Prevent, Reverse, Evaluate Prediabetes
The future can be very different, as we know that a person who has diabetes goes through a stage of prediabetes, also called borderline diabetes and currently, we have 90 million people in India estimated to be living with prediabetes, and 75% of these are estimated to develop diabetes within the next 5-7 years. Saying this, Dr. Arbinder Singal, co-founder and CEO, Fitterfly, stressed on the point that if we don’t do anything, then we are looking at 134.23 million people with diabetes in 2045.
At the recently held panel discussion “#FightPrediabetes”, the talks centred around a collaborative effort by the pharmaceutical and healthcare sectors in managing the condition. A critical aspect suggested the need for corporate HR to get involved in an employee’s metabolic health and wellbeing. Corporate Citizen shares nuggets from experts and doctors in the field of Endocrinology and Diabetology, from the panel discussion.
Metabolic risk factors
People do not suddenly become diabetic overnight. It is a gradual progression with the deterioration of their glucose tolerance. The increase in weight adds to insulin resistance, and as insulin secretions start to become lower, we tend to develop prediabetes and progress to diabetes. Thus, prediabetes develops as an intermediary between the development of diabetes and its final progression to diabetes.
Risk factors:
People with prediabetes can progress to diabetes which is a significant challenge. Prediabetics has all possible metabolic problems. An overweight person is known to have central obesity and has fat deposited in his abdomen, which is metabolically very active. The changes in the lipid levels result in higher blood pressure and the added risk of developing heart attacks and strokes.
Prediabetics can suffer heart attacks and strokes:
Many suffer from metabolic syndrome, which is a clustering of obesity, lipid abnormalities such as low HDL, high triglycerides, and higher blood pressure. Many suffer inflammation which is because of a greater amount of visceral fat or abdominal fat, which again amounts to inflammation and an increased risk of developing heart attacks. These heart attacks are at least 2-3 times more in prediabetes than in the general population. Those with prediabetes have at least 2-3 times higher risk of developing heart attacks. And those with full-fledged diabetes have twice this risk, about 4-8 times higher risk of developing heart attacks and strokes. Therefore, progression from prediabetes to diabetes is a vital cause for concern.
Reversing the risks: The rate of progression to diabetes is about 5-10% of prediabetics. But many can reverse back the impact too. About 30%-70% of people will become diabetic in India. And the factors that can predispose this progression are increasing age, higher BMI, higher triglyceride level, decreasing physical activity, HbA1c levels of more than 6 per cent. Those above a reading of 6 are more likely to progress to diabetes.
Indian studies have shown that lifestyle measures help manage prediabetes and that nothing additional is gained by adding medicines. The lifestyle brings a change, and overall about 30% reduction has been seen with the lifestyle changes in the Indian study statistics. Different pharmacological drugs have been tried to manage prediabetes, but the major problem is that they can have adverse effects. The effect of the medications is not persistent. Once you stop the medication, the diabetic state reverses back.
Reversing back to prediabetes: It is always a fluid state. There is no particular time frame for the reversal; it could happen within a few months to see a change. The typical time taken to see a change in frequency is about three months. That is also the average lifespan to observe the change in our HbA1c, a stable marker to monitor any changes. A patient can monitor the changes using the HbA1c marker once before and after making the lifestyle and dietary changes.
Things that we can change
While we cannot change some of these factors, there are things that we can change very clearly. Indians have a carbohydrate-rich diet that is not suitable and pleasant for developing metabolic diseases like diabetes and heart ailments. So, a change in the diet will certainly make a lot of difference for our population. As a population, most of us are physically less active, which can be changed. Factors like cessation of smoking can make a lot of difference. Since the diabetic progression is much faster in Indians, we need to be more agile, more active; and studies have shown that Indians need 60 minutes of exercise every day of the week. If you take even a 2-day gap from exercise, the diabetic parameters get back to the initial higher levels of diabetes. Therefore, we need to exercise daily and every day of the week.
