Prevent India from becoming the Diabetes Capital of the World

Are there other ways of tackling the problem? 

Life style modification and drug intervention in people with impaired glucose tolerance are Post primary prevention strategies which delay the development of Type 2 Diabetes mellitus. 

We need to concentrate on Primary prevention which is more important to reverse or halt the disease. 

One area of focus can be women with Gestational Diabetes Mellitus (GDM) who are an ideal group for primary prevention as they as well as their children are at increased risk of future Type 2 Diabetes Mellitus. 

Studies indicate that women with GDM have an increased lifetime risk of developing diabetes 16 years after the first pregnancy when compared with controls. One third of children born to mothers with GDM get evidence of IGT or T2DM. 

Pregnant women with glucose intolerance, due to decreased insulin secretion or action, have excess of glucose amino acids and lipids. When these elements cross the placenta, the foetus responds by secreting large quantities of insulin. This eventually causes decrease in foetal pancreatic reserve and results in risk for developing diabetes later.

So, screening for GDM is essential. 

Are we screening pregnant women at the right time?

Screening for glucose intolerance  is usually between 24 -28 weeks but foetal islets of Langerhans differentiate during 10th -  11th  weeks and begin to release insulin in response to nutrients as early as 11th  – 15th  weeks of gestation .

So undetected glucose intolerance in the early weeks of gestation influence foetal growth resulting in large babies for GDM mothers despite good glucose control in the third trimester.

Another area to focus on is the occurrence of T2DM within families. 

Is the familial nature of T2DM only due to genetic factors?

The genetic factor may be due to the major role played by maternal mitochondrial DNA in the transmission of the disease. A study revealed that children exposed to maternal diabetes before birth are at higher risk of obesity and diabetes than their unexposed siblings. This suggests that the increased risk is not only due to genetic causes.

Therefore, it is essential to focus on intrauterine environment, especially in our country. In India, both under -nutrition and over- nutrition exist during pregnancy. Both, nutritional deprivation or nutritional plenty can result in changes in pancreatic development and response to insulin that may lead to adult onset GDM or T2DM. So, both small – for date infants and large for date infants are at risk for future diabetes.

The aim should be to help pregnant women to have infants born with weight that is appropriate for gestational age by both sufficient and fitting nutrition and good blood glucose control.  (Fasting - < 90 mg/dl and peak < 120 mg/dl.)

(Ref: Transgenerational Transmission of Diabetes – Sesiah.V, Balaji.V, Balaji, Madhuri.S, Das, Ashok.K)