Diabetes A rising urban phenomenon

By Kumaran P | NT

Diabetes has  become a  global public health  crisis particularly affecting low  and middle-income countries.  Increase in obesity fueled by urbanisation, nutrition transition,  and an increasingly sedentary  lifestyle has made it a matter of  extreme concern among Asian  countries. It has been observed  that Asians tend to develop  diabetes at a younger age  and have lower BMI levels compared to Caucasians. Several factors  contribute to this:  a high intake of refined carbohydrates  (white rice and maida), reduced  physical activity levels, and incresed prevalence of smoking and  heavy alcohol use;

Doctors in India are concerned  and attribute the possibility of an  increase in diabetics to various  lifestyle reasons. Dr. Mahesh D M, consultant endocrinologist, Aster  CMI Hospital, says that poor nutrition in early life combined with  overnutrition in later life plays a  significant role. “Interaction between a westernised diet and lifestyle and an Indian genetic background, could accelerate the rate  of diabetes onset because of this  transition in nutrition,” says he.

Covid and diabetes

Doctors say there is a bidirectional relationship between Covid-19  and diabetes. Diabetes is a premorbid condition associated with an  increased risk of severe Covid-19.  Also, a new-onset diabetes and metabolic complications of pre-existing diabetes, have been observed in  patients with Covid-19. Most often  we see patients with prediabetes  develop into diabetes and some do  get  new  onset diabetes.  “This has been happening because the Covid-19 virus binds to  certain receptors in the pancreas  alternating insulin release and affecting glucose metabolism that  complicates the pathophysiology  of pre-existing diabetes, which further leads to the onset of diabetes.  Furthermore, inflammation from  Covid-19 also results in insulin  resistance among patients.  While there appears  to be a symbiotic relationship  between Covid-19 and  diabetes, steroid use during  the treatment of such patients also  leads to increased blood sugar level  and contributes to insulin resistance,” says Dr Mahesh. 

Bangalore being the IT capital,  many people are leading a sedentary lifestyle. The number is expected to rise in the coming years. It is  important to create awareness and  it is high time to address this issue.  Dr Mahesh says that at Aster CMI  over the last 3-4 months, they have  come across 100-150 new patients  among youngsters with diabetes.  Before the pandemic, it was 50-75  during the same period.

Dr. Kavitha Bhat, senior consultant paediatric endocrinology, Aster CMR says: “Diabetes in children  is usually type 1 or insulin dependent. It is caused due to the destruction of insulin producing beta cells  of pancreas by one’s own immune  system. We have seen around 4 to 5  new cases every month in children  under 10 yrs in the past 2 months.”  Bhat says that they have been seeing more children with diabetes  during the pandemic. “It is postulated that covid infection might be  a trigger to set off an autoimmune  process in our bodies,” she says.  Dr Priya Chinnappa, consultant endocrinologist and diabetologist, Manipal Hospital, Millers Road says, “Covid has direct  and indirect effects. At the time  of Covid, few patients with preexisting undiagnosed diabetes may  have been diagnosed.

In addition, certain medications like glucocorticoids may  cause diabetes. Another mechanism is the virus itself may cause  diabetes by binding to the ACE -2  receptors in the pancreas or inducing autoimmunity.” Autoimmunity is when antibodies cause  insulin producing beta cells to fail and cause diabetes. Covid-19 itself has  led to several autoimmune conditions. Many are showing symptoms of  type 1 diabetes, similar to  Multisystem inflammatory syndrome in children (MIS-C),  “Children were forced to sit  at home for nearly 1.5 years. Are  these kids prone to Type 2 diabetes? We will only know in the  next 2- 3 years, with regular follow-ups,” says Dr Suruchi Goyal  Agarwal, consultant paediatric  endocrinology.

Lifestyle changes

Dr Rajeshwari Janakiraman,  consultant endocrinologist, Manipal Hospital, Yeshwanthpur feels  that a sedentary lifestyle of the  lockdown months has had a toll.  “Online classes or work, lack of  regular walk