With a whopping 77 million people in India living with diabetes, a simultaneous and sharp rise has been observed in the prevalence of diabetes-related preventable vision loss, particularly among the young people, say experts.
Diabetic retinopathy is a chronic, progressive retinal disease that is a leading cause of vision impairment in today's young adults, working population. It's of major concern among children suffering from juvenile diabetes (Type-1 diabetes) and especially if they have had diabetes for over 10 years.
It is estimated that approximately 1.1-crore people are suffering from retinal disorders in India and more alarmingly, about one in every three people living with diabetes have some degree of diabetic retinopathy, a diabetes complication that affects eyes.
"With the growing incidence of diabetes, it has been estimated that diabetic retinopathy affects one in three people with diabetes and remains the leading cause of blindness in young working-aged adults," Dr Mahipal Sachdev, Medical Director and Chairman, Centre for Sight Group of Eye Hospital, told IANS.
"Approximately 7-10 per cent of young diabetics will go on to develop diabetic retinopathy, of which 2-4 per cent will have vision threatening sequelae if not taken proper treatment." added Dr. Aditya Sudhalkar, M.S. Ophthalmology, Consultant Vitreoretinal Surgeon.
The most common form of diabetic retinopathy is Diabetic Macular Edema (DME) which arises when the damaged blood vessels swell and flow into the macula of the retina causing visibility issues in the normal vision.
According to Dr. Chaitra Jayadev, senior vitreo-retinal consultant, Narayana Nethralaya Eye Institute Karnataka, studies have shown that the prevalence of DME and diabetic retinopathy is higher and more severe in young diabetics with a longer duration of diabetes.
"Diabetes in the younger is a distinct pathological entity characterised by a more aggressive presentation and manifestation. An earlier onset of diabetes leads to a longer exposure to insulin resistance and hyperglycemia. This gives rise to a greater propensity for developing long-term microvascular and macrovascular complications," Dr. Jayadev said.
Thus, screening for diabetes is of utmost importance, even if one is "young" and has no symptoms. It becomes more crucial if one has risk factors such as family history, obesity, sedentary lifestyle, or on long term steroid medications.
Dr. Sudhalkar said that in India, there is a general reluctance towards attending clinics and nearly 25 per cent of young patients with DME come late for diagnosis.
"It's important to know, only 11 per cent of diabetic retinopathy patients can actually reverse vision threatening sequelae once they set in. The rest continue to progress even with strict glycemic control," he noted.
"Retinopathy, unfortunately, is the most neglected complication of diabetes. We see so many patients come to OPD where eyes have not been checked for. So the screening, also known as Funduscopy, should be done at the time of diagnosis of Type-2 diabetes, in adults, and in children, five years after the onset of diabetes, and thereafter annually," Dr Dheeraj Kapoor, HOD, Endocrinology at Artemis, Gurugram, told IANS.
If diabetes occurs near puberty, then funduscopy should be checked for potential retinopathy.
"It is important because the condition poses no symptoms in the initial days. And once symptoms set in, such as bleeding in the eye, red vision, sudden loss of vision, it's too late," Kapoor said.
The doctors advised to adhere to the treatment and maintain a healthy lifestyle to effectively manage diabetes and to prevent the onset or progression of eye diseases.
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While Covid-19 spared none, people with diabetes were among the hardest hit. The infectious disease not only raised the risk of severe disease progression and death among diabetics, affecting even the recovery, it also contributed towards the burden of diabetes in the country.
World Diabetes Day is observed annually on November 14 to raise awareness on the high blood sugar condition and related consequences.
India, known as the diabetes capital of the world, is home to one in six diabetics in the world. The country has also suffered significantly from Covid-19.
While on an average, diabetes reduces life expectancy by 4-10 years increasing the risk of death due to other comorbidities, which include heart attacks, kidney failures and infections, Covid infection fast forwarded that among people with diabetes.
Diabetes increased inflammatory response among Covid patients, spiking their blood sugar levels. It then complicated the course of Covid, resulting in excess morbidity and mortality, as well as posing severe challenges in the recovery of patients.
