Context: The pancreas’ failure to secrete adequate insulin appears to have been the trigger for type 2 diabetes in over half of the Indian patients (especially those diagnosed before the age of 45) in an Indo-Swedish study. This is in contrast to Western countries, where type 2 diabetes is mostly caused by insulin resistance, said the study, which was published in The Lancet Regional Health-Southeast Asia.
Diabetes:
A metabolic disorder in which the body has high sugar levels for prolonged periods of time.
Types of Diabetes
Researchers at Lund University, Malmo, Sweden had in 2018 shown that diabetes can be divided into five subgroups, including:
1. SAID (Severe Auto-Immune Diabetes),
2. SIDD (Severe Insulin-Deficient Diabetes),
3. SIRD (Severe Insulin-Resistant Diabetes),
4. MOD (Mild Obesity-Related Diabetes) and
5. MARD (Mild Age-Related Diabetes).
SAID is also known as type 1 diabetes, the remaining four subgroups belong to type 2 diabetes.
Cause of type 2 diabetes
- The exact cause of this condition is not known.
- Type 1 Diabetes is a result of the autoimmune destruction of pancreatic islet cells that produce insulin.
- Genetics also plays a role in type 1 diabetes.
- Pancreatic diseases can also be the cause of type 1 diabetes
Cause of type 2 diabetes
- Insulin resistance occurs when the body is unable to use insulin the proper way. On the other hand, as type 2 diabetes worsens, the capacity of the pancreas to produce insulin keeps dropping, resulting in a deficiency.
- A normal person secretes enough insulin to achieve the desired effect on the tissues. But when the tissues cannot respond to the usual amounts of insulin, the pancreas has to secrete more. When this happens over a longer period of time, the pancreas gets fatigued and diabetes develops.”
- The other situation is where the tissues are responding reasonably well but the pancreas is not able to secrete insulin either because of genetic defects or its poor development in the womb or factors in the environment which may affect and damage the pancreatic beta cells. This is primarily an affection of the pancreas.
- Type 2 diabetes is usually linked to obesity. though Indians have a lower BMI compared to Europeans, they have a higher body fat percentage and this develops when they are growing in the mother’s womb. Multigenerational undernutrition of young Indian mothers seems to have contributed to this,
- Pune studies have tracked the development of diabetes and shown that poor growth of babies (lower birth weight or length) predisposes them to develop diabetes in later life. The risk is the highest in those who were born small but grew big in later life. If the system has low capacity, it cannot tolerate a load of excess calories in later life.
- In addition, vitamin B12 deficiency-related genes were associated with the MOD subgroup only in Indians, not in European patients with diabetes.
Consequences of Diabetes
- A number of studies in India and abroad have shown that increased liver fat is a characteristic feature of Indian type 2 diabetes patients.
- Diabetes can be effectively managed when diagnosed early. However, when left untreated, it can lead to potential complications that include: heart disease stroke kidney damage nerve damage etc. as shown in the image below:
Way forward
- It is well known that every patient with type 2 diabetes can behave differently.
- This genetic classification is a new step in identifying the underlying Pathophysiology in a particular patient and thus individualisation of treatment.
- Various subgroups of patients might have distinctive responses to various diabetes medications and hence this classification has implications as far as treatment and selecting an appropriate glucose-lowering agent is concerned.
- Classifying every patient and starting appropriate treatment will help better glycaemic control and decrease diabetes-related complications in the Indian population.
- Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt.
- Eat foods with more fibre, such as whole grain cereals, bread, crackers, rice, or pasta.
- Choose foods such as fruits, vegetables, whole grains, bread and cereals, and low-fat or skim milk and cheese.
- Drink water instead of juice and regular soda.
- Be active as much as you can.
- Be updated in terms of blood pressure, and foot check. Weight check etc.
