Last Updated on September 23, 2023 by Neelam Singh
Diabetes, a chronic health condition characterised by high blood sugar levels, affects millions of people globally. It poses significant challenges to their health and quality of life. Dr Altamash Shaikh, Endocrinologist at Masina Prince Aly Khan Hospital, Mumbai in conversation with THIP Media unriddles many queries related to diabetes and how to manage it successfully.
India has become the diabetes capital of the world. What do you think fuels the existing burden of this disease?
From being a nation with the least number of diabetes cases, we are now the nation with the second-highest number of diabetes cases in the world. Therefore this question is highly pertinent. If we do not take steps to prevent diabetes, we may become the number one in diabetes globally by 2025.
There are several reasons behind this. Firstly, our alarming lack of physical activity plays a crucial role in our position as the second-highest country in diabetes prevalence. Secondly, we are a very carbohydrate-centric population, where we eat a lot of carbohydrates in different forms. Digitisation is another reason. Everybody has a mobile phone or notepad in their hands and most of them are not even aware of what’s happening. Being constantly engaged with their devices leads to a loss of situational awareness. This distraction can result in emotional instability, heightened anger, and other related factors that contribute to the increased prevalence of type 2 diabetes and obesity. This happens because there is a decrease in physical activity.
How can people of different ages manage diabetes?
When considering the younger population, it is crucial to recognise that they are still in the process of reaching their full adult potential in terms of growth and development. Our primary objective is to attain diabetes remission by properly addressing the underlying risk factors that contribute to the development and progression of the condition. By identifying and mitigating these factors, we aim to empower individuals to overcome diabetes and regain optimal health. If obesity is a risk factor, we would want them to lose weight. Our focus should not only be on diabetes control, but also on ensuring a high quality of life and managing complications effectively. Additionally, for individuals above the age of 65 with long-standing diabetes, our aim should be to provide them with a meaningful and actionable life that positively impacts their overall well-being.
The priority should be to remove complications like hypoglycemia that can arise from treatment or overtreatment. We look at the existing complications because the longer you have diabetes, the more complications you will have, whereas the less the age of diabetes, the lesser the complications. The aim should be to effectively manage hypertension and cholesterol levels in individuals with diabetes, particularly among older adults who have heightened risk factors for heart disease and kidney complications. Additionally, priority is given to addressing peripheral neuropathy and diabetic foot issues. This approach involves the prevention of these complications in younger individuals. Whereas for older adults who may have already experienced complications, the focus is on preventing further complications and enhancing overall well-being.
What are some of the social factors that play a role in diabetes?
In India, diabetes is a social disease. We love to meet and eat. This leads to an increase in the density of food that we eat and increases the density of carbohydrates that we consume. On any occasion, we are very good at savouring the flavours of food. There is a need to start looking at these things differently. Let us replace cake-cutting rituals with fruit-cutting or go for walks instead of sitting and watching TV. These are some important social factors which can come into play.
Falling prey to misinformation also plays a big role in diabetes mismanagement. If you receive advice from someone who does not match your age, body type, culture, your health condition, your inner body or any other complications, then that piece of advice is bad for you. Today, we live in an era of customised diabetes. Therefore, the treatment process has to be precise and concise and tailored to the needs of the patient. People should approach diabetes with this approach and must talk to their endocrinologist for the proper treatment.
What are some common myths that you have encountered during your practice and how do you debunk them?
I think the first and foremost myth is that they do not accept their reports saying that “It’s not possible for me to have diabetes.” But 51% of diabetes cases are detected at the asymptomatic stage. That is when we start the treatment to avoid complications opting for various strategies before starting the medication. If you are on the borderline, it’s called pre-diabetes and it can be reversed.
Another big myth is that diabetes means the end of life. This is not true. Diabetes teaches moderation. It teaches discipline. You don’t have to avoid a lot of food. The necessary thing for you to do is to change your daily routine. You have to control your habits, discuss your goals with doctors and ways to set them. Another common myth is about home remedies that are said to be good for diabetes. In my opinion, such claims should be thoroughly scrutinised and cross-checked with qualified doctors.
With the recent advancement in technology, how do you see diabetes management evolving in the next 5-10 years?
There are flash glucose monitoring and continuous glucose monitoring. There are wearable devices that detect the variation or variability of glucose, how high or how low it can go. Earlier, we had devices that we put on the tummy or the hand for three to four days, or in some cases 14 days. We also had such devices which were only to be used under professional guidance. Now, there are devices patients can use themselves. Also, by the end of this year, there are going to be certain drugs which will reduce the immense dependency on insulin. However, above all, lifestyle modification is going to be ever-evolving and that is the most important thing that we must focus on.
Can you discuss some ongoing research or clinical trials that you find particularly exciting or promising?
There are many. There are thousands of research papers on diabetes that come out every month. These researches should be judged based on their potential impact. For example, regarding diabetes and kidney disease, there have been a lot of advancements in new treatments and the development of tablets, which can prevent kidney disease and dialysis.
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