High Blood Glucose , created by intake of Calorie dense, greasy, starchy food ,with cokes, snacks, burgers and that too- again and again ,throughout the day and day after day ,it will not be hard to imagine what will finally happen to the poor Pancreas and it’s “limited powered” Beta Cells .....they will fail to cope up with the pressure..


In fact Beta cells of Indians can be compared with a Pentium I Processor of Older computers ,with limited RAM backing it, and if commands are too many and too frequent ,without enough processing time in between, then it is bound to crash!


Yet another aspect of modernization and changing lifestyles detrimental to Beta cells are the problems of –Physical Inactivity,emotional /work Stress & Depression (with variable grades!


We have solid scientific evidence which tells us that Risk For Cardiovascular complications in terms of Heart attacks, Brain attacks or Strokes, Peripheral Vascular Disease (along with Impotence) and Non alcoholic Steatosis and Steato-hepatitis(linked to fatty liver) which can end up as permanent Liver damage, all start YEARS before the Diabetes actually arrives on the scene ! Infact trouble starts 8 - 12 years before at " prediabetes stage "


As many as 35% to 40% of Pre-diabetes cases can actually progress to Diabetes.Even those who do not progress to Diabetes , still have High cardiac risk.


I can therefore put forward the following reasoning for “ why Pre-diabetes should be aggressively looked for in an average Indian not ony by fasting Glucose test BUT also by a a Glucose test 2 Hr after 75 G of Glucose load what we call as 2hr.PPBG.Both should be mandatory in any screening program .(at least in Indians)


Reasons are as follows:


  ♦This category as such, is clearly linked with High complications risk for all the above deadly conditions !
  ♦This category can progress to Diabetes.
  ♦Diagnosis of Pre-diabetes needs NO EXTRA effort. You are actually doing the same tests for the Diagnosis of            Diabetes.


AND while screening for Pre-Diabetes you may ,by chance, find out many cases of UNDIAGNOSED Diabetes as well !A very real possibility because around 40-50 % cases of undiagnosed in our populations.


   ♦ We can do a lot for these people through appropriate interventions including Drugs for this particular category.
   ♦AND above all - We have solid evidence, again, that these interventions ACTUALLY MAKE DIFFERENCE ! and a        world of difference! We can reduce overall risk for all the complications mentioned above and also can revert         OR at least slow down/delay. the progress to Frank Diabetes !

We should have new recommendations for Health care people and masses in general at least in south Asia:


Keeping in view the latest International Diabetes Federation’s recommendations and also the rising trends of Diabetes, Heart attacks., Strokes, Impotence and NASH-(Non Alcoholic Steato-hepatitis – linked to Fatty liver )& Peripheral Arterial Disease,we need to actively and aggressively look for Pre-Diabetes in our populations.

We should also not forget that Indians ,as a race are already genetically prone to all these conditions ,which tend to occur earlier by TEN years to us and then progress rapidly thereafter! For all the right thinking and really concerned Health Care Individuals this should be their DUTY to Pro-actively look for Pre-Diabetics-“A stitch in time saves NINE”


Therefore my recommendations are:


For all Indian Individuals above 35 yrs of Age it should be mandatory to Test for Fasting Blood Glucose and for Post-Prandial Glucose at TWO hrs after 75 Gs of Glucose load and if found normal then it should be repeated at every 2 yrs!


AND Also all overweight(85th percentile weight and above) adolescents of above 10 yrs of age, should be subjected to active screening ,because with “soon arriving” puberty and hormonal changes/surges ,this age group will not give you enough time for interventions while progressing from Pre-Diabetes to Diabetes, in fact within few months the damage and progress to Diabetes may be complete and the Intervention phase for Pre-diabetes gets totally missed /lost in the process !


Pleasantly even Americans are waking up to the idea of proactive search and drug treatment of PredIabetes as indicated by many recent publications.

Pre Diabetes- FAQs


Q1:What is meant by Pre-Diabetes?

Ans: This is a Biochemical abnormality which may be a precursor for Diabetes that’s why the name is given as that.


Q2.How do we clinically define it? How it can be detected?

Ans: The tests for detection of Diabetes and Pre-Diabetes are exactly the same, it is the extent of abnormality which differentiates them into two different classes. This is as under:
Fasting Blood Glucose      Normal Below 100 mg %(70-100)
                                            Diabetes Above 126 mg% 
Then there is a gap! 
What will you say for the Glucose Levels from 101 to 125 mg% ?


This is called as Impaired Fasting Glucose OR IFG- in short


Now, there is another way of Diagnosing Diabetes and that is, when you get Post-meals Glucose levels of 200mg% or above OR we put a challenge load of 75 Gms. of Glucose on to the system and at Two Hrs, if Glucose levels cross 200 mg %.This 200 mg % is set as the limit above which we label the patient as Diabetic..

But coming back to the levels for- after meals or at 2Hrs after 75 Gms of Glucose load, we know the Normal upper limits are 140 mg%!

So again, there is gap here, from 140 of the normal limits to 200 mg% ,a point where Diabetes starts, there is this category, from 141 to 200 mg%


what we call as Impaired Glucose Tolerance OR IGT- in short !


