Dr. Nikhil Tandon, Professor and Head of Endocrinology Department, AIIMS, New Delhi, talks about the dreaded disease of diabetes.
Q: What is the impact Of Covid-19 on diabetic patients?
A: It is difficult to show the impact of Covid-19 in a short time. The concern over diabetes and Covid was due to multiple factors:-
1-The infection affects someone who has a tendency to get diabetes but does not have diabetes yet. Sugar may rise then become diabetes, which is well known.
2-Someone might feel a certain indication of diabetes in Covid-19. When people are given steroids, they can actually see a spike in sugar and feel the effects of diabetes.
3-People, who had diabetes in the past but never actually tested for diabetes, came to medical attention because of Covid-19. When their tests were done, they were found to have diabetes.
4-Whether Covid-19 itself could cause the diabetes is being ascertained. However, there is a basis for that suggestion. The pancreas has a receptor through which a virus can enter and, therefore, damage the pancreas, but whether this can really happen or not is unknown since a study on this is underway.
Q: How prevalent is diabetes in India?
Prevalence has been identified through studies across India. The ICMR has conducted its research in 27 states and 2 union territories, whereas 5 union territories are pending, including islands like Lakshadweep and Andaman Nicobar. We have a very good idea about the prevalence of diabetes in the country, mostly type 2 diabetes. We are a large country. To add to the numbers significantly and the movement in absolute terms of numbers, we are second to China. We have apprehension that we will surpass the number of patients in China in years to come because of the ongoing increase in patients.
Diabetes affects a percentage of the population, and several countries that are smaller than us have a higher prevalence, per hundred population or per thousand population, including some islands in the western Pacific and some in Middle Eastern countries, where the percentage prevalence is higher than what we observed.
Q: What are the diagnostic criteria for diabetes?
There is a very simple diagnostic criteria for diabetes. If the fasting glucose is 126 milligrammes per decilitre or more ,and the post glucose load, a part of the oral glucose tolerance test, after giving 75 grams of glucose two hours after that glucose value exceeds 200 milligrammes per decilitre, it is diabetes. In some circumstances, we also use HbA1C, and the value of HbA1C is 6.5%. Everywhere across the world, including Asia, Africa, Europe, and North America, the same diagnosis criteria are followed.
Q: What are some of the symptoms of diabetes?
Diabetes happens mostly when blood glucose levels are very high. We can have marginally elevated or moderately elevated glucose levels without any symptoms. The diagnosis of diabetes cannot depend on waiting for somebody to get symptoms. It can be a silent disease, and therefore, periodic screening is mandatory.
Therefore, the symptoms of diabetes include very high glucose levels that the body tries to regulate by producing an extra level of urine. You have excess urination to remove glucose through urine. If you pass out a lot of water, you feel thirsty since there is a lot of glucose in the blood , but it is not used by the tissues either because of insulin deficiency or insulin resistance. The body may also feel hungry. However, poor wound healing, skin infections, recurring urine infections, and recurring infections of the private parts are more common, especially in men and women. All of these can be part of the symptoms of diabetes.
Q: How can diabetes be treated?
New medicines keep coming for diabetes. Diabetes, which addresses different pathways, is caused by the release of insulin from glucose. Smart drugs also look at the release based on the prevailing glucose level. There are drugs which also reduce weight along with controlling glucose ,so there have been several medicines in the last 10 years that address different aspects of glucose control. That has made the job of the treating physician simpler and easier. However, patient efforts are still the most important thing, both in terms of diets and physical activities.
Q: What have been some of the major changes in last 3 decades?
In our long practice, we have discovered that diabetes can occur at a much younger age group, and the concern is that people who have been exposed to diabetes are more likely to have complications, and complications from diabetes are irreversible. As a result, the concern is not only about the number of diabetics, but also about their age, which is getting younger with the passage of time. For example, type 2 diabetes is now occurring as early as the second half of the second decade of life and definitely in the third decade of life, which means that each individual is much more likely to have a higher risk of complications unless they keep the parameters in good condition.
Interviewed by Manohar Prasad Kesari , Special Correspondent, iTV Network