New Delhi: About 537 million adults around the world are currently living with diabetes and this number is predicted to rise to 643 million by 2030 and 784 million by 2045. The situation in India is no better – As per International Diabetes Forum, 77 million Indians have this metabolic condition.

Diabetes is a major public health problem worldwide that seems to be approaching epidemic proportions. In India, it is on the  rise affecting the urban as well as rural populations.
Diabetes control involves a holistic approach with the right balance of diet, exercise, and medication.

Some diabetes medicines may cause weight gain, exhaust ones pancreatic beta cells and increase hypoglycemia (low sugars) risk, and there is a high chance that most patients may be taking these medicines, warned Dr Naresh Purohit- Advisor for National Programme For Prevention And  Control of Diabetes.

On the eve of World Diabetes Day Senior Epidemiologist Dr Purohit said that diabetics should try to keep BMI under 23 to avoid complications.

It is strongly recommended to maintain body mass index (BMI under 23 as lowering BMI to 23 or less is known to minimize many complications apart from diabetes such as obstructive sleep apnea, osteoarthritis, systemic and pulmonary hypertension.

He further said that sulfonylureas are a class of medicines very widely used and while they are potent and cheap, they come with the baggage of excess weight gain, draining out pancreatic beta cells, sometimes to the point of failure, and causing hypoglycemia. Insulin, although very important in some cases like high HBA1C (very poor sugar control) with osmotic symptoms (increased urine frequency etc), is an anabolic hormone that causes weight gain. Hence both sulfonylureas and Insulin are preferred as third line agents.

National Diabetes Forum Executive Member Dr Purohit averred that more than 70% Indian diabetic patients are already obese or overweight and most guidelines recommend a weight loss inducing or at least weight neutral diabetic medicine. Better classes such as SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, etc), GLP1RAs (liraglutide, dulaglutide) metformin, alpha-glucosidase inhibitors  are known to cause weight loss. 

He further said that diabetes affects almost every part of the body and the risk of heart attack, heart failure, kidney disease is very high. The above mentioned classes of medicines apart from weight loss properties are known to prevent most types of heart and kidney diseases. The newer regimens of anti-diabetic meds are known to protect the pancreatic beta cells, reduce the risk of hypoglycemia/low sugars, improve vascular (arteries) health, improve fatty liver, reduce uric acid.

He added that with weight loss and other such great benefits, insulin sensitivity improves, and the patients daily insulin requirement comes down drastically. In many instances, insulin may even be stopped. Better diabetes control with such protective effects on major organs may even translate to increased lifespan.

He pointed  that most importantly structured diabetic diet and exercise recommendations form the pillar of any diabetes management along with such newer and safer anti-diabetic regimens.

Renowned Physician Dr Purohit strongly recommended that diabetes patients should exercise 150 minutes a week in total and follow the diet program to be created under the control of a diabetologist   in order to control blood sugar levels. 

He  emphasized that even a 5 percent decrease in body weight reduces insulin resistance.