"During Covid patients were succumbing to it, not because of the original disease, but because despite all other efforts their glucose levels remained high. Thus recognising glucose as a vital sign very similar to blood pressure and pulse rate, respiratory rate, became more necessary during the pandemic," Jothydev Kesavadev from Jothydev's Diabetes Research Centres, Kerala, told IANS.
"Studies from all over the world show that the majority of the deaths from Covid were linked to high glucose values, and this includes both patients with no diabetes and with the new onset of high glucose," he added.
Further, the use of steroids, to control the serious manifestations of Covid-19, worsened the glucose levels in the patients.
High blood sugar levels, coupled with increased use of steroids, also led to other complications such as an unprecedented surge in cases of mucormycosis, commonly known as black fungus. It is a fungal infection, which occurs by inhalation of spores and can disseminate to various organs rapidly.
According to a recent study, published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews, more than 86 per cent of mucormycosis or black fungus cases related to Covid in India, had uncontrolled glucose values.
"While the Covid cases are closely related to diabetes, mucormycosis is also very closely related to diabetes in Covid. Whenever the glucose is high, there is a deranged immune mechanism and in the presence of an infection it is persuaded rapidly," Kesavadev said.
Another study, published in the same journal showed that people with Type-2 diabetes who also suffered Covid-19 were more likely to experience severe fatigue than those who did not have the infectious disease, emerging as a major roadblock in the recovery of patients infected with SARS-CoV-2.
Moreover, among diabetes patients, those with increased fatigue level post Covid-19 also had increased postprandial blood glucose levels.
Covid also contributed to new onset of diabetes in many people, particularly the young. On one hand, Covid-induced lockdowns increased diabetes cases as people spent more time indoors, while eating more and exercising less.
On the other hand, Covid also contributed to nearly 25 per cent rise in diabetic patients in the country, according to an analysis of OPD data from a private hospital in Delhi.
Doctors found that among patients with confirmed Covid-19 infections, there was nearly 25 per cent of new onset of diabetic patients. Stress induced hyperglycemia -- high blood sugar -- was seen in 10 per cent of patients who had Covid-19 infection.
"The younger population is increasingly affected. We have seen that happening during Covid-19 epidemic. Increasing number of young people with more severe diabetes are now being seen," Dr Anoop Misra, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, told IANS.
As per a recent study, among the younger generation in India, below the age of 30 years, there is a rapid increase in the occurrence of diabetes over the last 10 years.
"For these, diabetes as a disease will result in complications after 10 to 15 years. Imagine a situation where more and more people are developing diabetes at the age of 25 years or 30 years, which means even during the productive age group, by the time they are 35 years or 40 years, they will start developing complications. if the disease is not treated properly," Kesavadev said.
"There is an urgent need to decrease the screening age of diabetes to 25 years, from the current 30 years, in India," Dr Misra said, adding that "there is increasing urgency to ensure that young people follow correct lifestyle practices including more exercise, correct food choices, and maintenance of weight to normal, or even leaner category".
While diabetes cannot be treated it can be controlled and reversed by adopting a healthy lifestyle, diet and having proper sleep, as well as exercising for at least half an hour every day, suggested the experts. (Rachel V Thomas)
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Chronic inflammation caused by obesity may trigger the development of cells that break down bone tissue, including the bone that holds teeth in place, finds a new research.
The study, completed in an animal model, found that excessive inflammation resulting from obesity raises the number of myeloid-derived suppressor cells (MDSC), a group of immune cells that increase during illness to regulate immune function.
MDSCs, which originate in the bone marrow, develop into a range of different cell types, including osteoclasts (a cell that breaks down bone tissue).
"This research promotes the concept that MDSC expansion during obesity to become osteoclasts during periodontitis is tied to increased alveolar bone destruction," said researcher K.H. Kwack from the University at Buffalo.
"Taken together, this data supports the view that obesity raises the risk of periodontal bone loss," Kwack added.
Bone loss is a major symptom of gum disease and may ultimately lead to tooth loss.
Also known as periodontal disease, gum disease affects more than 47 per cent of adults 30 years and older, according to the Centers for Disease Control and Prevention.
