Remission of diabetes, desirable, but not essential

General Studies Paper 2

Context: It may not be possible to make India ‘diabetes free’, but a ‘diabetes complications free India’ is within reach.

Introduction

• The concept of a reversal of diabetes has become very popular recently. Several commercial organisations have jumped on the bandwagon of a ‘reversal of diabetes’ and are making tall claims. Therefore, it is important to consider the pros and cons of a reversal of diabetes.
• Diabetes
• Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
• Insulin is a hormone that regulates blood glucose. Hyperglycaemia, also called raised blood glucose or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.

Type 1 diabetes

• Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. In 2017 there were 9 million people with type 1 diabetes; the majority of them live in high-income countries. Neither its cause nor the means to prevent it are known.

Type 2 diabetes

• Type 2 diabetes affects how your body uses sugar (glucose) for energy. It stops the body from using insulin properly, which can lead to high levels of blood sugar if not treated.
• Over time, type 2 diabetes can cause serious damage to the body, especially nerves and blood vessels.
• Type 2 diabetes is often preventable. Factors that contribute to developing type 2 diabetes include being overweight, not getting enough exercise, and genetics.

‘Remission’ of diabetes

• First, the term ‘reversal’ of diabetes is scientifically incorrect; the appropriate term is ‘remission’ of diabetes. Reversal implies that the condition has permanently reverted to normal and a cure has been achieved. ‘Remission’ implies that diabetes has only gone away temporarily. We know for instance that cancer can go into remission, but can come back in a more virulent form.

Remission and type 2 diabetes

• Diabetes is not a single condition but consists of several types. When we talk of remission of diabetes, we are referring most often to type 2 diabetes. However, there are other forms of diabetes such as type 1 diabetes where long-term remission is very unlikely to occur.
• There are certain individuals with type 2 diabetes who are more likely to achieve remission. This can be identified by the letters ABCDE.
• A refers to A1c (glycated haemoglobin) which should not be very high;
• B refers to Body Mass Index (BMI) or body weight. If it is high, you are more likely to achieve remission due to weight loss;
• C stands for C-Peptide, a measure of insulin secretion. If it is good, you can achieve remission more easily;
• D stands for Duration of diabetes; the shorter the duration, the greater the chances of remission; and
• E stands for an Enthusiastic individual who is keen to achieve remission.

Good Legacy Effect

• One should remember that even if one achieves remission of diabetes only for a few months or years, it is still worthwhile because it leads to a good ‘legacy effect’ which provides protection from complications caused by diabetes.

Data on India

• According to our recent Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study, there are currently 101 million people with diabetes and 136 million people with prediabetes in India.
• In those with prediabetes, preventing the majority of these individuals from developing diabetes for a considerable number of years is possible with just lifestyle modifications.
• In those who already have diabetes, we should, of course, try to achieve remission of diabetes. But if this is not possible, meeting the ABCD guidelines of the treatment of diabetes will ensure that they can all live a long and healthy life without any diabetes-linked complications.

Conclusion

• Even though we may not be able to make India ‘diabetes free’, my dream is that we can at least have a ‘diabetes complications-free India’. On the occasion of World Diabetes Day (November 14), let us rededicate ourselves to achieve this dream.