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A young man in his early thirties struggles through traffic on his small Honda motorbike. As he enjoys a short break at a traffic signal, one foot on the road, his eyes are attracted to a billboard picturing a succulent burger. While he gazes, fantasizing about lunch, his vision starts to blur.
The light turns green, but the traffic remains motionless as people rush toward the Honda to pick up the young man, now fallen on his side. A bystander offers to take him to the nearest hospital, where he joins the burgeoning population of Indians who have been diagnosed with type 2 diabetes.
According to the International Diabetes Federation, 61.3 million people in India had diabetes in 2011. That figure is projected to rise to 101.2 million by 2030. IDF data reveal that India has more diabetes than the United States. In fact, India is ranked second in the world in diabetes prevalence, just behind China.
Environmental and behavioral factors (sedentary lifestyle and poor nutrition) have contributed to the worldwide epidemic of obesity and type 2 diabetes.
However, one of the major debates in diabetes etiology is the notion of “thrifty genotype” versus “thrifty phenotype”. The “thrifty genotype” concept suggests that a predisposition to type 2 diabetes may result from a genotype that promotes fat storage during famine periods—a possible evolutionary advantage. This hypothesis partly explains the high prevalence of type 2 diabetes in Pima Indians, a population genetically prone to type2 diabetes.
When this specific genotype is exposed to an obesogenic environment (a diet high in simple refined carbohydrates and saturated fat, combined with a sedentary lifestyle), obesity and type2 diabetes soon follow.
The “thrifty phenotype” hypothesis—which is based on the observation that low birth weight is an important risk factor for type 2 diabetes — suggests that type 2 diabetes is mainly caused by early environmental factors and by genetic factors to a much lesser extent. However, given the compelling evidence in support of the role of genetic factors in type 2 diabetes, it is likely that both hypotheses may modulate type 2 diabetes risk, although some believe that the “thrifty genotype” theory will prevail over the “thrifty phenotype” theory.
Overweight and obesity are critical health problems in our modern society. Both conditions significantly increase the risk of type 2 diabetes and CVD. Yet obesity does not occur in a vacuum. It is a complex disorder in which environmental and behavioural factors interact with genetic susceptibility. All these factors combined have contributed to the worldwide obesity and type 2 diabetes epidemic.
About 1 million people died from diabetes in India in 2012. More than 20% of the population in India has at least one chronic disease and more than 10% of the people have more than one. One-third of non-communicable disease deaths in India involve people less than 60 years of age.
The annual cost for India due to diabetes was about $38 billion in 2011. According to the WHO, if one adult in a low-income family has diabetes, “as much as 25% of family income may be devoted to diabetes care.”
According to the World Economic Forum, cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions will cost India 126 trillion rupees between 2012 and 2030.
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Dr. Rajiv Kovil
Consultant Diabetologist,
Dr. Kovil’s Diabetes Care Centre
Dr. Rajiv Kovil is a Consultant Diabetologist at Dr. Kovil’s Diabetes Care Centre, the first Preventive Diabetes Centre & Diabetic Foot Clinic in Mumbai, KLS Memorial Hospital and Holy Spirit Hospital among others. He is a founder member of United Diabetes Forum, a forum of practising diabetologists in India. He has also written various articles on diabetes for medical journals such as Asian Journal of Diabetology and Medical Image.
His Preventive Diabetes Centre & Diabetic Foot Clinic is an initiative to provide preventive diabetic measures as well as to function as a specialized Foot Clinic for diabetic patients not only in terms of equipment but more importantly in terms of expertise.