For the study, published in the Journal of Dental Research, the team examined two groups of mice fed vastly different diets over 16 weeks -- one group, a low-fat diet that derived 10 per cent of energy from fat, the other group a high-fat diet that drew 45 per cent of energy from fat.
The investigation found that the high-fat diet group experienced obesity, more inflammation and a greater increase of MDSCs in the bone marrow and spleen compared to the low-fat diet group.
The high-fat diet group also developed a significantly larger number of osteoclasts and lost more alveolar bone (the bone that holds teeth in place).
Also, the expression of 27 genes tied to osteoclast formation were significantly elevated in the group fed a high-fat diet.
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The Associated Chambers of Commerce and Industry of India (ASSOCHAM), the apex trade association of the country, as part of its 'Illness to Wellness' campaign and in the light of the forthcoming 'World Diabetes Day' on Saturday unveiled a report on the findings of a National Level Survey conducted on the state of Diabetes in India.
The release was followed by a webinar on "Diabetes Free India" organized with the objective of cascading awareness and disseminating wisdom on diabetes management and its prevention, which was attended by a panel of eminent experts and doctors from across the country.
The survey report entitled "Diabetes in India" was produced by ASSOCHAM and the Delhi-based think tank, Thought Arbitrage Research Institute (TARI). The survey was designed and conducted by IMRB-Kantar and covered 2,33,672 people and 673 public health offices in 21 state clusters covering appropriate regions and age segments.
The key findings of the survey relate to the burden of diabetes and its primary causes or risk factors which lead to its rise and increasing spread in the country. According to the report, the prevalence of diabetes cases in India almost doubled from 42.6 million cases in 2005 to 85.4 cases in 2019.
Globally, on the other hand, the prevalence of diabetes increased from 273.4 cases in 2005 to 460 million cases in 2019. Small wonder then that India has the dubious distinction of becoming the global hub for diabetes cases with prevalence of cases increasing from 15.6 per cent to 18.6 per cent cases in the same interval.
Globally, diabetes accounts for 70.9 million DALYs (Disability-Adjusted Life Years) and 36.7 YLDs (Years Lived with Disability) in 2019. In India, diabetes accounts for 12.8 million DALYs, 6.7 million YLDs and 0.3 million deaths during the same time-period.
In terms of risk factors for diabetes, dietary habits related to high intake of junk / fried foods, most common in younger people today, has highest relative risk of 47 per cent. The next highest risk factors as elicited by the survey report relate to low physical activity (38 per cent), low intake of fruits and vegetables (28 per cent), and other causes such as stress, pollution, and high consumption of alcohol and carbonated/ sugary drinks.
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Over the time, uncontrolled diabetes leads to serious body's systems damage, especially the nerves and blood vessels. There are ample studies conducted by RSSDI (Research Society for the Study of Diabetes in India) which emphatically depict and highlights that diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation.
The survey outlines the prevalence landscape of diabetes in that it accounts for 25 per cent of all NCDs in India at a rate of 2.9 percent. The disease incidence increases significantly in individuals above 35 years of age and affects men more than women.
The report also finds that about 16.8 per cent of the male adult population (15 years) and 14.6 per cent of the female adult population (15 years) on average are estimated to be diabetic. Prevalence of diabetes is highest in southern states including Puducherry, Kerala, Tamil Nadu, Andhra Pradesh and Telangana and lowest in Uttar Pradesh and Rajasthan.
In terms of sufferers seeking treatment for diabetes, the survey presented some important insights in this regard too. About 7 per cent of the respondents who were suffering from diabetes stated that they were not seeking any treatment at all. However, more than 56 per cent of the respondents stated that they are seeking treatment for more than one year, a fact testifying to the indisputable and inevitable morbidity of this disease.
Diabetes is proven through studies to be associated with a high risk of cardiac arrest and there have been substantial increases in new cases of diabetes during the Covid-19 pandemic due to various reasons. In the current situation, diabetes has become a serious health concern since large numbers of patients are already vulnerable to the coronavirus.
