India is among the countries which has the largest burden of diabetes in the world, says Dr. V. Mohan, the chairman and chief diabetologist at Dr. Mohan’s Diabetes Specialities Centre, a WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, in Chennai.
A Padma Shri recipient (2012) for his extensive contributions to the field of diabetes research, Dr. Mohan has recently been felicitated with the highest award for biomedical research in India -- Dr. B. R. Ambedkar Centenary Award -- by the Indian Council of Medical Research.
An alumnus of Madras Medical College, Dr. Mohan is also the president and director of Madras Diabetes Research Foundation, an ICMR Centre for advanced research on diabetes. He speaks to The Hindu about the disease, its implications, prevention and research in the area.
How has you extensive work in the field of diabetes helped the common man, especially with India having such a huge burden of the disease?
I have been working in the field of diabetes for nearly 40 years. I first started working on diabetes research as an undergraduate student helping my father, Prof. M.Viswanathan, who is considered the ‘Father of Diabetology’ in India.
Our initial studies were clinical, but they helped us understand the Asian Indian phenotype of diabetes better and laid the groundwork for my future research in this field. In my early years, I worked on a condition called “Fibro Calculus Pancreatic Diabetes”, which is a type of diabetes secondary to stones inside the pancreas. It is a rare form of diabetes, but my work helped to understand the natural history of the disease and to lay down the criteria for its diagnosis. This helped in understanding the condition better. Later, I moved to the more common forms of diabetes like Type 2 diabetes which constitutes 95% of all the types of diabetes in India.
We took up extensive studies on the epidemiology of diabetes. Initially our studies were restricted to Chennai and the Chennai Urban Rural Epidemiology Study (CURES) produced very good data on diabetes and its complications as well as co-morbid conditions such as hypertension, obesity and dyslipidemia.
Later, with the support of my daughter, Dr. Anjana, and all my colleagues at the Madras Diabetes Research Foundation and a host of collaborators all over the country, we took up the massive ICMR -INDIAB study.
This is funded by the ICMR and is perhaps the largest epidemiological study of diabetes in the world. We are studying the prevalence of diabetes and related conditions in every State of the country. The study has a sample size of 1.24 lakh people and provides authentic data on the prevalence of diabetes, hypertension , obesity etc. in the whole country. This has provided data on the prevalence of diabetes in urban and rural India and the changing trends and thereby helped the policy makers in framing policies for prevention and control of diabetes.
We have also been working on genomics (genetics of diabetes) and these studies have led to the development of a new field in diabetes called “Precision Diabetes”. In fact, we are just launching perhaps the world’s first department of Precision Diabetes at Dr. Mohan’s Diabetes Specialities Centre. It will help us in accurate diagnosis and treatment of various forms of diabetes.
Tell us about your work in terms of diabetes prevention?
Our epidemiological studies showed that not only is there a huge burden of diabetes in India (70 million people with diabetes) but an even greater burden of pre-diabetes (80 million people). This is worrying because we have also shown through our studies that Indians tend to progress much faster to diabetes from the stage of pre-diabetes compared to any other ethnic group which has been studied.
On the other hand, it also gives us a huge window of opportunity to prevent diabetes. We first started with community-based lifestyle changes programme, which we implemented in the Asiad Colony at Thirumangalam in Chennai where the residents built a park with their own resources. This led to a slowing down of the diabetes epidemic in and around that colony, thanks to the increase in physical activity.
This then led us to take up a mega prevention trial, called the D-CLIP Diabetes Prevention trial, where we enrolled 600 people with pre-diabetes and put them through a lifestyle improvement programme, including healthy eating and increased physical activity. The results were amazing. Up to 32% of people with pre-diabetes could be prevented from developing the disease.
If this programme can be scaled up to the rest of the country, it can help millions of people prevent the disease. All that is needed is to make diet a little healthier and include at least 30 minutes of walking everyday.
What would you say about the many diabetes-control diets being prescribed?
Every now and then the some fad diet is introduced, usually with commercial interest. While I have nothing against such diets, the problem is that they tend to be extreme diets which work in the short term but are not sustainable in the long term. Moreover, they can lead to nutrient imbalances.
One example is the Paleo diet, which is the latest craze in India. By switching to Paleo diet, which has near-zero carbohydrate, dramatic results in weight reduction can be achieved. However, when 60 to 70% of our total calories in India come from carbohydrate, to go on a zero-carbohydrate diet is not sustainable in the long run. Moreover, when people stop such extreme diets, they tend to put on weight again and all the metabolic problems recur. Instead of doing this, we would suggest taking a balanced diet.
Undoubtedly, the carbohydrate has to be reduced as the main culprit is polished white rice in the south and east of India and wheat in the north and west of India. We suggest that instead of highly polished white rice, high-fibre white rice or brown rice can be consumed. More importantly, the protein and fibre content has to be increased by adding plenty of legumes and pulses like Bengal gram, green gram, black gram and soyabean.
Equally important is to add plenty of green leafy vegetables and fruits to the diet. These will give the necessary vitamins, minerals, iron and other nutrients and also help to balance out the diet.
Where does our country stand in the field of diabetes research?
Taken as a whole, the quantum of research done in general and diabetes in particular is still far from adequate in India. The number of doctors involved in research is abysmally small and even when some research is done, it is mostly some clinical report of an interesting case that they have seen.
Extensive work has been done on the epidemiology of diabetes, genomics of diabetes, diabetes in the young, on the complications of the disease and the way Indians respond to various therapies. There has also been a lot of work on the low birth weight hypothesis and how under-nutrition, especially in utero, can lead to the diabetes epidemic. Having said this, a lot more work needs to be done in the field of diabetes research.
What are the areas of research where government intervention is required?
Government intervention is required at all levels of diabetes research. There are several projects which can be done in the field of diabetes prevention to reduce the burden of the disease in India. There are also several unique features of diabetes in India, for eg. it affects Indians at a much younger age and even in the absence of severe obesity, as seen in the west. The exact reasons for these are still not understood. The government can give more subsidy to the farmers to help them in the production of fruits and vegetables. India already had a ‘green revolution’ and ‘white revolution’, what we now need is a ‘fruit and vegetable revolution’.
