Features

doi:10.1038/nindia.2013.153 Published online 20 November 2013

Diabetes prevention is in your mom's hands

It was World Diabetes Day on November 14. As India continues to house close to 17 per cent of the world's diabetic population, Muthuswamy Balasubramanyam argues that the 'early prevention' message should now be taken more seriously to nip an impending epidemic in the bud.

Muthuswamy Balasubramanyam

World Diabetes Day is aimed at raising diabetes awareness and calling for urgent action to tackle the diabetes epidemic. It marks the birthday of Frederick Banting, who, along with Charles Best, is credited with the discovery of insulin.

World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns on the escalating health threat of diabetes. It became an official United Nations Day in 2007 recognising diabetes as "a chronic, debilitating and costly disease associated with major complications that pose severe risks for families, countries and the entire world."

According to the 2012 International Diabetes Federation Atlas, the number of people living with diabetes worldwide has risen to 371 million. Sadly, India alone harbors 63 million of these diabetics and is seeing a continuous escalation in numbers.

The World Diabetes Day theme for 2009-2013 has been 'education and prevention'. The campaign calls on all those responsible for diabetes care to understand diabetes and take control.

For people with diabetes, this is a message about empowerment through education. For governments, it is a call to implement effective strategies and policies for the prevention and management of diabetes to safeguard the health of their citizens with and at risk of diabetes. For healthcare professionals, it is a call to improve knowledge so that evidence-based recommendations are put into practice. For the general public, it is a call to understand the serious impact of diabetes and know how to avoid or delay diabetes and its complications.

Mom's the word

Research studies clearly point out that the risk for diabetes is programmed in the mother's womb itself .

One big way to prevent diabetes is to take care of women during their pregnancy. Transient diabetes occurs in certain women during pregnancy. This is called gestational diabetes mellitus (GDM). The prevalence of GDM is increasing worldwide especially in developing countries. In India the prevalence of GDM is as high as 20%. It is crucial to detect women with GDM as the condition is associated with a diverse range of adverse maternal and neonatal outcomes. The health burden is not only to the mother but also to the offspring at a later stage of the life. In addition, having a history of GDM puts the mother at risk for development of Type 2 diabetes mellitus or recurrent GDM.

Taking care of the mother during the pregnancy, therefore, and following post natal periods with appropriate medical care would prevent diabetes in the mother and also diabetes development in the offspring at a later stage. Moreover, by careful food habits and parental care, a mother can prevent her daughter or son from becoming obese and thereby prevent diabetes.

Diabetes control needs a seventh sense

This seventh sense is 'structured diabetes education' and the 'know-how' of diabetes prevention. Accumulating research shows that there are a number of factors that contribute to a person's overall likelihood of developing type 2 Diabetes which include overweight/obesity, high blood glucose, hypertension, abnormal lipid metabolism, inflammation and hypercoagulation, physical inactivity, alcohol intake and smoking.

The good news is all these risk factors are modifiable with appropriate education and health counseling.

What about genetics? Is it a non-modifiable risk factor? If an individual's immediate and/or extended family had diabetes, that person's chances of developing diabetes, increases as well. The good news is that even the genetic risk of diabetes can be modified beneficially by appropriate lifestyle modifications.

Aging is a major risk factor for several diseases including type 2 diabetes. But, diabetes can be considered as an accelerated form of aging. Studies reveal that 'telomeres' (the ends of chromosome) shorten in a much more accelerated way in patients with type 2 diabetes . As one gets old, telomeres are shortened and this is a universal process and reflective of 'chronological ageing'. But what is seen in diabetes is a form of 'accelerated ageing' or 'biological ageing' in cells, tissues and organs.

Again, the good news is that biological ageing is reversible and therefore, provides room for preventive strategies and therapeutic intervention.


References

  1. Ruchat, S. M. et al. Gestational diabetes mellitus epigenetically affects genes predominantly involved in metabolic diseases. Epigenetics 8, 935-943 (2013)
  2. Balasubramanyam, M. et al. Telomere shortening and metabolic/vascular diseases. Ind. J. Med. Res. 125, 441-450 (2007)