Opinion

Diabetes assumes threatening proportions

Prathap C Reddy | Updated on November 12, 2021

Testing times   -  Velankanni Raj B

Diabetes has heightened risks for Covid patients, while also afflicting those recovering from Covid. It needs close monitoring

The numbers rang a warning bell even before Covid struck. The statistics of the past decade pertaining to diabetes do not augur well for the future. According to the latest statistics available in the IDF Diabetes Atlas, the proportion of people with Type 2 diabetes is increasing in most countries. Of the over 537 million diabetics between the ages of 20 and 70 years worldwide, approximately 81 per cent are from low and middle-income countries.

The diabetic population is expected to rise to 643 million by the end of the present decade and to 784 million by 2045. Diabetes has been an increasing contributor to mortality from NCDs with a 5 per cent increase in premature mortality due to diabetes between 2000 and 2016. There have been 6.7 million deaths from diabetes in 2021.

India is at a high risk. Diabetes ranks third among the NCDs contributing to overall mortality in India. A study by the Ministry of Health and Family Welfare published earlier this year showed 11.5 per cent of Indians above the age of 45 had diabetes. With an urban skew, 26.1 per cent of those aged 60 years or more and living in urban areas were suffering from diabetes.

Risks and consequences

Factors that increase the risk of developing diabetes include those that are non-modifiable such as genetic predisposition, family history of diabetes, and age. But there are modifiable factors that can be addressed through behaviour change and these include lifestyle factors such as unhealthy diet, physical inactivity and being overweight and obese.

The consequences of diabetes if not diagnosed early and managed with medication and lifestyle modification include the risk of premature death. But apart from this, the complications also include stroke, heart attack, kidney failure, blindness and amputation of a limb or limbs.

Diabetes and Covid

The Covid pandemic brought an entirely new challenge to the diabetic community. Early studies found increased severity of Covid-19 in patients with diabetes mellitus, with worsening of prognosis.

People with diabetes are also more likely to have serious complications from Covid-19. However, this risk may be lower if the diabetes is well managed.

Hence it is crucial that there should be strict control of blood glucose levels to keep susceptibility low and prevent severe Covid-19.

The infection also resulted in predisposing individuals to hyperglycaemia and this was an important risk factor for death in Covid-19 as shown by the Coronado study in France.

While the impact of acute hyperglycemia due to stress in critically ill patients is known, it has been reported that acute hyperglycemia occurs in about half the patients hospitalised for Covid-19.

This throws up new challenges in treating Covid patients who are diabetics even if their blood sugar is well controlled. The use of steroids for Covid treatment is another factor that increases blood sugar levels by various mechanisms including increasing insulin resistance and reducing action of beta cells.

This could result in their blood sugar levels not going back to pre-Covid levels and requiring either tweaking the medication dosage of oral antidiabetics or in some cases also going the medication ladder requiring initiation of insulin.

Prediabetes and Covid

In November 2020, a study published in the journal ‘Diabetes, Obesity and Metabolism’ found around 14.4 per cent of people who were hospitalised with severe Covid-19 also developed diabetes. While there is no evidence as yet that Covid-19 leads to the onset of diabetes, prediabetics or susceptible individuals without previous history of diabetes, may get diagnosed with new onset diabetes based on certain blood glucose parameters.

After all, a majority of the people with prediabetes don’t know that they have prediabetes, even though they are at the highest risk of progression to being diagnosed with Type 2 diabetes.

Focus on winning both wars

This World Diabetes Day (November 14), we need to focus on controlling hyperglycemia. Uncontrolled diabetes is a silent killer that needs proper timely management for optimal outcomes in both the short and long term.

While we are winning the battle against the Covid pandemic through vaccination and precautions, let us also continue with the war on the diabetes pandemic through regular testing, lifestyle changes, and medical management. We need to win both for a healthy India!

The writer is Chairman, Apollo Hospitals Group

Published on November 12, 2021

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