About Diabetes

• Diabetes is a chronic (long-lasting) disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces.
• Insulin is a hormone made by the pancreas that acts like a key to let glucose from the food we eat pass from the bloodstream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.
• Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues.

Types of Diabetes

• There are three main types of diabetes – type 1, type 2 and gestational. 
• Type 1 diabetes can develop at any age, but occurs most frequently in children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control. 
• Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body does not make good use of the insulin that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet. However, over time most people with type 2 diabetes will require oral drugs and/or insulin to keep their blood glucose levels under control.
• Gestational diabetes (GDM) is a type of diabetes that consists of high blood glucose during pregnancy and is associated with complications to both mother and child. GDM usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life.

Current Scenario

• India is often referred to as the diabetes capital of the world. Over the past decade, cases of both Type 1 and Type 2 diabetes have seen an increase among children and adolescents.
• The Indian Council of Medical Research (ICMR) stated that there are currently 95,600 cases of Type 1 diabetes among children under 14 years of age, with nearly 16,000 new cases added every year.
• The 10th edition of Diabetes Atlas, a 2021 report by the International Diabetes Federation’s (IDF) states that India has the highest estimated prevalence of Type 1 diabetes in people under 20 years (229,400) followed by the US (157,900) and Brazil (92,300).
• While India adds an estimated 24,000 new cases each year, the US adds 18,200 and Brazil 8,900. This is a major shift from the trend five years ago, when India was second to the US.
• Research shows that “Covid-19” has also been a big factor for the rise in Type 1 diabetes cases since the onset of the pandemic as sars-cov-2 virus can destroy insulin-producing cells.
• A study by the US Centers for Disease Control and Prevention says, “Persons aged less than 18 years with covid-19 were more likely to receive a new diabetes diagnosis more than 30 days after infection.
• The study noted that India already has a significant health burden caused by diabetes and estimates suggest 77 million adults have diabetes and this number is expected to almost double to 134 million by 2045.

Type 2 diabetes soaring among youth

• More than Type 1, the exponential rise of Type 2 diabetes among younger populations warrants concern because the condition is preventable.
• A new research has warned that more than half of men (55%) and some two thirds (65%) of women aged 20 years in India will likely develop diabetes, with most of those cases (around 95%) likely to be type 2 diabetes.
• While it is likely 5-7% of those under 25 will have diabetes, the number of prediabetic cases may be more than double, and will convert to diabetes in three or four years. 

• Prediabetes is a condition wherein the patients blood glucose level is higher than normal—100 to 125 mg/dL, above which it converts to diabetes.

• Prediabetes can beidentified only for Type 2 diabetes.

• As per the Comprehensive National Nutrition Survey (2016-18) by the Union Ministry of Health and Family Welfare, UN Children’s Fund (unicef) and Population Council, overall, one in 10 children in India is prediabetic.
• Northeastern states such as Manipur (22%), Sikkim (21.6%), Tripura (21.1%) and Mizoram (19.7%) have highest percentage of prediabetic children aged 5-9 years, while for adolescents in the 10-19 age group, Kerala has the highest prediabetic rate at 32.2%.
• The rise in Type 2 diabetes is parallel to the increase in obesity among children. As per the World Obesity Federation, India has a childhood obesity risk score of 4/11 (with 11 being the highest risk), and is likely to miss the World Health Organization’s

target of “no increase in childhood obesity prevalence by 2025”. The federation says at current rate obesity will increase to 6.2% among adolescents and 10.8% among children aged 5-9 by 2030.

Impact on Demographic

• Greater prevalence of diabetes puts the younger populations at higher risk of mortality and morbidity.
• A December 2020 study by researchers from MDRF finds that “individuals diagnosed at a younger age have a more severe form of diabetes and poor glycemic control when compared with those with late-onset diabetes.”
• Thus, Urbanization, decreasing diet quality and decreased levels of physical activity are all contributing to this hidden epidemic in India.

Conclusion 

• Such high probabilities of developing diabetes will have severely negative implications for India’s already strained health system and also out-of-pocket expenditure on diabetes treatment by patients.