If you make one promise in the new year, vow to stay diabetes-free
Personal targets for yourself and your family can help lower your risk of developing the condition, so start now.columns Updated: Dec 31, 2017 11:19 IST
If your new year’s resolution involves setting personal goals to turn healthier, consider steps to ward off diabetes, which affects 70 million people in India. If untreated, diabetes — a chronic condition in which the body is unable to regulate blood sugar levels efficiently — leads to complications such as kidney failure, heart disease, stroke and blindness.
Several studies show that South Asians, including Indians, develop diabetes a decade earlier than Europeans at a lower weight, and those with pre-diabetes — or impaired glucose tolerance — progress to overt disease at a faster rate. The progression in South Asians happens at a rate of 12% to 18% a year, compared to 5% to 11% in White populations.
Not about race
A new study from the US confirms that more than race, modifiable lifestyle factors determine your chances of developing Type 2 diabetes by middle-age. And if these modifiable risks are controlled in young adults, the chances of their developing diabetes fall dramatically, found the study of young Black Americans, who are twice as likely to develop Type 2 diabetes as their White counterparts.
Several studies in the past have shown that the likelihood of a person developing diabetes differs with race, with African Americans and Native Americans being at greater risk than White populations, but none factored in lifestyle and modifiable biological risks.
The US study of 4,251 people (49% Black, 51% White), published in the scientific journal JAMA, found that adjusting for five modifiable factors — biological (fasting glucose, Body Mass Index), neighbourhood (social segregation), psychosocial (depression, anxiety), socioeconomic (education, income), and behavioural (smoking, alcohol and/or substance abuse) — eliminated the risk disparity associated with race.
Since Indian and other South Asian populations have risk levels similar to African Americans, controlling modifiable risk factors can lower your chances of developing diabetes and also heart disease and certain cancers. Along with exercise, a diet high in natural fibre found in whole grains, legumes, fruit and vegetables, and low in fat, carbohydrates, sugar and salt can lower disease risk by bringing down fasting glucose levels, waist size, body weight and unhealthy levels of blood fats such as cholesterol and triglycerides.
Biological factors include a family history of diabetes, so people who have a parent or sibling with the condition need to track and control the risk factors more closely.
Young adults with a family history of diabetes need to routinely test for impaired glucose tolerance, which puts Indians at a 1.4 times higher risk of developing diabetes. With 7.3% of India’s adults over 20 already pre-diabetic, according to the Indian Council of Medical Research, identifying glucose intolerance through a simple blood test can help those at risk make lifestyle adaptations to delay and even reverse the condition.
Step it up
Abdominal fat — excess fat that collects under the skin and in the abdomen — hampers blood glucose control, as does a fatty liver and excess fat in the pancreas, which produces insulin. Low physical activity (less than 8,000 steps a day) and an unhealthy diet high in fat, refined carbohydrates and sugars collectively lead to ever-widening waists.
To lower the risk of diabetes and heart disease, waist sizes must be less than 90 cm (35.4 inches) for men and 80 cm (31.5 inches) for women. So if you find yourself moving a size up in clothes, push activity levels up instead.
Don’t worry, be happy
Psychosocial determinants such as depression and chronic anxiety also increase risk, as do socio-economic factors such as employment status, marital status (singles are at higher risk), education and income, found the US study. People with higher education and income levels tend to have a healthier lifestyle because of better access to information and diagnostic tools.
People addicted to tobacco, alcohol and other addictive substances are also more likely to have depression and anxiety, so stopping substance abuse gives the body a physical and mental reprieve.
Diabetes in India has already begun undergoing an epidemiological transition, with pre-diabetes rising among the poor even in the most backward states. Bihar, for example, has a low diabetes prevalence of 4.3%, but 10% of its people have pre-diabetes, which indicates that the disease will likely explode over the next two to three decades.
While the JAMA study shows that using tools that address socio-economic inequities can help lower diabetes rates across a wider population, personal targets for yourself and your family can do the same at an individual level, so start now.