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Cardio Diabetes Medicine 2017 605

Primary Prevention of Type 2 Diabetes

Make In India

Ambady Ramachandran, Chamukuttan Snehalatha,
Arun Nanditha, Arun Raghavan

India Diabetes Research Foundation and
Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, India

Summary
Primary prevention of type 2 diabetes is shown to Fasting Glucose (IFG) and/or Impaired Glucose Tol-
be feasible and is a major step in preventing the ris- erance (IGT). It is also predicted that this number is
ing prevalence of diabetes. India, which has a large likely to grow to 63.3 million by 2040, indicating the
population with diabetes and also a large number of presence of a large pool of persons with the poten-
people with prediabetes, has to implement primary tial to convert to diabetes. In addition to the need to
prevention programmes at community level. Several manage the large number of persons suffering from
studies in India have proved that conversion to dia- the disease, there is an urgent need to curb the rising
betes from prediabetes can be reduced, either by the incidence of diabetes. The major step towards this
use of lifestyle modification or by use of small doses goal would be implementation of primary prevention
of metformin. Several challenges exist in translating of diabetes among the people at risk of developing
the research findings into real world practices which the disease (1).
includes social, economic, availability of sufficient re- Studies from different parts of the world and in peo-
sources and lack of facilities for large scale screening ple of different ethnic origin have conclusively shown
to identify those at high risk. Awareness on diabetes the possibility of preventing diabetes in people with
and its complications is generally poor among the high risk by lifestyle modification or by use of phar-
public. Therefore, education of the general popula- macological agents such as metformin (2).
tion by camps, group lectures and by the mass media
is required. India can claim that it has contributed very import-
ant pioneering observations on the practicality, meth-
There is also a lack of adequate national health care odology, insight into the mechanism of prevention
budget for preventive care. Therefore support of the modalities and also on innovative and pragmatic
governmental, non-governmental, national and inter- methods of translating the research findings to the
national agencies are required to promote preventive use of public at large (3). It is well known that T2D
endeavours at national level.
develops because of the interaction of genetic and
Introduction environmental risk factors. The recent epidemic of
the disease is attributed to changes in environmen-
Primary prevention of type 2 diabetes (T2D) will be a tal risk factors caused by socio-economic transition,
major step in preventing the relentless increase in the resulting in adverse biological profile favouring early
global prevalence of diabetes. More than 80% of the expression of diabetes.
people affected with diabetes live in the developing
countries and therefore the highest health care and A few pioneering studies from India (3,4) shown in
economic burden are seen in these countries (1). Of the Table have proven that T2D is preventable among
the total 415 million adults with diabetes in 2015, In- Asian Indians, despite having several adverse biolog-
dia has 69.2 million and holds the second position ical characteristics. These include increased adiposity
among the countries with the largest number of peo- despite having relatively lean Body Mass Index (BMI),
ple with diabetes. Moreover, India also has 36.5 mil- susceptibility to develop diabetes at a young age, in-
lion people with prediabetes consisting of Impaired creased insulin resistance, lean muscle mass and a

Cardio Diabetes Medicine