To summarize now-
Normal levels           Fasting                70-100 mg%
                                 Post meals         <140 mg% 
Diabetes means Fasting Bld Glucose ----126 mg% & above
OR at 2 Hrs After meals ------ 200 mg% & above
OR at 2Hrs After 75 G Glucose load —Above 200 mg%

IFG OR Impaired Fasting Glucose                 101 to 125 mg%    *
IGT OR Impaired Glucose Tolerance           141 to 199 mg%    *
**Both these later categories of IFG & IGT put together are called and categorized as Pre-Diabetes by most of the clinicians.


Q3. What are the Risk Factors for Pre-Diabetes:


Ans : RISK FACTORS FOR PRE-DIABETES ARE

There are a number of risk factors which significantly increase the likelihood of the disease's onset. These are:

  ♦ a family history of Type 2 Diabetes or heart disease
  ♦ being overweight or obese
  ♦ being aged 45 or older
  ♦ suffering from hypertension (high blood pressure)
 ♦ belonging to a high-risk ethnic group, namely African-Americans, Asian-Americans,       Latinos or Pacific Islanders
 ♦ being "apple-shaped" rather than "pear-shaped," meaning that excess weight gathers     around your waist, rather than your hips
 ♦ if female, suffering from Gestational Diabetes while pregnant or giving birth to a baby    weighing more than 9 lbs
  ♦ eating an excess amount of carbohydrates
  ♦ leading a sedentary lifestyle with little or no exercise
  ♦ being recently diagnosed as suffering from Insulin Resistance
Researchers have found a link between Pre-Diabetes and other conditions such as the cluster of cardiovascular diseases called Metabolic Syndrome (Syndrome X), as well as the hormonal imbalance called Polycystic Ovarian Syndrome (PCOS), which is a major cause of female infertility. Research has indicated that up to 40% of women with PCOS suffer from Pre-Diabetes or Type 2 Diabetes by the age of 40.



Q4.Why all this effort of creating yet another category of ab-normals out of Normals ? If you are Not Diabetic then you are Normal !Why at all Prediabetes should be created from within the Non Diabetics ? What is the logic behind this?


Ans: We have solid scientific evidence which tells us that Risk For Cardiovascular complications in terms of Heart attacks, Brain attacks or Strokes, Peripheral Vascular Disease ,Impotence and Non alcoholic Steatosis and Steato-hepatitis(linked to fatty liver) which can end up as permanent Liver damage, all start YEARS before Diabetes actually arrives on the scene !


And you know 35% to 40% of Pre-diabetes can actually progress to Diabetes. I can therefore put forward the following reasoning For Pre-diabetes being created as a separate condition:


  ♦ This category is clearly linked with High complications risk for all the above deadly conditions!
  ♦ This category can progress to Diabetes.
  ♦ Diagnosis of Prediabetes needs NO EXTRA effort. You are actually doing the same tests for the Diagnosis of Diabetes and only in the process, you encounter thesePre-diabetics !AND while screening for Pre-Diabetes you may by chance, find out few cases of UNDIAGNOSED Diabetes as well !A very real possibility.
  ♦ We can do a lot for these people through appropriate interventions including Drugs, for this particular category.
   ♦  AND above all - We have solid evidence, again, that these interventions

DO MAKE DIFFERENCE ! and a world of difference! We can reduce overall risk for all the complications mentioned above and also can revert OR at least slow down & delay the progress to Frank Diabetes !


DO MAKE DIFFERENCE ! and a world of difference! We can reduce overall risk for all the complications mentioned above and also can revert OR at least slow down & delay the progress to Frank Diabetes !


Q4: So this seems to be logical then; but what are the recommendations for Health care people and masses in general?


Ans: Keeping in view the latest International Diabetes Federation’s recommendations and also the rising trends of Diabetes, Heart attacks., Strokes, Impotence and NASH-(Non Alcoholic Steato-hepatitis –a Liver damaging situation linked to Fatty liver ),we need to actively and aggressively look for it’s presence in our populations. We should also not forget that Indians ,as a race are already genetically prone to all these conditions ,which tend to occur earlier by TEN years to us and then progress rapidly thereafter! For all the right thinking and really concerned Health Care Individuals this should be their DUTY to Pro-actively look for Pre-Diabetics-“A stitch in time saves NINE”


Therefore my recommendations will be :
For all Indian Individuals above 35 yrs of Age it should be mandatory to Test for Fasting Blood Glucose and for Post Prandial Glucose at TWO hrs after 75 Gs of Glucose load and if found normal then it should be repeated at every 2 yrs!


Adolescent Overweight and Obese-Diabetes in Children ! Overweight(85th percentile weight and above) adolescents of above 10 yrs should also be subjected to active screening ,because with “soon arriving” puberty and associated hormonal changes ,this age group will not give you enough time for interventions while progressing from Pre-Diabetes to Diabetes, in fact within few months the damage and progress to Diabetes may be complete and the Intervention phase of Pre-diabetes gets totally missed and lost in the process !