ICMR's new rules for type 2 diabetes, patients add up to 72.9 million
New Delhi : The Indian Council of Medical Research has issued new guidelines to take care of type 2 diabetes patients. The set of rules targets on epidemiology, diagnostic criteria, pharmacological intervention, treatment goals and complications of the disease. Stakeholders can send comments and suggestions on the draft to the council until May 18, 2018
IMRC’s new rule will act as a guide book for physicians and care takers of diabetes patients in the country. India is believed to be second largest in the number of people with diabetes in the world. It is likely that the global figure will rise to 134.3 million by 2045. Experts say that prevalence of diabetes in large metropolitan cities has increased from 2 percent in the 1970s to over 20 percent at present and the people in rural areas are also prone to the disease.
About Type 2 Diabetes
Type 2 diabetes is a metabolic-cum-vascular syndrome characterised by major insulin resistance with varying degrees of insulin secretory flaws. The IMRC observes that the disease is more common in overweight and obese individuals of middle to late age. Conversely, it is also increasingly being seen in younger age groups and in those with lower BMI as well. Experts say that the Asian Indian phenotype (AIP), a peculiar constellation of abnormalities, predisposes South Asians to the development of insulin resistance.
Asian Indians, at any body mass index (BMI) and age, have higher body and visceral fat, waist circumference, lower skeletal muscle mass, thinner hips, short legs and profoundly higher rates of insulin resistance, metabolic syndrome and diabetes.
The major treatment of Type 2 Diabetes include glycemic control and prevention of acute complications; identification and management of co-morbid conditions like obesity and hypertension; prevention of microvascular complications like retinopathy, neuropathy and nephropathy;and prevention of macro-vascular complications like cardiovascular, cerebrovascular and peripheral vascular disease.
The IMRC guidelines for Type 2 Diabetes underline the necessity of timely screening as disease occurs at least a decade earlier in Indians compared to other major ethnic groups. Screening of asymptomatic individuals allows diagnosis of diabetes and pre-diabetes to be made at an earlier stage and provides a chance for screening of cardiovascular risk factors. The council suggests that screening should be performed in all individuals above 30 years of age. It should be carried out at an earlier age in adults who have family history of diabetes and are overweight or obese.
Type 2 Diabetes screening can be done by fasting plasma glucose, an oral glucose tolerance test using 75gm glucose or random plasma glucose. Glycosylated haemoglobin (HbA1c) is also recommended by the health experts.
Children and adolescents aged 18 years and below should be screened for diabetes if they are overweight and have risk factors such as family history in first degree relatives, signs of insulin resistance, hypertension or dyslipidaemia. Urine glucose monitoring is suggested for estimation of ketones if blood glucose is greater than 400 mg/dl.
The guidelines also suggest self monitoring of blood glucose at regular intervals with Glucose Monitor to achieve better control of the disease.
Considering the calorie distribution, the council observes that as much as 55-60 per cent of energy from complex carbohydrates is an ideal recommendation. All patients with diabetes should be encouraged to take 6 small meals a day. Proteins should provide 12-15 per cent of the total energy intake for people with diabetes. Proteins from pulses, soy, grams, peas, low fat dairy, fish and lean meats are recommended.
Fats should provide 20-30 per cent of total energy intake. It is best to avoid alcohol. If alcohol is consumed, it should not be counted as part of the meal plan. However, it should be borne in mind that alcohol does provide calories, 7 kcal/ g, which are considered as ‘empty calories’. In the fasting state, alcohol may produce hypoglycaemia. Alcohol can further intensify fatty liver, neuropathy, dyslipidaemia and obesity and can worsen blood glucose levels. Smoking and tobacco chewing is totally prohibited.
Regarding physical activity, the IMRC suggests about 150 minutes of aerobic activity or its equivalent per week along with some resistance training at least twice a week and flexibility exercises. People with diabetes need an extra dose of carbohydrate snack before the exercise and during the exercise, if the activity period extends the daily routine.
When glycemic control is not achieved with the maximum tolerable dose of a single oral agent or combination of oral drugs, the guidelines suggests the use of oral drugs along with insulin to achieve blood sugar control level.
The IMRC Council has also observed that indigenous drugs from other systems of medicine such as Ayurveda, Homoeopathy and Unani do have blood glucose lowering effects. “Their exact mechanism of action is still not clear. There is a common belief that all herbal drugs are safe and non-toxic which is not necessarily true. In view of the widespread use of these indigenous medicines, physicians should be aware of the herb-drug interactions,” the guidelines mentioned.