The World Health Organization (WHO) recently reported that over 77 million individuals aged 18 and above grapple with type 2 diabetes, while an additional 25 million are on the precipice of prediabetes in India. What’s even more alarming is the surge in type 2 diabetes cases among children, specifically adolescents aged 12-18. While this condition has long been associated with older adults, a disconcerting trend is emerging among the younger demographic. Join us in a conversation with Dr. Lakshmi Nagendra, MD, DM (ENDO), an esteemed endocrinologist at the Centre for Diabetes and Endocrine Care, as we delve into the factors driving these unsettling trends.
Excerpts from the interview:
HoA: What is the primary cause behind the increasing incidence of diabetes among India’s youth?
Dr Lakshmi Nagendra: The main factors contributing to the rising prevalence of diabetes among India’s youth are sedentary lifestyles and unhealthy eating habits, leading to a significant shift in the lifestyle patterns.
HoA: How has the diagnosis of diabetes in the younger population changed over the years, particularly in terms of type 1 and type 2 diabetes?
Dr Lakshmi Nagendra: In the past, type 1 diabetes was more common among the young. However, the current trend shows an increasing incidence of type 2 diabetes in younger age groups due to lifestyle factors playing a significant role.
HoA: Can you share any clinical experiences regarding the age at which diabetes, especially type 2 diabetes, is being diagnosed in children?
Dr Lakshmi Nagendra: Type 2 diabetes has been diagnosed in children as young as five years old, indicating a notable decrease in the age at which this form of diabetes is identified. Lifestyle factors and genetic predisposition contribute to this trend.
HoA: How does the management of diabetes differ between adults and children, specifically for type 1 and type 2 diabetes?
Dr Lakshmi Nagendra: While lifestyle management remains a cornerstone for both adults and children with type 2 diabetes, insulin is crucial for those with type 1 diabetes. The treatment approach varies based on the type of diabetes diagnosed, with additional forms like MODY and pancreatic diabetes requiring different strategies.
HoA: Can you explain the fundamental differences between type 1 and type 2 diabetes for our audience?
Dr Lakshmi Nagendra: Type 1 diabetes results from insufficient insulin secretion, often due to autoimmunity. In contrast, type 2 diabetes involves insulin resistance, where insulin is present but not effectively utilized. Insulin is essential for type 1 diabetes management, while type 2 diabetes may involve lifestyle changes, medications, and, in some cases, insulin.
HoA: What protocols or strategies contribute to the remission of type 2 diabetes, and how does weight loss play a role in this process?
Dr Lakshmi Nagendra: The direct trial study emphasizes weight loss as a significant predictor of type 2 diabetes remission. Managing obesity, often through lifestyle changes, can positively impact insulin resistance and contribute to remission.
HoA: How are obesity and diabetes interconnected, and how does fat deposition affect the development of diabetes?
Dr Lakshmi Nagendra: Unhealthy lifestyles and elevated BMI increase the risk of diabetes. The twin cycle hypothesis highlights the role of fat deposition in the liver and pancreas, impacting insulin secretion and leading to diabetes. Weight loss can address this and contribute to diabetes remission.
HoA: Could you elaborate on the concept of prediabetes, its diagnosis, and the associated risks?
Dr Lakshmi Nagendra: Prediabetes is diagnosed based on criteria like elevated HbA1c levels. It indicates an increased risk of developing diabetes and is associated with complications like cardiovascular diseases and neuropathy. Regular screening and intervention are essential for those with prediabetes.
HoA: Are there gender-based differences in how type 2 diabetes presents in men and women, and does it affect their reproductive health differently?
Dr Lakshmi Nagendra: While the presentation of type 2 diabetes is similar in men and women, women often delay seeking healthcare. Early diagnosis and treatment are crucial, as diabetes can affect reproductive health. Well-controlled diabetes, however, does not significantly impact reproductive potential.
HoA: What measures should individuals take to ensure their blood glucose levels are well-controlled, apart from medication?
Dr Lakshmi Nagendra: Besides medication, regular checkups, adherence to prescribed diets, and maintaining a healthy lifestyle through exercise are crucial for managing diabetes. Personalized care and close monitoring of blood glucose levels help tailor the treatment approach for each individual.
HoA: How does exercise play a role in managing diabetes, and what considerations should individuals with diabetes keep in mind when it comes to exercising?
Dr Lakshmi Nagendra: Exercise is a key component in diabetes management, with 150 minutes per week being effective. However, exercise plans should be personalized based on an individual’s health, fitness level, and diabetes complications. Seeking expert advice and incorporating regular, moderate exercise into daily routines is essential.
