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Spot test for diabetes

Darkening of the skin in the nape of the neck is an early indicator of diabetes in Indians, say experts, which makes it possible to diagnose the disease without the usual blood test

india Updated: Jan 08, 2006 01:39 IST

Darkening of the skin at the nape of the neck could be an early indication of insulin resistance and diabetes, more so in Indians, say researchers from the All India Institute of Medical sciences (AIIMS). The condition, called acanthosis nigricans, is marked by the darkening and thickening of the skin on the sides or back of the neck, the armpits, under the breast, and groin.

“Acanthosis nigricans is a skin manifestation of insulin resistance and an early indication of diabetes, and initial findings of our study shows that it is more common in Indians than in the West,” says Dr Anoop Misra, professor, department of medicine, AIIMS.

The study, which followed adult patients with acanthosis nigricans who had no history of diabetes, was done by the Department of Medicine and the Department of Biostatistics and presented at the International Congress of Obesity and Hypertension in Berlin. Fifty-eight per cent of the patients reviewed had the metabolic syndrome, a clutch of heart-threatening disorders such as abdominal obesity, high blood pressure and bad cholesterol; 36 per cent had impaired glucose tolerance that usually develops into diabetes; and 24 per cent had full-blown diabetes. All were clueless about their diabetic status.

For the study, the researchers measured waist circumference, hip circumference, waist-hip ratio, height, weight, body mass index, skinfold thickness at nine sites, body fat, blood glucose and serum-fasting insulin on oral glucose tolerance test and lipid profile.

About 40 million people have diabetes in India and another 40 million are at risk of it, which makes the disease almost as common as the common cold. Unlike the cold, however, diabetes needs to be treated, but only a third of diabetics end up using medicines to control their blood sugar levels.

The reasons are many. “There are no symptoms till late stages of the disease and most people do not even realise that they have diabetes until it affects their vital functions,” says Dr Misra. Indians also play truant when it comes to taking their prescription medication. “As soon as medicines get blood glucose levels down to the desired limit, some patients start to skip medicines or lower the dose without consulting a doctor,” says Dr Ambrish Mithal, senior consultant, department of endocrinology, Apollo Hospital.

Most people in India have adult-onset or type-2 diabetes, which is triggered off by unhealthy diets and sedentary lifestyles. Initially, people develop insulin resistance, a condition in which fat, muscles and liver cells do not use insulin properly. At first, the pancreas works harder to produce more insulin to keep up with the added demand, but over time it loses its ability to secrete the required insulin and the person becomes unable to metabolise the blood sugar. Usually, it takes about 12 years for a person with insulin resistance to develop diabetes.

Diabetes, however, can be controlled and a person can lead a productive life for decades after being diagnosed. “Uncontrolled diabetes, however, increases the risk of many diseases like heart attacks, stroke, kidney failure, blindness and even gangrene,” says Mithal.

While medicines can help diabetics control and keep the related complications at bay, only lifestyle modifications such as losing weight, exercising and eating healthy can help manage the disease. Medicines can work just this far and once the tablets stop working, about 5 per cent of diabetics have to move to insulin. In the West, longevity results in 20-25 per cent of adult-onset diabetics needing insulin in the later stages of the disease.

Some of the common complications associated with uncontrolled diabetes include heart attack (the leading cause of death in people with diabetes) and stroke. The risk of heart disease and stroke is two to four times higher for people with diabetes, according to the American Heart Association. Women with diabetes are at greater risk, with a study showing that women over 55 years with diabetes are seven times more likely to have heart disease. Research suggests that arterial inflammation is a possible reason for insulin resistance and increased risk of heart disease among diabetics. The American Diabetes Association recommends diabetics should take aspirin to reduce inflammation and block thromboxane production to lower their risk of heart disease and stroke.

Other complications include nerve damage (diabetic neuropathy) throughout the body, with symptoms of numbness, pain or weakness in the extremities such as the hands, feet and legs, kidney failure; erectile dysfunction; diabetes retinopathy (a potentially blinding complication that damages the retina); and hypoglycaemia (sudden dip in blood sugar caused by delayed meals, excessive dose of diabetes medications, or excessive alcohol).

“The bottomline is that everyone who is overweight, doesn’t exercise and has a family history of diabetes should get the blood glucose tested each year to detect and control the disease in time,” says Misra.