Children’s Day: Kids Showing Early Signals of Diabetes in India

By tracking more than 700 families from Pune for three decades under a study, it was found that many individuals have a tendency towards high glucose in their early childhood. These families are now moving into their 3^rd generation and the authors of the study have now called for a diabetes prevention strategy from early childhood, coming close to the recommendations by experts to lower the screening age for diabetes from 30 to 25 years.

How the tracking was done?

The scientists at the Diabetes Unit of KEM Hospital, Pune have been carrying out research for 35 years to understand the commonality of diabetes in Indians. In 1993, the scientists began with the Pune Maternal Nutrition Study (PMNS) across 6 villages near Pune and followed more than 700 families ever since. They tracked women from before they became pregnant and during their pregnancy and their children through childhood, puberty, and now as adults. Dr. C S Yagnik, Director of the Diabetes Unit at KEM Hospital, and co-authors have published a study called – ‘Poor In Utero Growth, Reduced b-Cell Compensation and High Fasting Glucose from Childhood are Harbingers of Glucose Intolerance in Young Indians’ in a journal of the American Diabetes Association – ‘Diabetes Care’.

What did they find?

Glucose, insulin concentrations, and other vital data at the ages of 6, 12 & 18 were measured by the researchers. About 37% of men and 18% of women, at the age of 18 years, had elevated levels of glucose (pre-diabetes), among them half of the participants were underweight (having body mass index less than 18.5 kg/sq.m.)lects

Children with sub-optimal development in the womb have a significant risk of diabetes and high circulating glucose levels from the time they are born. Even when assessed at the ages of 6 and 12, this high glucose inclination was evident. Finally, the researchers concluded that this was caused by a malfunctioning pancreas that couldn't keep up with the demands of growing older and that this most likely reflects poor pancreatic growth throughout fetal life as part of overall growth failure. Even a small rise in maternal glucose during pregnancy affects the baby's pancreas.

Diabetes in India

According to the World Health Organization (WHO), India has an estimated 8.7% diabetic population between the ages of 20 and 70, with 77 million diabetics. Diabetes is impacting children and adolescents in a large manner, according to the first national nutrition study (2016–2018) conducted by the Union Ministry of Health and Family Welfare, UNICEF, and the Population Council among children and adolescents. The survey, released in 2019, said that almost 1 in 10 children between ages 5-9 were pre-diabetic and 1% was already diabetic. A combination of factors like – rapid urbanization, sedentary lifestyle, unhealthy diet, tobacco use, and increasing life expectancy are driving the rising prevalence of diabetes.

What is the current screening strategy?

The present recommendation by the government to screen for diabetes is the age of 30. Dr. Yagnik said – “Diabetes prevention trials still mainly target middle-aged individuals who already have obesity and advanced metabolic abnormalities”, and further added – “an integrated life course approach is required and prevention has to start at the community level and not just in the clinic. What we need are public health experts, not just doctors, to tide over this problem. Constructing such evidence is beyond the scope of clinicians and will take a long time. We need to act sooner than later.”

The Chairman of the International Diabetes Federation, South East Asia Dr. Shashank Joshi said – “This is predominantly in the research domain. We do not have sufficient data to translate in the public health domain, especially in a resource-limited country like India. We need robust translational research that is reproducible, affordable, and has hard evidence from a public health standpoint.”

A trend of the increasing prevalence of diabetes in the younger age groups in the last decade is shown in a new report published in the journal – ‘Diabetes and Metabolic Syndrome – Clinical Research and Reviews’. After analyzing data from various diabetes centers, researchers found that 77.6% of those below 30 were either overweight or obese. “The government should lower the age of screening” – said Dr. Anoop Mishra, the report’s lead author.

“This is a country-wide study and several others have recommended screening above 25years in resource-limited countries including India. The focus is also on women and child health. Maternal nutrition during pregnancy should be focused upon as a preventive measure” – said Dr. Joshi.

Note - The motive to publish this news is to create an awareness among the farming/rural community so that they know about diabetes.