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Cardio Diabetes Medicine 2017 23

Addressing The Twin Epidemics of

Diabetes and Heart Disease In India

Dr. V. MOHAN
M.D., FRCP (London, Edinburgh, Glasgow & Ireland), Ph.D., D.Sc.
D.Sc (Hon. Causa), FNASc, FASc, FNA, FACE, FTWAS, MACP
Chairman & Chief of Diabetology, Dr. Mohan’s Diabetes Specialities Centre,
President & Director, Madras Diabetes Research Foundation, Chennai

INTRODUCTION : most important gene implicated in type 2 diabetes is
Diabetes, which is already a huge global health prob- the TCF7L2 gene. Recently, our Genome Wide Asso-
(1)
lem , is now spreading its wings to low and middle ciation Studies (GWAS) done with UK collaborators
income countries like India. Earlier, many epidemi- in individuals of South Asian ancestry published in
ological studies have reported that migrant Asian NATURE GENETICS identified six novel type 2 dia-
Indians living in other countries like UK, USA, Fiji, betes in South Asians (predominantly Indians) which
Singapore, Malaysia and Middle East countries in the were not seen among Europeans or other races (4).
Gulf region have much higher prevalence rates of di- Our findings thus provide support for possible novel
abetes compared to native Indians within the Indian associations with type 2 diabetes in our population.
subcontinent . According to the International Diabe- However, although genetic factors undoubtedly play
(2)
tes Federation (IDF), Diabetes Atlas Seventh Edition a major role in the predisposition of diabetes in Indi-
(2015), India had 69.2 million people with diabetes in ans, environmental factors contributes to over 50% of
the year 2015 and this is expected to increase to 123.5 the risk and indeed the epidemic is driven by envi-
million by the year 2040 . The epidemic of diabe- ronmental factors as our genes did not change in 40
(1)
tes in India is still spiraling upwards and the Indian years. Rapid economic growth in India has resulted in
Council of Medical Research, India Diabetes (ICMR– rapid nutritional transition contributing to excess cal-
INDIAB) study, the largest epidemiological study on ories mainly from refined carbohydrates in both rural
the prevalence of diabetes published in Lancet Di- and urban population (high dietary glycemic load) (5,6)
abetes & Endocrinology showed wide variation in along with decreased physical activity. Recently, we
prevalence of diabetes in India . The prevalence showed that consumption of white rice was strongly
(3)
of diabetes across all 15 states from the ICMR–INDI- associated with risk of type 2 diabetes in our popula-
AB study was 7.3%. When we looked at the GDP of tion . A recent study from our centre has shown that
(7)
various states in relation to prevalence of diabetes, replacing white rice with brown rice could improve 24
there was a fairly good correlation between diabetes hour blood glucose and insulin levels . Therefore,
(8)
prevalence and the GDP of the different states. Over it is logical to assume that adopting a diet that is
50% of people who participated in the study were rich in whole grains along with increasing physical
unaware of their condition indicating low awareness activity could be a cost-effective, feasible and sus-
about the disease. The prevalence of the disease in tainable approach to diabetes prevention and control
urban India is twice that of rural India. In most states, in India. However, our studies (9,10) the promotion of
the rate of pre-diabetes exceeded the rate of diabe- whole grains also revealed the challenges in doing
tes, a forewarning that the epidemic is far from over. so such as colour and texture of the cooked brown
Thus, effective preventive programmes need to be ur- rice having low acceptability in society. Hence, we
gently implemented to tackle the diabetes epidemic further engaged in research to lower the white rice
in our country. This will also indirectly help stem the digestibility (lower GI than high GI of white rice) using
coronary heart disease epidemic also. classical hybridization techniques. Recently, we have

The first question is, why the pandemic of diabetes? pioneered and produced an innovative High Fibre
- Is it due to genetic or environmental factors?. The White Rice which has 5 times higher fibre content and
lower glycemic index. This is a “first of its kind among

Cardio Diabetes Medicine