DR. RAKESH SAHAY,
- President-Elect, ESI and South Asian Federation of Endocrine Societies (SAFES)
Building Awareness
Our country needs more preventive action against diabetes to stop the onslaught of non-communicable diseases, especially diabetes. The Indian economy has not received significant and sustained contribution as far as healthcare is concerned compared to developed countries. As we are amongst low socioeconomic countries, we need to have more preventive approaches and more outreach as a community.
Debunking misconceptions: To fight the myths, you have to clearly understand the various interventions and lifestyle changes spoken about by the medical fraternity. Most importantly, we need to understand, believe and be persistent in following up on the prescribed treatment guidelines. Good monitoring and education will decide the outcome and no matter which expert you follow, always remember that lifestyle interventions are the first piece of advice. Action is needed at all possible levels – individual, family, social, media, FDA, political and legal. Amongst all the approaches that we talk about, probably making changes is the most necessary and will be the most pivotal intervention. Indians are an exceptional population: We don’t stay prediabetic for a long time; we quickly get converted to Type 2 diabetes. We need to have plans to get regular family check-ups. Families go dining and on holidays, but how often do you ask yourself or plan health check-ups for family members? It is time that people understand the importance of early diagnosis and interventions.
DR. MANGESH TIWASKAR,
- Secretary- General, Association of Physicians India
Curb predisposition of prediabetes
I have had prediabetes for a long time, and the reading had gone up to 6.2 points. It has been around 12 years now, and I would say that with good physical activity, healthy eating, it went down to 5.6. But, sometimes, with a little bit of stress in life, the reading returned to 6.2. So I do at least 1-1.5 hours of exercise, take around 10 000-20,000 steps daily, and eat healthily.
Managing other factors:
Manage stress-stress is an essential factor and especially so in the IT sector. So I would say not to sit constantly in one place, stand and do your work if possible, and move more to burn calories. Sleep well-even if you miss a day’s sleep, glucose levels are hampered and could rise slightly. Get at least 6-8 hours of sleep. Do not use laptops, mobiles, and gadgets during bedtime, which can hamper sleep time and sleep cycles, triggering prediabetes.
Prediabetic risk factors:
Prediabetes is the precursor before developing diabetes. Hence, the risk factors are the same as diabetes, and the most critical risk factor is obesity. The difference in Asians is that you may not be obese but may suffer from abdominal obesity, which is also a risk factor as the person is more insulin resistant.
Understanding the onset of the diabetic condition:
As we age, our risk of developing diabetes also increases. If you have a family history of diabetes, then your risk of developing prediabetes is also more. If you have had a history of polycystic ovarian disease, that is also a risk factor. Other risk factors are obstructive sleep apnea, skin condition called Acanthosis Nigricans, which can be a risk factor for developing non-insulin-dependent Diabetes Mellitus. If you have high triglycerides, then with low HDL (high-density lipoproteins or the ‘good cholesterol), you are at high risk for developing diabetes. A sedentary lifestyle or a state of ‘no exercise’ at all is another significant risk factor for diabetes.
At least 60 mins exercise per day can help:
We are concerned because a lack of exercise can increase the risk of cardiovascular diseases and stroke. But the good news is that a workout for at least 60 mins per day can help. Since Indians are more predisposed to insulin resistance, we also have less insulin reserve. So, in such individuals, at least 60 minutes of exercise with a healthy lifestyle, including eating patterns, could prevent developing diabetes.
DR. GANAPATHI BANTWAL,
- President, Endocrine Society of India (ESI)
What is pre-diabetes?
Knowing the golden numbers:
Diabetes is a syndrome of high glucose levels, and prediabetes is a disease condition or is a state where you catch the patient before they reach the state of diabetes. So, if we can catch the patient with prediabetes, it can impact the prevention of the diabetic stage. If we address the patient at that level, then we are also preventing the complications of diabetes and promoting health.
