A 30-year-old study, tracking more than 700 families in Pune, Maharashtra, has shown that there is a tendency towards high glucose in early childhood in many individuals. This research was carried out by the Diabetes Unit of KEM Hospital, Pune. The study, titled Poor In-Utero Growth, Reduced b-Cell Compensation and High Fasting Glucose from Childhood are Harbingers of Glucose Intolerance in Young Indians, by Dr C.S. Yajnik, Director of the diabetes unit at KEM hospital, and co-authors, has been published in a journal of the American Diabetes Association viz., Diabetes Care. This study, which is now into the third generation of families, was an attempt to understand why diabetes is so common in Indian population.
The finding of this research has called for a diabetes prevention strategy from early life. Recently, experts have also recommended to lower the screening age for diabetes from 30 to 25 years.
In 1993, the scientists started the Pune Maternal Nutrition Study (PMNS) across six villages near Pune. Since then, they have followed more than 700 families and have been tracking women from ‘before they became pregnant’ and ‘during their pregnancy’, and ‘their children through childhood, puberty, and adulthood’. The researchers measured the glucose and insulin concentrations and other vital data of the sample population at ages 6, 12, and 18 years.
Findings of the Study
- The researchers found that about 37 per cent of men and 18 per cent of women were prediabetic with elevated glucose levels at the age of 18. Additionally, half of the selected population was underweight with a body mass index (BMI) less than 18.5 kg/sq m.
- It was found that children with sub-optimal growth in the womb had high levels of risk factors for diabetes from early childhood and had high circulating glucose levels.
- The researchers also measured high glucose levels at the ages of 6 and 12 and concluded that this was driven by the poor functioning of the pancreas, which was not able to cope with the demands of increasing age. When maternal glucose was slightly increased during pregnancy, it led to stress in the pancreas of the foetus.
- It was found that the poor growth of the pancreas during the foetal life was a part of general growth failure.
Diabetes in India
According to the WHO, between the age group of 20 and 70, an estimated 8.7 per cent (around 77 million people) of the population, are diabetic.
The first national nutrition survey was conducted jointly by the Union Ministry of Health and Family Welfare, UNICEF, and the Population Council between 2016 and 2018. It also found that diabetes is greatly affecting children. The findings of the survey, released in 2019, stated that almost one in 10 children, between the ages of five and nine, was pre-diabetic, and one per cent was already diabetic. A combination of factors, such as rapid urbanisation, sedentary lifestyle, unhealthy diet, use of tobacco, and increasing life expectancy has driven this rising prevalence of diabetes.
As per a recently published report in the scientific journal, Diabetes and Metabolic Syndrome: Clinical Research and Reviews, there is a trend of rising prevalence of diabetes in younger age groups since the last decade. Further, the analysis of data from different diabetes centres showed that about 77.6 per cent of the population, below the age of 30, were either overweight or obese.
Present Screening Strategy for Diabetes
As per the government recommendations, the screening for diabetes is to be done by the age of 30. It was found that diabetes affected mainly middle-aged individuals who are obese and have advanced metabolic abnormalities. So, there should be an integrated approach for the prevention of diabetes at the community level; not just in the clinic. Public health experts, and not just doctors, are the need of the hour.
According to the International Diabetes Federation, South East Asia, there is no sufficient data to translate in the public health domain, especially in a resource-limited county like India. Therefore, a suitable and robust translational research methodology would be required which could be reproduced. The methodology should also be within the economic range, as well as should share strong evidence from a public health standpoint.
Conclusion Given the above situation, the government should focus on women and child health. Maternal nutrition during pregnancy should also be focused upon as a preventive measure. Emphasis should be given upon the correct lifestyle, eating habits, and timely screening of the suspected, such as the obese, the overweight, those who use tobacco or drugs, etc.
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