Thus, diabetic patients affected by Covid-19 can cause a major health crisis. Reports show that large occurrence of diabetes makes it a serious comorbidity in Covid-19 patients. Diabetes also imposes a substantial burden on society in the form of higher medical costs, lost productivity, premature mortality, and intangible costs in the form of reduced quality of life.
Setting the tone for the panel discussion at the webinar, Anil Rajput, Chairperson, ASSOCHAM CSR Council, said: "This year marks the 100th anniversary of the discovery of insulin. It is, however, unfortunate that diabetes has been underrated as a global public health issue. This needs to be addressed on priority and we as a nation need to take urgent important steps to address this challenge. It is a fact that diabetes is one of the top three NCDs in India and with each year the burden of this disease is rising."
Dr. Banshi Saboo, President, Research Society for Study of Diabetes in India (RSSDI), said: "Diabetes prevention must be part of a larger national mission. Students should be taught 'Health Science' as a subject in schools which can help in preventing this disease and creating awareness about healthy lifestyles among our future generations. We must also change the age limit for the cyclical three-year testing protocol for sugar from 30 years presently to 25 years of age."
Dr. (Col.) Sudhir Tripathi, Chairperson and HOD, Endocrinology and Metabolism, Sir Ganga Ram Hospital New Delhi, said: "Diabetes can be prevented even at the pregnancy stage. Healthy mothers give birth to healthy children. We must also educate and inform people that this disease is reversible with healthy lifestyle and timely interventions.
Babies who are healthier, not obese, have a far lesser risk of developing diabetes in adulthood. It is advised that we must now have a National Diabetes Month in November to spread awareness and access about diabetes amongst people."
Dr. Dinesh Agarwal, Senior Consultant Internist and Head of Department, Department of Medicine Marwari Hospitals, Vice Chairman, RSSDI Assam Chapter, said: "One of the key risk factors and causes of diabetes is stress and junk food. Even children undergo a huge amount of stress these days due to a highly competitive and strained environment.
It is a fact that stress leads to hormonal changes which in turn can trigger diabetes in individuals. Add to this the fact that lack of exercise among both children and adults lead to an onset of the disease which could have easily avoided by following simple steps."
Dr. Rajesh Kesari, Founder and Director, Total Care Control, Delhi-NCR, said: "Diabetes free India is a dream for all of us. Diabetes, a chronic disease, has so many affected all of us either as families or as individuals. It is important to control this disease because not only does it cause many other diseases or co-morbidities and complications to take place, but also leads to a huge economic burden. The interesting aspect here is that 95 per cent of diabetes can be prevented, and it is important that we all work towards this."
The webinar was addressed by Shri Anil Rajput, Chairperson, ASSOCHAM CSR Council; Dr. Kaushik Dutta, Founder and Co-Director, Thought Arbitrage Research Institute (TARI), New Delhi and eminent doctors which included - Dr. Banshi Saboo, President, Research Society for Study of Diabetes in India (RSSDI), Dr. (Col.) Sudhir Tripathi, Chairperson and HOD, Endocrinology and Metabolism, Sir Ganga Ram Hospital New Delhi, Dr. Dinesh Agarwal, Senior Consultant Internist and Head of Department, Department of Medicine Marwari Hospitals, Vice Chairman, RSSDI Assam Chapter, and Dr. Rajesh Kesari, Founder and Director, Total Care Control, Delhi-NCR.
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Indians eat more fibre-rich plant based diet than people in the Western countries, reducing their risk of gut-related problems such as inflammatory bowel diseases like crohn's disease, Irritable Bowel Syndrome (IBS), colitis, and colon cancer, according to a research on Tuesday.
The international study, including researchers from the Indian Institute of Science Education and Research (IISER)- Bhopal, sought to understand the relationship between gut bacteria and inflammatory diseases.
"Increased intake of carbohydrate in the form of fibre such as wheat, vegetables, fruits and lentils, mostly found in Indian diet lowers the incidence of IBD, crohn's disease, colitis, colectral cancer, etc., than western diets that are generally meat-based," lead author Dr Vineet K. Sharma, Associate Professor, Department of Biological Sciences, IISER Bhopal, told IANS.
