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00:00Namaskar to all. I am Dr. Anupa Jain, Senior Journalist with ETV Bharat.
00:04And today we will discuss about diabetes which is rapidly evolving as a silent epidemic in India.
00:10To discuss more about this disease and to decode this growing crisis,
00:16we have with us Diabetologist Dr. Sanjay Reggie from famous Fortis Hospital, Cunningham Road, Bangalore.
00:23So, welcome to our channel, sir.
00:25Thank you, madam. Namaskar to everybody.
00:28So, let's explore this rising burden of diabetes, the approach is to its prevention and management.
00:36So, doctor, first we would like to know as India is often referred to as a, you know,
00:41diabetic capital of the world. So, what are the key factors driving this sharp rise in cases?
00:48Good afternoon, everybody. And just to say that the world, the world diabetic population is increasing
00:55at a tremendous phase. At present, we have around 583 million people living with diabetes according
01:02to the IDF 2025 estimates. And we have more than 101 million people living in India alone.
01:09And our prevalence is around 11.7 percent and the global prevalence is also similarly so.
01:18More so in developing countries, in developed countries and so-called poorer countries also,
01:25there is an increasing burden of diabetes which is exploding at a phenomenal rate.
01:32For every type 2 or every diabetic who is diagnosed, we have another diabetic there who is not diagnosed.
01:40And you have one more. For example, if you have 101 million people with diabetes in India,
01:45we have 120 or odd people with pre-diabetes who have potential to become diabetes.
01:50Now, why is this? Why do you think diabetes and elevated blood glucose is a chronic disorder?
01:59Mostly doesn't present with most symptoms. The reason for it is genetic, biological, psychological,
02:09psychological, social and cultural.
02:13And economic. All these factors are responsible for the growth of diabetes. Genetically, as Southeast Asians,
02:22we are predisposed to diabetes. Now, this predisposition of diabetes also, with the background of this
02:30emerging economic wave, has made people exercise, work less physically, increase weight,
02:41more consumption of calories, which are, with the calorie consumption is also basically more from carbohydrates.
02:49Since we are a carbohydrate-eating nation, 65% of our diet is carbohydrate, whether you take north, east, west
02:56or south.
02:57Physical inactivity. Now, all the behavioral changes which we are having, we have faster modes of transport,
03:05we are walking lesser, we are exercising less, probably there is not enough space for all our kids to play.
03:11I don't see, how many playgrounds do we see in a city and kids playing? Which, earlier days, even entire
03:18two cities play.
03:19Today, I'm more worried about the kids who are here and what's going to happen next 50 years. The projection,
03:24by 2050, is a 45% increase in the world diabetes population and probably a 75% increase in our
03:33country.
03:33Right. So, where are we headed? Now, it's not diabetes alone. The most important is diabetes-related complication.
03:40Now, as I told you, it's genetic, it's biological, it's psychological, it's economic and social. Now, it's not one particular
03:54reason and it can be environmental too.
03:57So, it's not one particular reason we are trying to deal with. We are trying to deal with the whole
04:00cauldrum of all this.
04:02So, to be healthy, you have three types of health today. Mental health, physical health, biological health.
04:09Exactly. So, sir, to understand this better, over the past decade, how have you seen the pattern, you know, diabetic
04:16pattern evolve in India, particularly among young population?
04:21Well, this is a very disturbing trend which we have been observing. If you look at the definition for an
04:26young diabetic, across the world, you say anybody less than 40 diagnosed with type 2 diabetes,
04:31and then you have type 1 diabetes which usually occurs in the end. But what we see nowadays, and I
04:37sit in my clinic the last decade or so, more than a decade, around 15 years,
04:42seeing patients between 20 and 40 walking into the clinic, especially most of them, not everybody, most of them are
04:52obese, have never exercised,
04:55or mostly doing their job, erratic eating habits, have never played a game, majority, I just ask for curiosity, what,
05:04do you play, are you playing anything?
