Research in diabetes has become very pivotal to find ways and means to curb the malady’s growing menace. Raelene Kambli meets Prof (Dr) Shashank Joshi, President, Indian Academy of Diabetes (IAD) and an endocrinologist affiliated with Lilavati Hospital, Bhatia Hospital, Grant Medical College and Sir JJ Group of Hospital to learn about his research on this disease and major developments in the field of diabetes management
What is the current state of diabetes in India?
We have around 65 million people living with diabetes and around 130 million people in the pre-diabetic stage. The good news is that we have been able to bring down the rate at which diabetes was growing. Due to increased awareness about the disease and its associated complications, people are now resorting to leading a healthy lifestyle. As healthcare providers, our aim is to stop the 130 million Indians who are currently at high risk of becoming diabetic. And for this, we are constantly researching on various strategies that can help these people.
You have covered two important aspects on diabetes – obesity and hypertension, in your research. Share some insight on your findings.
Our research related to the ‘thin-fat Asian Indian’ phenotype indicated that diabetes in India is due to evolutionary enrichment of thrifty genes, which long ago enhanced survival during periods of famine. Due to this, Indians have a higher proportion of fat in their body composition and more so in the abdominal area.
Our second research work -The Screening India’s Twin Epidemic (SITE) study aimed at collecting information on the prevalence of diagnosed and undiagnosed diabetes and hypertension cases in outpatient settings in major Indian states to better understand disease management, as well as to estimate the extent of underlying risk factors. This study has opened our avenues for further studies.
What are the other research areas that you are currently working on?
We are currently working on a study that examines the association between obesity and low relative skeletal muscle mass (sarcopenia) with type 2 diabetes. Apart from this, we are also working on developing low cost solutions. We are also working on developing a mobile app to measure sugar levels. On the research front, we are working on a programme called NEAT (non exercise activity thermogenesis), which is the energy expended for everything we do apart from sleeping, eating or sports-like exercise. It is a critical component to find out how we maintain our body weight and/or develop obesity or lose weight.
As per our findings it is important to have physical activity for 60 minutes per day. This physical activity should be categorised in three different ways: working, muscle strengthening and de-stressing. The other areas of our research is based on environment disrupting hormones and the relation between diabetes and cancer.
What according to you is the way forward to curb diabetes?
The only way to keep diabetes at bay is to live a healthy lifestyle and screen for diabetes every year after the age of 20. The mantra that healthcare professionals should give their patients is ‘to strictly follow the ABCDE of healthy living (A1C level below seven, blood pressure below 120-80, cholesterol below 70, have a proper diet and exercise regularly). For this, each one should eat less, eat on time, walk more, sleep well and always keep smiling’. I always tell my patients that 1000 steps a day will keep diabetes at bay.
On the national front, India needs a nationwide comprehensive screening strategy supported by the government. We need cheaper drugs and have to increase the availability and accessibility of these drugs. As an industry, we need to build our capacity for the same. The good news from the industry’s side is that we have developed our first new chemical entity (NCE) called saroglitazar. We need more of such NCEs to be developed by Indian pharma companies.
Lastly, it is important to educate the GPs on diabetes management because it is a treatable disease which can and should be managed at the grassroot level.
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