The human gut contains 300-500 types of bacteria that are necessary for our survival. These bacteria help in digestion, protect us from infections and even produce essential vitamins and neurochemicals.
Depending on the kind of bacteria that dominates the gut, human beings are generally classified into three "enterotypes" -- Prevotella, Bacteroides or Ruminococcus.
The study included 586 healthy samples from western and non-western populations including 200 samples from India, and 189 IBS samples from western populations.
The 200 gut samples from India were taken from people from several locations in -- Madhya Pradesh, Delhi-NCR, Rajasthan and Maharashtra, Bihar, and Kerala. It is also the largest gut metagenome study from India, as most such studies are largely based on the Western population.
The findings, published in the Nature's Biofilms and Microbiomes journal, showed that the Indian gut microbiome has the highest abundance of the Prevotella genus of bacteria, in particular, a species called Prevotella copri (P.copri).
This bacterium was also found to dominate the guts of other populations that consume a carbohydrate and fibre-rich diet, such as the Italian, Madagascarian, Peruvian, and Tanzanian. But, the gut microbiomes of people from Western countries like the US are dominated by Bacteroides.
Further, they found that P. copri is significant in the metabolism of complex polysaccharides and dietary fibres in non-western populations.
It is thus logical that this type of bacteria predominates the gut microbiome of the healthy Indian and non-western population that consumes a diet rich in plant-carbohydrates and fibres, Sharma explained.
"The proportion of P.copri in Indians is 30 per cent and can reach upto 60-70 per cent. Of the more than 1200 species of Prevotella, P.copri is the most abundant in Indian human gut," Sharma told IANS.
On the other hand, the guts of Western population were found to have other Prevotella species such as P. intermedia and P. nigrescens. These bacteria are usually found in the mouth, which points to a mouth-gut axis. These bacterial species are inflammatory and have high virulence and antibiotic resistance genes, making the Western population more susceptible to gut inflammatory diseases.
"Our insights would help in the development of new probiotics and prebiotics for different health-related conditions associated with the gut which is much needed for non-western populations," Sharma said.
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US researchers have discovered a gene that may help explain why some people who lead enriching lives are less prone to Alzheimer's and age-related dementia.
Many people develop Alzheimer's or other forms of dementia as they get older. However, others remain sharp well into old age, even if their brains show underlying signs of neurodegeneration. Among these cognitively resilient people, researchers have identified education level and amount of time spent on intellectually stimulating activities as factors that help prevent dementia.
The study, led by researchers at Massachusetts Institute of Technology, showed that this kind of enrichment appears to activate a gene family called MEF2, which controls a genetic programme in the brain that promotes resistance to cognitive decline.
The researchers observed this link between MEF2 and cognitive resilience in both humans and mice. The findings suggest that enhancing the activity of MEF2 or its targets might protect against age-related dementia.
"It's increasingly understood that there are resilience factors that can protect the function of the brain," said Li-Huei Tsai, Director of MIT's Picower Institute for Learning and Memory.
"Understanding this resilience mechanism could be helpful when we think about therapeutic interventions or prevention of cognitive decline and neurodegeneration-associated dementia," Tsai added. The study appears in the journal Science Translational Medicine.
The MIT team set out to try to figure how the environmental factors, such as education level, type of job, number of languages spoken, affect the brain at the neuronal level. They looked at human datasets and mouse models in parallel, and both tracks converged on MEF2 as a critical player.
In two human datasets comprising slightly more than 1,000 people all together, the MIT team found that cognitive resilience was highly correlated with expression of MEF2 and many of the genes that it regulates.
To study cognitive resilience in mice, the researchers compared mice who were raised in cages with no toys, and mice placed in a more stimulating environment with a running wheel and toys that were swapped out every few days.
As they found in the human study, MEF2 was more active in the brains of the mice exposed to the enriched environment. These mice also performed better in learning and memory tasks.
The findings suggest that enhancing MEF2 activity could help to protect against dementia, but, because MEF2 also affects other types of cells and cellular processes, more study is needed to make sure that activating it wouldn't have adverse side effects, the researchers said. (Agency)
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