05:06No, they are all, so the younger generation, which we see, we see most of this in Lamington. Imagine somebody
05:13who is diagnosed with type 2 diabetes at the age of 25.
05:17Yeah.
05:17He has to live with diabetes-free complications throughout his life. That is my goal. Somebody coming at 55 and
05:25looking at their lifespan. We want a morbidity-free diabetes survival.
05:31Now, how do we achieve it? And so on. It's disturbing. We have a lot of young people now. So,
05:37coming in. And what we have to do about it, I think we can discuss later.
05:41Okay. So, in this background, I'd like to know what are the early symptoms or warning signs people often ignore
05:46before being diagnosed with this disease?
05:49Okay. Now, for that, let us get into some traditional risk. Majority of the time, most people with diabetes don't
05:57come with symptoms.
05:57Okay. They go to the laboratory for something. They admit it for something. Their blood glucose is checked. And they
06:04find that they are elevated and they would come.
06:07Diabetes, symptoms of diabetes, by the time symptoms of diabetes occur, we call them hyperosmolar symptoms. For example, excessive thirst,
06:16excessive weight loss, thirsty, feeling hungry more often, extremely tired.
06:22There's some other thing. Some people suddenly come and say, I have some tingling numbness in my feet, which is
06:27there, feeling extremely tired for no reason.
06:30Then the third thing was, suddenly after I eat, I find off lately, I find this. These are subtle things.
06:37Blurring of vision.
06:38Okay.
06:39But these are present only in a minority of the population. Say, less than 10% of the population where
06:46the sugars are very high.
06:47For diagnosis, the sugars are not necessary. These are not present. That's why we recommend that everybody checks their blood
06:56sugar after the age of 30.
06:58I say even lesser. If you have a strong family history. And then traditional risk factors. Suppose you have a
07:04risk factor.
07:04A family history of diabetes. Both parents are diabetic. Your BMI is more than 25. If you are sedentary lifestyle,
07:12you have thyroid disorders.
07:13You have menstrual dysfunction or PCOD. If you have been diagnosed with diabetes during pregnancy. And if you have any
07:23other metabolic disorder.
07:24Meaning to say, if you have a young hypertensive. So, all these people should be aware that they should check
07:31more frequently.
07:32Okay.
07:32Now, these fall into majority of the category. Then we will not talk about the environmental factors. These are the
07:38traditional risk factors.
07:39And diabetes increases with age. Somebody at 80 says, I don't want to check my blood sugar. I don't have
07:44that. No. It exponentially.
07:46As you age, the chance of you getting diabetes is more. Okay.
07:50Saying that, if you look at more than 45 years and old, the prevalence will be more than 20%.
07:55Mm-hmm.
07:55In the south, in India, take 50 years and old, anybody, check two people. In the south, at least down
08:02the wind years, one and two will have diabetes.
08:04Okay.
08:04So, it is true across the country. Meaning to say, 50 years and above, two people you check, one will
08:10have diabetes.
08:10Other may be normal or may have pre-diabetes also. So, the idea is first, you don't get symptoms in
08:18every patient with diabetes. That is why majority of the people don't go to a doctor and check the blood
08:25glucose.
08:26So, another important thing is for all my fellow colleagues and everybody, making blood sugar the fifth vital sign. Like
08:36how you say heart rate, blood pressure, saturation, and all of these factors need make blood pressure also.
08:44Blood glucose also is one of the signs, one of the things to check so that we can diagnose more
08:50people with or identify people earlier with diabetes.
08:53Right. So, taking this discussion forward, type 2 diabetes account for the majority of cases in India. So, what are
09:00the most effective early interventions to prevent or delay its onset?
09:05Okay. Suppose, as I explained, you have all these stress factors. What should I do? The first and foremost thing
09:10is you should try to see if you can change your behaviour in terms of your lifestyle.
09:17This behavioural change which we call. So, eat right, meaning to say, make sure that don't put on weight. Try
09:29to maintain an idle body weight. Make sure you play a game or exercise regularly at least for 150 to
09:37170 minutes per week.
