A three-decade study tracking more than 700 Pune families, now going into the third generation, has sought to understand why diabetes is so common in Indians, and found a tendency towards high glucose in early childhood in many individuals. The authors have called for a diabetes prevention strategy 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.
How were these families tracked?
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. They have tracked women from before they became pregnant and during their pregnancy, and their children through childhood, puberty and now as adults.
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, Director of the diabetes unit at KEM hospital, and co-authors, has been 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 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.
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.
What is the current strategy for screening?
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, Dr Yajnik said.
“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,” Dr Yajnik said. “Constructing such evidence is beyond the scope of clinicians and will take a long time. We need to act sooner than later,” he said.
Dr Shashank Joshi, Chairman, International Diabetes Federation, South East Asia, said: “This is predominantly in the research domain. We do not have sufficient data to translate in the public health domain, especially in a resource-limited country like India. We need robust translational research that is reproducible, affordable and has hard evidence from a public health standpoint.”
A new report published in the journal 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.
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The report’s lead author, Dr Anoop Misra, had said the government should lower the age of screening.
Dr Joshi said: “This is a country-wide study and several others have recommended screening above 25 years in resource-limited countries including India. The focus is also on women and child health. Maternal nutrition during pregnancy should be focussed upon as a preventive measure.”