DAINIK NATION BUREAU
The underlying cause of diabetes is insulin deficiency which is absolute in type 1 diabetes and partial in type 2 diabetes. Although diabetes may occur at any age, surveys indicate that prevalence rises steeply with age. Type 2 diabetes usually comes to middle years of life and thereafter begins to rise in frequency. Malnutrition related diabetes affects large number of young people. The prognosis is worse in younger diabetics who tend to develop complications earlier than older diabetics. south-east Asia, an excess of male diabetics has been observed type 2 diabetes, has strong genetic component.
Obesity particularly central adiposity has long been accepted as a risk factor for type 2 diabetes and the risk is related to both the duration and degree of obesity. The association has been repeatedly demonstrated in longitudinal studies in different populations, with a striking gradient of risk apparent with increasing level of BMI, adult weight gain, waist circumference or waist to hip ratio. Indeed waist circumference or waist to hip ratio (reflecting abdominal or visceral adiposity) are more powerful determinants of subsequent risk of type 2 diabetes than BMI. Central obesity is also an important determinant of insulin resistance, the underlying abnormality in most cases of type 2 diabetes. Voluntary weight loss improves insulin sensitivity· and in several trials has shown to reduce the risk of progression from impaired glucose tolerance to type 2 diabetes. Sedentary life style appears to be an important risk factor for the development of type 2 diabetes. Lack of exercise may alter the interaction between insulin and its receptors and subsequently lead to type 2 diabetes.
A high saturated fat intake has been associated with a higher risk of impaired glucose tolerance, and higher fasting glucose and insulin levels. Higher unsaturated fatty acids from vegetable sources and polyunsaturated fatty acids have been associated with reduced risk of type 2 diabetes and lower fasting and 2-hour glucose concentrations. In many studies, high intakes of dietary fiber have been shown to result in reduced blood glucose and insulin levels in people with type 2diabetes and impaired glucose tolerance. A minimum daily intake of 20 grams of dietary fiber is recommended. Malnutrition, Excessive intake of alcohol, viral infection and a number of chemical agents e.g.,alloxan,streptozotocin ,the rodenticide are known to be toxic to beta cells. A high intake of cyanide producing foods (e.g., cassava and certain beans) may also have toxic effects on beta cells. One of the most important epidemiological features of diabetes is that it is now common in the lower social classes whereas 50 years ago, the gradient was the reverse. One reason could be rapid changes in lifestyle in lower classes.
DR Sanjay Kumar Varun
Synergy Hospital, Dehradun