Written by Editorial Team |Updated : November 25, 2024 5:01 PM IST
Diabetes Risk Factors: Most people associate Type 2 diabetes with obesity or excess weight, assuming normal-weight individuals are immune to the disease. Nothing can be farther from the truth!
While weight does play a role, diabetes can strike people across the spectrum of body sizes. It is important, therefore, to know more about 'Lean Diabetes', a variant of Type 2 diabetes, discover its lesser-known nuances and recommend methods and behaviours for its prevention and management.
For starters, let's understand what the term 'lean' indicates
The Body Mass Index (BMI), is the gold standard to classify body types for health-related categorizations. Based on the BMI, individuals are classified into the following distinct groups: A person having a BMI of less than 18.5 is classified as underweight, 18.5 24.9 as normal (healthy weight: height ratio), 25.0 29.9 as overweight, and 30.0 and above as obese.
In the past, people in the lean/normal range BMI i.e. less than 25 kg/m2, were considered low risk for diabetes. A recent study on 'Lean Diabetes Mellitus from India, involving 10000 individuals with Type 2 diabetes revealed that around 3.5% of patients were underweight, with a BMI < 18.5, with the larger share of around 63% of patients having ideal body weight at the time of diagnosis. The findings indicated that only a third of patients were either overweight or obese.
Originally referred to as Atypical Diabetes or MODY (Maturity Onset Diabetes of the Young), Lean Diabetes was more common in individuals coming from less privileged socioeconomic backgrounds or those who have faced post-natal or childhood malnutrition. However recent studies suggest that every Indian is at high risk of developing diabetes, despite lower body weights.
What could be the mechanisms of Lean Diabetes?
The general belief is that Type 2 diabetes is caused particularly by an unhealthy obesogenic diet, leading initially to insulin resistance (inadequate insulin action despite high insulin levels in response to eating) leading to impaired glucose tolerance and then to clinical diabetes. By contrast, individuals with Lean Diabetes appear to have insulin insufficiency (low levels of insulin secretion in response to glucose load) due to a variety of reasons including smaller pancreas with lower number of insulin-producing islet cells, high glucose output by the liver along with many other reasons including genetic reasons, programming during intrauterine life and air pollution. While the exact cause of Lean Diabetes is not yet known, what we do know is what we can do once we develop diabetes and how to prevent it.
Diet plays a major role both in the prevention and management of diabetes. Traditionally, Indians from across the country consume a diet that is high in carbohydrates. Further, the carbohydrates that we consume have a high glycemic index (GI). GI is a measure of how fast glucose is absorbed in the gut and released into the bloodstream. Given an arbitrary number of 0-100, with 100 being the highest, it is a useful dietary measure to understand how certain foods raise blood sugar levels. For example, pure glucose as found in certain commercial products, or refined sugar when consumed straight have a GI of 100. A GI of 70 or more is considered to be high, and foods with high GI include refined flour, white rice, cornflakes, starchy vegetables such as potatoes and highly ripened fruits. By contrast low GI foods include all non-starchy vegetables, whole grain millets, pulses and most non-vegetarian foods.
In terms of the prevention of Lean Diabetes, a plate method (figure) has been suggested where the plate is divided into three parts and a variety of foods are suggested in three main portions. Each portion is further subdivided into three and foods that are somewhat unhealthy but are part of many people's diets are included. Portion control is an important aspect, both in the prevention and management of diabetes. It is important that we do not overeat during any meal. However, if we do overeat, we must make adjustments in the next meal. In addition to low carbohydrates, a high protein and healthy fat consumption is advised. This includes lentils, nuts, low-fat yoghurt, milk, fish , chicken and other lean meat. Nuts should be consumed in moderation as they have high energy content and can increase weight.
Low physical activity or exercise and a sedentary lifestyle can increase the risk of diabetes. Sedentary living or prolonged periods of sitting can disrupt metabolism and lead to insulin resistance. Therefore, it is important that we stand at least once, after every half an hour of continuous sitting. In addition, a leisure time physical activity of 30-60 minutes of brisk walking every day, depending on body weight (people with normal weight can walk for 30 minutes/day) will help. Muscle strengthening and stretching exercises should be done at least twice a week for 10-15 minutes on each occasion.
Stress, though not recognized easily, is an important risk. Originally acquired as a body's "fight-or-flight" protective response when man was a hunter-gatherer, it has become a liability in the modern world. Stress can trigger hormones like cortisol which can increase blood sugar contributing to diabetes risk. It is important to learn coping mechanisms of stress through Yoga or other methods. Physical activity is a great stress buster.
Despite the presence of risk factors, a few simple, proactive measures can significantly reduce an individual's chances of developing Diabetes both in lean and obese individuals.
Maintain a healthy diet and focus on fruits, vegetables, whole grains, and lean protein, limiting processed foods and sugary drinks
Early diagnosis is crucial for effective management. Be aware of these potential warning signs of lean diabetes:
A visit to a doctor and a few simple blood tests can help in assessing blood sugar levels. In some cases, genetic testing can identify specific subtypes of Lean Diabetes.
Remember, Lean Diabetes, while challenging, is manageable with the right approach. By understanding the risk factors, taking preventive measures, and seeking timely diagnosis and treatment, it is possible to live a healthy and fulfilling life.
(This article is authored by Prof (Dr) D. Prabhakaran, Executive Director, Centre for Chronic Disease Control)
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