India has more than 69 million people with type 2 diabetes, and the number is expected to rise to 140 million by 2040. This could be due to the presence of high body fat, abdominal fat, liver and pancreatic fat and lower lean mass, says a paper published by Indian researchers in the Current Diabetes Reviews journal in July. The paper also points out that the progression from pre-diabetes to diabetes occurs more rapidly in Indians than in Caucasians. What’s more, the reversion to normal glucose regulation with appropriate lifestyle measures is more difficult in people in the subcontinent.
“This study clearly shows why it is very important to focus on the prevention of diabetes,” says Anoop Misra, chairman of the Fortis Centre for Diabetes, Obesity and Cholesterol (C-DOC) in New Delhi.
Exercise can keep this lifestyle-related menace at bay. This was proven by British researchers who analysed the findings of 23 studies. Their report, published in the journal Diabetologia last month, says that those who exercise at least 150 minutes a week (or 30 minutes a day) had a 26% lower risk of developing type 2 diabetes. The results also suggest that exercising more than the recommended 150 minutes had even greater benefits, cutting the risk of diabetes by more than half.
Another study, published in the same journal, shows that the timing of the exercise is important—a 10-minute walk after eating helps brings post-meal blood sugar levels down by 22%, and is more effective than walking at other times of the day.
A study done in Chennai and published in 2015 in the Diabetes Research And Clinical Practice journal has found that 80% of the risk can be explained by five modifiable factors. “These are obesity, physical inactivity, unfavourable diet risk score (eating wrong), hypertriglyceridemia and low HDL (good) cholesterol,” says Sudha Vasudevan, senior scientist and head of foods, nutrition and dietetics research at the Madras Diabetes Research Foundation, Chennai, who was part of the study team. “Modifying these risk factors could, therefore, help prevent the majority of cases of incident diabetes in the Indian population,” she says.
The study found abdominal obesity to be the biggest contributor to diabetes—this, again, can be controlled easily.
Skinny? don’t be complacent
The relationship between body weight and diabetes is complex. While the obese are at a higher risk, the fact is that even lean people get diabetes; so you can’t sit easy just because you are thin. “In fact, there is a body type which is called the thin fat Indian, where a person many be thin overall, but has abdominal obesity and an increased waist size. This excess fat around the waist predisposes one to type 2 diabetes,” says Shaival Chandalia, consultant endocrinologist and diabetologist at Jaslok Hospital, Mumbai. “There are lots of diabetics who are undiagnosed, and it’s possible that many of these people have a lean frame,” he warns. “The reason could be genetics, fatty liver, or even excess stress. That is why it’s just as important for lean people to maintain healthy blood sugar as it is for the overweight and obese.”
The stress factor
Prolonged stress leads to disturbance in the secretion of hormones like adrenalin, noradrenalin and cortisol, which raises blood sugar levels. “And if this stress is consistently high, the on and off sugar elevation can become persistently high, resulting in diabetes,” explains Dr Misra. “It can also result in increased and/or ‘binge eating’, which leads to weight gain, and that leads to elevation of blood sugar,” he adds. A recent study published in the Psychoneuroendocrinology journal also details the positive link between emotional stress and diabetes.
Be wary of fatty liver
“It is an established fact that diabetes is associated with an increased risk of fatty liver but it works the other way round too; fatty liver is not just a result, but also a cause, of insulin resistance and type 2 diabetes. It can thus increase the risk of developing diabetes,” says Dr Chandalia. “Actually, deposition of fat in the liver tends to destabilize several metabolic pathways, which leads to diabetes,” adds Dr Misra.
In fact, a study published in The Journal Of Clinical Endocrinology & Metabolism in 2011 showed that the risk of developing type 2 diabetes was higher among those with fatty liver.
Increase the protein
The role of eating the right carbohydrates (whole grains) to keep diabetes at bay is well known. Now, the role of protein is becoming clearer too. “Protein helps boost insulin secretion, but it is the quality of protein that is important as many protein-rich foods are also high in fats like meat, chicken, etc. So vegetable protein foods like pulses and legumes, which are also rich sources of fibre, are a better bet to aid in blood glucose control,” says Vasudevan. “Similarly, protein-rich dairy foods have been shown to have an inverse association with diabetes risk from both national and international studies,” she adds.