09:40Check your blood sugar. Check your blood sugar regularly. Third, keep your blood pressure under control. Try to sleep well.
09:46If you don't sleep well to seven hours, if you think sleeping is an important factor, I think we also
09:53should get away from the addiction on to your laptops and your mobile phones because that also decreases sleep.
10:02You keep watching them all the time. Eat as a family. Don't eat in front of watching TV or so
10:09on for the kids because you don't know what you're eating.
10:11Right. So, small changes in behaviour, regular exercise, good diet, not taking too many calories, decreasing your carb, not that
10:21avoiding carb, isn't it?
10:23Reducing your carb content, carbohydrate portion to less than 50%, keeping an ideal protein content and fat and fibre in
10:32your diet and maintaining this regularly. Don't smoke, don't drink, don't drink alcohol.
10:37So, all of these, drink excessive alcohol which causes an increase for development of diabetes. I think it's a healthy
10:45lifestyle which is all there.
10:47Yeah. In continuation to this, if I ask, can high or fluctuating blood sugar level impact a person's mood, a
10:53person's behaviour, mood swings and leading to irritability, anger, some behaviour issues also, right?
10:59This is a very nice question but I would ask, I would like to frame it in another way. So,
11:04when do behavioural changes come into life? This happens when you're taking anti-diabetic drugs.
11:10See, high sugar, if you're very high sugar will not cause too much of behavioural changes but if you're taking
11:17anti-diabetic drugs, the chance of you getting into low sugars are there.
11:21So, when the sugars start getting low, some, they are called, I call them irreversible brain attack, irreversible brain attack,
11:30meaning to say you feel floggy, you have a headache, your heart rate starts going up, you start sweating, you
11:37start, and you start behaving abnormally because of your individual who's running a company or your, sorry, your CEO, you're
11:46taking important decision,
11:48you need to, that goes into monitoring of blood glucose for those taking medications, your behaviour starts changing at 12
11:56o'clock because you're going into low sugars.
11:59These behavioural changes but there are a lot of data which is coming in which is telling us that high
12:05blood glucose values have something to do with neuro behavioural changes in terms of probably dementia, Alzheimer's,
12:14there's a lot of research going in that area. Don't know if people with long term have any sort of
12:20this conclusive proof but there is a lot of research happening.
12:24If you have very good glycemic control, probably the onset of these can be delayed a little further.
12:30Okay. So, sir, is diabetes reversal or remission truly possible, especially in type 2 diabetes?
12:35Okay. Now, reversal of diabetes is not the right terminology to use. Remission of diabetes is possible. Now, remission of
12:44diabetes came into this world because of a trial called the direct trial and from all the data which came
12:51in from anti-obesity treatment, basically bariatric surgery.
12:55Okay. You take people who are obese, died to diabetes, put them on a strict diet, 800 kilocalories. This came
13:03from the direct trial which was done in the UK and they found that they could pull off their medications
13:08over a period of time and they went into, there's a lot of things happened which is called, which happened
13:14because they lost a lot of weight and these people who lost that, if you lose 15, if you're obese
13:19and you lose 15% of your weight, diabetes goes into remission.
13:24Okay. That is why the advent of the new drugs, the GLP-1 analogs which have come in, that is
13:30semaglutide and as well as desapatide, which have been like, if you start them early in patients with, you can
13:38get them into remission for some time and you need to continue. These drugs, not only having effect on weight
13:44loss, glycemic management, they're very beneficial to the heart, liver and the kidney.
13:50Okay. There's lot and lot data more coming in. One of the drug, they are also drug, one of the
13:55drugs among, upright, is approved for even MS healthy. Meaning to say the fat goes away from the, visceral fat
14:02is lost, your hepatic fat goes away, muscle fat. So you will become more insulin sensitive.
14:07And then they can go into remission. It is a possibility. There are three ways. And then a lot of
14:13people use a lot of apps and AI's and say, okay, can we get you onto this? This is nothing
14:19but direct trial based on less than 800 kilocalorie diet.
