New Delhi: There will be a standard protocol for treatment and management of type-2 diabetes in India with the Indian Council of Medical Research (ICMR) issuing draft guidelines for this.

The guidelines, which will prove to be a rule book for physicians for diabetes, are open for public consultation.

Type-2 diabetes is a metabolic-cum-vascular syndrome characterised by predominant insulin resistance with varying degrees of insulin secretory defect. It is a progressive disease often associated with central obesity, dyslipidaemia and hypertension.

“It is more common in overweight and obese individuals of middle to late age but is increasingly being seen in younger age groups and in those with lower BMI as well. The Asian Indian phenotype, a peculiar constellation of abnormalities, predisposes South Asians to the development of insulin resistance," the guidelines note.

Screening should be performed in all individuals who are more than 30 years of age, the guidelines emphasise. Children and adolescents aged 18 years and below should be screened for diabetes if they are overweight and have risk factors such as family history in first degree relatives, signs of insulin resistance, hypertension or dyslipidaemia, the guidelines add.

Regarding calorie distribution, the council observes that as much as 55-60% of energy from complex carbohydrates is an ideal recommendation. The guidelines also highlight the various factors that impact the condition and elaborate on exercises and management by specific foods.

The International Diabetes Federation (IDF) estimates that there were 72.9 million people with diabetes in India in 2017. This is projected to rise to 134.3 million by 2045. The prevalence of diabetes has increased in urban India, especially in metropolitan cities and the rural areas are also fast catching up.

“In a recent study there were surprising findings of high prevalence of pre-diabetes and diabetes in generally non-obese populations such as rural farming communities and those with no association of diabetes and atherosclerosis with traditional risk factors. This strengthens arguments that either heavy metals or persistent organic pollutants coming through chemical fertilisers are the causes for this," said Anoop Misra, chairman, Fortis C-DOC Centre for Diabetes, and vice president of the Diabetes Foundation of India.

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