Understanding the ‘Goldilocks’ (prediabetic) zone:
Prediabetes is just the right condition, and it is the goldilocks zone-if you catch the patient there, you can prevent prediabetes, and you can prevent the disease from becoming too big and from becoming unmanageable. But, if you test yourself for prediabetes before the goldilocks zone is reached, it is unnecessarily troubling to many healthy people, forcing them to follow a strict diet and exercise. It is this ‘Goldilocks zone’ that we must catch, and all necessary medical and lifestyle interventions are applied after recognizing the risks within this zone and thereafter.
DR. SANJAY KALRA,
- VP, SAFES and Past President, ESI
Getting tested for prediabetes
The prediabetes test is not a blood test, but is 100 % accurate and serves as an indicator. This is a predictive model
- Who should take the two-minutes prediabetes test?
- Individuals Above 35 years, with a family history of diabetes.
- Whose BMI is above 25, and the waist ratio is on the higher side crossing 90 centimeters.
- Has hypertension
- Women with the polycystic ovarian disorder (PCOD) who have pregnancy-led diabetes.
The prediabetes test is not a blood test, but is 100 % accurate and serves as an indicator. This is a predictive model, and we predict the outcome based on the mass population. If 10,000 people do the test and many score a reading above 5, then this score indicates a relative risk of a prediabetes stage. It alerts you on the high-risk factor, and you should then test yourself for HbA1c and fasting sugar levels.
DR. ARBINDER SINGAL,
- co-founder and CEO, Fitterfly
Social Media and Covid-19 trigger e-healthcare norms
Healthcare has evolved:
In the last 1.5-2 years the landscape has completely changed. The first impact has been on telemedicine. Close to INR 50 million new users have come online, and there has been a growth of more than 500%. About 80% of the users in telemedicine were completely new, and that 44% of them were from non-metro cities. The other impact has been on online pharmacies, with the rapid growth of around 157% during the lockdown. Also, around 9 million people were added to online pharmacies, which is also expected to rise to around 70 million people by 2025. Also, 98 % of the healthcare professionals have been engaged on the virtual platform during the lockdown. Around 68% of the doctors and experts said they would like to continue with the virtual platform going forward. It would build a hybrid diagnosis method comprising both faceto- face and digital modes.
Technology as a healthcare tool:
Technology can offer an integrated and personalised diabetes management system. Therefore, it will enable patients to master the complexity of managing diabetes in the long run-in time and range of treatment. Moving forward, the holistic platform of social media and digital connectivity would engage healthcare professionals and empower patients in making decisions for better treatment outcomes. We can connect the health care professionals (HCPs) effectively with the patients for their self-care from home. Once virtual diabetes clinics become prevalent, these healthcare units can offer their In-Patient Department (IPD) offerings to ensure digital solutions. We can then transform diabetes via a combination of face-to-face and digital leaning.
OMAR SHERIEF,
- Head, Roche Diabetes Care
Research and prediabetes
As I went through the various research on prediabetes, I was surprised to see that the type of research conducted is primarily clinical research. The research is based on either the complications encountered or on the behaviour of prediabetic individuals. The study is based on how they behave and the prevailing inertia in following healthy lifestyles. I think that the research on the progression of prediabetes leading to diabetes is not substantial, so awareness campaigns have become relevant. Together, we can focus on actionable research that can make individuals with prediabetes more sensitive and sensitise them in avoiding the ‘prediabetic’ state to prevent diabetes in the future.
FARIDA HUSSAIN,
- CMO, USV Pharma
Trends in preventive health-checks
From a historical perspective, preventive check-ups are not traditionally what people in India do regularly. But, if you look at the last 4-5 years, preventive check-ups have picked up, primarily driven by corporates, advertisement, and promotional events and activities. Yes, it is urban centers that are becoming much more aware. The pickup has been higher in the urban centers in comparison to Tier-2 or Tier-3 towns. However, looking at data in the last 1 or 2 years, we have also seen smaller towns for preventive health checks, which is a very positive sign, and we believe that this trend will hopefully continue.