14:22Okay. But how long can you have an 800 kilocalorie diet? So what happens is, these are the, they are
14:29challenges, but remission is possible and a reality in future.
14:34Okay.
14:34Reversal is not the right word. Remission, in five years, six years, you may go up. You don't understand the
14:39basis for this because diabetes has increased from 48 years to 70.
14:45The lifespan from 1948 to now, it's got 70 years. And we have more and more elderly population over the
14:52years. The more and more elderly population, more and more chronic diseases, 20% of death today, 10 more than
14:5815% of death could be due to diabetes related complications.
15:01So to prevent the burden of these complications, I think a preventive strategy program should be in place. It should
15:10be tenured or directed first on the education front.
15:17Exactly.
15:18Now, I don't know if there is any add on Doordashin on saying, oh, you have this, this, this, please
15:24check your blood sugar.
15:26I think we don't have it. That's the first one. You don't, I first time saw something on obesity in
15:32IPL and I was very happy. It was done. CSR initiative from, see, now, for example, this is not done
15:39in Doordashin last 40 years.
15:40Exactly.
15:41Forget about private challenge. So, but you do have Tikalagao. Yes. And look at what is done. Look at how
15:50many people in our country. It's fabulous. Almost 98% are humanized children today.
15:56Yeah.
15:56So same thing can happen if this program starts off now in the next 10, 20 years in terms of
16:02education, in terms of newspaper education, wherever, media. You have so much of them on here.
16:09So I think we start there and then build a consensus over checking everybody's blood sugar and probably a registry
16:18of sort.
16:19Yeah.
16:19It's a very, very big task. You get all of this paper and out of pocket expenses of all diabetes.
16:28It's like this. You need to bear everything out of your pocket.
16:33Now, for people who have the money, I think they will bear it. But people who do not have the
16:39money, and I'm telling you, there are a lot of treatments that are going on. They're all expensive.
16:43Now, people who have central government health schemes are very fortunate enough. The government of India does a fabulous program.
16:49Most of the drugs are available.
16:50Some of the state governments have initiated programs in PHCs where they do have diabetes, like Tamil Nadu, Kerala have
16:58a very good program. But how much the government can do now?
17:02How do we get this cap filled up for people who already have diabetes and for prevention of diabetes? I
17:08think it should start from school. A curriculum in school is saying healthy living.
17:12Right.
17:14Early on, encouraging kids to start playing. I know they're all reading well. But if you look at many programs,
17:22I don't know. But playing a lot are much better. They're more focused. They know more about things. They will
17:29do better in future.
17:30Yeah. And, sir, lastly, your concluding remarks, your one key message to individuals, families to better prevent and manage diabetes.
17:41So, my key message is one. Prevent occurrence of diabetes. Postpone it to as long as you can. Lead a
17:52healthy lifestyle. Eat appropriately. Exercise or play a game. Sleep well. Then, for those who have diabetes, please check. And
18:03everybody, those who don't have diabetes, after the age of 30, every year, check at least your blood glucose value.
18:09To see whether you're diabetic or not. Then, you can identify diabetes earlier and prevent complications of diabetes. Those who
18:16have diabetes, visit your doctor regularly. Screen for complications once a year. Screen for your lipids, your blood pressure, your
18:26weight. Make sure your kidneys are okay. Get your fundus picture. Screen for your feet that your sensations are right.
18:33So, that you don't develop these complications. So, that you don't develop these complications. Take your medications regularly. Keep your
18:39A1Cs well under control. Blood pressure and LDL targets right there.
18:43So, those who have this. So, those who have this, this is one. Those who don't have it, I think
18:48it's, and make sure that you do everything possible.
18:54Give, I have one thing. One hour a day of, one hour in a day for you.
19:00True.
19:00True.
19:01True.
19:02True.
19:30True.
19:31So, thank you. I'm signing off. This is Dr Anupajain with Cameraperson, Prashant from ETV Hairat, Bengaluru.
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