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Why India should seriously pay attention to its children's pre-diabetes

A new national survey shows 10% of children are at risk of developing diabetes. Policies must focus on getting them to eat right and exercise. In 2016, diabetes was directly responsible for 1.6 million deaths around the world, according to the WHO...

, ET Bureau|
Updated: Nov 10, 2019, 10.00 AM IST
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If overweight and obesity are not aggressively addressed, the burden of non-communicable disease may extract a terrible cost on the development of India.
One of the new patients to walk into Jothydev Kesavadev’s Diabetes Research Centre in Thiruvananthapuram last week was a 22-year-old man with alarmingly high levels of blood sugar. His HbA1c in the blood — which is used to measure diabetes — was dangerously high at 12.5 per cent, double the level beyond which one is considered diabetic.

But the worst was yet to come. On seeing that the patient’s 17-year-old brother looked overweight, the doctor suggested that he, too, should do an HbA1c test, which measures the average plasma glucose levels in the last 2-3 months. “The results were shocking. His reading was 14 per cent,” says Kesavadev.

The age of the onset of diabetes has been reducing over the years, says Kesavadev, who began private practice in 1997. “In the last 10 years, in general health camps in Kerala, we have observed that asymptomatic patients of diabetes and those with pre-diabetes are on the rise.”

What is more alarming is that these are not isolated trends. It confirms new data released by the Comprehensive National Nutrition Survey (CNNS) — conducted by the Ministry of Health and Family Welfare, UNICEF and Population Council — which found that 10 per cent of children and adolescents up to the age of 19 are pre-diabetic. In the pre-diabetic stage, your blood sugar is higher than normal but not yet high enough to be type 2 diabetes, which accounts for around 90 per cent of all diabetes cases. Changes in diet and lifestyle can prevent or delay prediabetes from progressing to type 2 diabetes. This is unlike type 1 — or insulin-dependent — diabetes, which is not preventable. The exact causes of type 1 are unknown.

But without interventions in eating habits and exercise, pre-diabetes can progress to type 2 diabetes. In 2016, diabetes was directly responsible for 1.6 million deaths around the world, according to the World Health Organization. The new data comes even as India is struggling with a diabetic population of over 72 million.

The CNNS highlighted for the first time the problem manifests at an early age (see Extent of Risk). The data shows these children might become diabetic if there is no proper care, says Praween Agrawal, monitoring and evaluation specialist at UNICEF’s India office. “It should be treated as an eye-opener.”

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The early onset is a big surprise, says Vinod K Paul, a member of NITI Aayog and head of the pediatrics department at AIIMS. “It is a reality we should be mindful of, because India is facing a double burden — of under-nutrition, particularly in less-developed areas, and over-nutrition, especially in better-off states,” says Paul.

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Ambrish Mithal, head of endocrinology at Medanta in Gurgaon, says: “India has to battle under-nutrition, but also do it the right way, with a high protein, high fibre diet, instead of processed atta.”

There should be a full review of the nutritional composition of all foods in public programmes as many of them are refined cereals and include sugar, says Purnima Menon, senior research fellow at International Food Policy Research Institute. “India should be aiming to buy healthier foods with the funds that go into publicly financed programmes.”

Additionally, there is a correlation between malnutrition and diabetes. “Low birth-weight babies are excessively prone to developing diabetes and heart diseases in adult life. When they are in the womb, their nutrition is compromised. Once they are born, they are biologically maladjusted,” says Paul.

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Experts say the data on pre-diabetes presents a chance for course correction. “There is a window between the time you are pre-diabetic and diabetic. That should be treated as a window of opportunity to make changes in diet and lifestyle,” says UNICEF’s Agrawal. With an active lifestyle and the right diet, diabetes can be kept at bay. “If you are smart about your pre-diabetes, you can pull back and you will be fine for decades,” says Mithal.

Ajay Khera, commissioner in the Ministry of Health and Family Welfare, says health education in schools and the health and wellness centres planned as part of Ayushman Bharat would play critical roles in preventing and controlling non-communicable diseases (NCDs), including diabetes. “The role of physical activity in preventing obesity is also being adopted as a key strategy, along with an emphasis on eating right.”

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The CNNS has warned that “if overweight and obesity are not aggressively addressed, the burden of non-communicable disease will extract a terrible cost on the development of India.” A major risk factor for NCDs is high blood glucose. Kesavadev in Thiruvananthapuram says: “Preventing diabetes requires next to no money — it is all about exercise and diet control.” And the will to do both.

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