Last Updated on September 6, 2023 by Team THIP
With an illustrious career spanning decades, Dr. V Mohan has played a pivotal role in shaping diabetes research, treatment, and awareness in India and beyond. As the founder of the Dr. Mohan’s Diabetes Specialities Centre, he has tirelessly worked to provide comprehensive and patient-centric diabetes care.
Dr. Mohan’s impact extends beyond clinical practice. He has authored record number of research papers, articles, and books, enriching the medical community’s understanding of diabetes management. His visionary approach has led to the implementation of innovative strategies for diabetes prevention and control, addressing the growing burden of the disease in India. In 1996, the Padma Shri recipient established the Madras Diabetes Research Foundation (MDRF).
In an interview with The Healthy Indian Project (THIP), Dr. Mohan sheds light on myths associated with diabetes care and its reversal, management and awareness of the disease. Edited excerpts:
India has been termed the ‘Diabetes Capital of the World’ in many reports. How serious is the situation?
It is true that a few years ago India was termed the ‘diabetes capital of the world’, because at that time we had highest number of people with diabetes in the world and China was in second place. Subsequent reports over the last 10 years show that China is actually ahead of India in terms of total number of people with diabetes in the world and we are now in second place. Having said that, recently India has overtaken China in the total population of the country, and therefore, it may not be long before we once again become the ‘diabetes capital of the world’.
The ICMR INDIAB study published in June 2023 showed that there are now 101 million people with diabetes in India. Not just how many people with diabetes, but also how many of them experience serious complications, underscores how serious the situation is. Assuring that even 20% of them develop kidney complications, this would mean that there would be 20 million people with diabetic kidney disease in India. Even if 5-10 million people go on to develop end stage kidney disease, this could be a huge problem in India, because the only known treatment for end stage kidney disease, is either a renal transplantation or lifelong dialysis treatment. Both of these are extremely expensive and not feasible to offer to such large numbers of people. Apart from this, the burden due to blindness, amputations, heart attacks and other complications will also be very high.
The number of diabetes patients has increased multifold in India. Despite newer medicines, and continuous awareness building, what exactly is going wrong?
The increase in the number of people with diabetes is due to the parallel increase in the obesity rates. Rapid lifestyle changes have occurred in the country with people eating too much junk foods which are rich in calories, sugar and fat. Physical activity has also gone down considerably. Sleep patterns have also changed dramatically with people staying up late at night due to addiction to cell phones or to movies, videos, etc. All these predispose individuals to diabetes. People are under the false impression that just because newer medicines for diabetes are developed the number of people with diabetes would go down. People forget that medicines are used only after one gets diabetes and not before. Although awareness building is going on, it is still not enough to reach the 1.4 billion population of India, due to the multiple challenges with language, cultural differences, etc. Hence, more awareness programs to improve the lifestyle of people is the need of the hour.
Type 2 Diabetes has a genetic predisposition. With 100 million people having diabetes in India, their next generation stands at risk. How do we fix this?
Yes, it is true that type 2 diabetes has a genetic predisposition. However, one must remember that only 40% of type 2 diabetes is due to genetic factors and 60% is in fact, due to environmental factors, of which unhealthy diet, physical inactivity, obesity and overweight and irregular sleep patterns are the primary factors. All these are modifiable and even if one has a genetic predisposition to diabetes, it is possible to prevent or postpone diabetes by a few decades. If one gets diabetes when one is 50 or 60 years old, it doesn’t matter, because then, the lifespan of the individual is not affected. It is when the youth of the nation get affected, that by early adulthood, they will face the risk of developing complications. Diabetes is definitely preventable if lifestyle modification is done right from childhood.
There are a lot of theories around how various Indian foods like Amla, Karela, and Methi can control diabetes. What is your view about using ‘Food as medicine‘ and ignoring regular diabetes medicine?
