Knowledge Nugget: What Lancet study reveals about Diabetes in India and why it matters for UPSC exam

Why in the news?

According to a new paper published in ‘The Lancet Global Health’ journal, at least one in five people aged 45 and older had diabetes in India in 2019. Significantly, two out of five people with diabetes (or 40 per cent of those diagnosed) were unaware of their condition.

Key Takeaways:

1. The Lancet paper is based on the findings from the Longitudinal Aging Study in India (LASI) that surveyed nearly 60,000 adults in India aged 45 years and older between 2017 and 2019 to estimate the prevalence, awareness, treatment and control of diabetes.

2. According to the study, an estimated 20 million Indians have undiagnosed diabetes. Overall, eight per cent of the elderly (60-plus) subjects have been found to be undiagnosed.

3. The study also found that rates of diabetes were similar among men and women (19.6 per cent of men vs 20.1 per cent of women). Urban diabetes prevalence (30 per cent) was approximately twice as high as rural prevalence (15 per cent).

4. The study also provides updated evidence on the patterns of diabetes within India. States in southern India tend to have a higher rate of diabetes after adjusting for age, while others in central and northeastern India have a lower rate.

States in southern India tend to have a higher rate of diabetes after adjusting for age.

5. The states with the highest age-adjusted diabetes rates among adults aged 45 and above were Chandigarh (36.9 per cent), Kerala (36.0 per cent) and Puducherry (36 per cent). The states with the largest number of adults having diabetes were Tamil Nadu (6.1 million people), Maharashtra (5.8 million people) and Uttar Pradesh (4.7 million people).

What is diabetes?

1. Diabetes mellitus is one of the endocrine diseases that is caused due to inadequate secretion of the hormone insulin from the pancreas. Lack of insulin causes an increase in sugar in our body, leading to the condition called diabetes mellitus. (NCERT)

2. Until recently, most children and adolescents with diabetes were thought to have Type 1 (insulin dependent) diabetes. However, Type 2 diabetes mellitus (DM Type 2) among children is now being increasingly reported from several parts of the world. (NCERT)

3. Adolescents who are obese are more likely to get Type 2 diabetes which is manifested as high blood sugar.

4. To tackle this, the Central Board of Secondary Education (CBSE) recently directed its affiliated schools to establish sugar boards to monitor and reduce sugar intake in children. The board noted a significant increase in type 2 diabetes among children over the past decade.

BEYOND THE NUGGET: Understanding GLP-1 drugs

1. GLP-1 is both an incretin hormone and a neurotransmitter. In physiology, it is secreted from the small intestine and from the hindbrain after we eat a meal. It travels to the pancreas, where it helps to regulate our blood sugar by increasing insulin and decreasing glucagon. This is what we call the incretin effect.

2. This effect is blood glucose-dependent, meaning it is only if the blood glucose is elevated that it has an effect here. GLP-1’s effects in the pancreas and brain are the important ones to help control blood glucose and body weight.

3. The reason natural GLP-1 is so short-lived is that it is chopped up by metabolic enzymes known as DPP-4 and cleared by the kidneys.

4. The drugs used for the treatment of diabetes belong to a class of medicines called GLP-1 (glucagon-like peptide-1) receptor agonists. Semaglutide and tirzepatide both mimic the action of GLP-1. Tirzepatide additionally also mimics the action of another hormone called glucose-dependent insulinotropic polypeptide (GIP).

5. These drugs work by improving the secretion of insulin that allows more of the glucose in the bloodstream to enter cells where it can be used for energy, and inhibiting the secretion of the hormone glucagon that stimulates the liver to release stored glucose into the bloodstream.

6. These drugs work to slow down the emptying of the stomach so that the glucose levels in the bloodstream don’t spike and reduce appetite by signalling to the brain that one is satiated.

1. 01

   How is ‘obesity’ defined?

   Obesity, as defined by the World Health Organisation (WHO), is an abnormal or excessive accumulation of fat that poses health risks. A person with a BMI of less than 18.5 is considered to be underweight, a BMI between 18.5 and 24.9 is considered to be normal, those with BMI between 25 and 29.9 are considered to be overweight, while those with BMI over 30 are considered to be obese.

2. 02

   What is Type 5 diabetes?

   This year, the International Diabetes Federation (IDF) has officially recognised Type 5 diabetes as a distinct form of the disease. It is a form of diabetes affecting lean and malnourished teenagers and young adults in low- and middle-income countries. Type 5 diabetes causes pancreatic beta cells to function abnormally, leading to insufficient production of insulin. In Type 2, the body resists insulin action despite producing it.

Post Read Question

Consider the following statements:

1. Diabetes mellitus is one of the exocrine diseases caused due to inadequate secretion of the hormone insulin.

2. GLP-1 is both an incretin hormone and a neurotransmitter.

Which of the above-mentioned statements is/are correct?

(a) 1 only

(b) 2 only

(c) Both 1 and 2

(d) Neither 1 nor 2

(Source: One in 5 older Indian adults had diabetes in 2019, says Lancet study: Should there be universal screening?, What’s Type 5 diabetes that has been recognised after decades all about?, How GLP-1 drugs like semaglutide have revolutionised obesity treatment, NCERT)

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