The role of Amla, Karela and Methi has been researched for several decades. They all do have some glucose lowering property, particularly methi. However, by themselves, they would be useful only in early cases of diabetes. Everybody is keen to avoid diabetes medicines thinking that they produce side-effects and that they are dangerous. If medicines are used judiciously and in proper dosages, they are quite safe. I have a large number of patients who have completed 40, 50 or even 60 years of diabetes and regularly taking diabetes medicines, and they are all doing well. Of course, diet and physical activities are the corner stone of type 2 diabetes treatment. This does not mean that when needed, diabetic medicine should not be used.
What is your view about the term ‘Diabetes Reversal’?
‘Diabetes Reversal’ has become a very popular term in recent times. However, it is not new. The correct term for it, is ‘Remission of Diabetes’, because, remission implies that the disease or disorder has temporarily gone into a shell and that it may come back any time. In 1986, we published our first series of patients with diabetes remission and ever since many of our patients have achieved diabetes remission. The problem is that the disease can always come back if one puts on weight or starts an irregular and unhealthy lifestyle again.
A lot of people who promote unscientific ‘Diabetes Reversal’ methods build their argument on the conspiracy theory that ‘pharma companies never want you to get cured’. How do you react to that?
This is one of the myths which are promoted on social media. Most of the people who conduct these programs are not doctors, but businessmen who resort to unproven methods for diabetes reversal, many of which are not sustainable and some even harmful. These people not only accuse pharma companies, but also accuse doctors that we just want people to be on medicines and don’t want them to achieve reversal. This is not true, because all the time we are trying to achieve remission of diabetes. The fact is that when people achieve remission, they think that they are ‘cured’ of diabetes. Very often they come back with even worse disease than they had earlier. I call this as ‘Re-reversal of diabetes’. Any treatment that is undertaken should be continued for a long time, i.e., it should be sustainable. There are five types of people with diabetes who can achieve diabetes remission and I call that as the ABCDE mantra.
The ABCDE of remission
A – A1c or HbA1c – Those who do not have markedly elevated A1c are more likely to achieve remission
B – Body weight – Greater the body weight, greater the chances of achieving remission, as around 5 – 15 kg weight loss is needed to achieve remission
C – C-peptide (a test to measure the amount of insulin produced in the body). The better the C-peptide levels, the greater the chances for remission
D – Duration of diabetes – Shorter the duration, greater the chance of remission
E – Enthusiasm – Meaning that a great degree of motivation is needed for remission
Despite so many medical advancements where we could find the COVID vaccine within months, why haven’t we found a cure for diabetes?
The answer is easy. Covid is due to a communicable, viral infection, whereas type 2 diabetes is a lifestyle disorder with a genetic component. I wish we had a vaccine which will take care of unhealthy diet, sedentary behaviour, irregular sleep and obesity.
In your profession as a doctor, how difficult did you find ‘health misinformation’ as an obstacle to tackle? Any instances when you personally saw patients suffer as a result of misinformation?
I find this quite often, especially after the emergence of ‘WhatsApp Universities’ and ‘Google Doctors’. People find something on the Internet and keep sending this out and keep sharing this fake information to thousands of people and very soon the ‘lie’ of fake news is perceived to be ‘true’. I know people, including some people in my profession who despite severe uncontrolled diabetes have refused to take medicines to control their diabetes because of fear of side effects and very soon, developed kidney failure or blindness or amputation of the limbs. One has to be careful, because if left uncontrolled, diabetes can lead to severe complications.
Do you think we are doing enough to create health literacy among the common masses about Diabetes Management?
There are efforts being taken to improve the health literacy and this particular column and interview is also a step in that direction. However, it is never enough, because knowledge and science keep changing and we have to continuously educate people regarding diabetes management. People have to know that a well-controlled person with diabetes is often better than one without diabetes, but they should trust their doctors and go to them regularly, follow a healthy lifestyle, have their medical check ups at least 3–4 times a year and, wherever needed, medicines should be taken. This will help people to have a long and healthy life despite diabetes.
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