Bayer Zydus Pharma, in collaboration with Prof Dr Shashank Joshi (Padma Shri awardee and President of Association of Physicians of India) and nine other imminent endocrinologists/diabetologists, conducted the STARCH study across five regions in India – North, South, East, West and Central India. STARCH stands for Study To Assess the dietaRy CarboHydrate content of Indian type-2 diabetes population. The study was conducted with the objective to assess the total and complex carbohydrate content in the daily diet of the diabetes population. Dr Joshi was the Lead Investigator for this study.
Data from the STARCH study has also been published online in the international medical journal, BMJ Open. The analysis clearly shows that the Indian diabetes population consumes higher than recommended carbohydrates in their diet (64.1% energy comes from carbohydrates).
India has the 2nd largest diabetes population with an estimate of 65 million affected people, as of 2013. This is projected to rise to 109 million by 2035 according to the International Diabetes Federation. Diet and dietary carbohydrates have a direct impact on blood glucose control (especially the post-meal blood glucose) in diabetes patients. All national and international guidelines suggest diet management as the initial mainstay for the management of diabetes. Barring a few studies, there has been no study documenting the dietary habits of the diabetes population compare to non-diabetes population across India. There was a need to conduct a dietary survey considering the diverse food habits in various parts of the country.
“Diabetes is emerging as a major health issue for India. Through the STARCH study we hope to provide medical professionals valuable insights on the carbohydrate consumption patterns across India and its impact on diabetes management. The STARCH study is our endeavor to improve the life of our patients and is in line with our mission at Bayer – Science for a Better Life” says Angel- Michael Evangelista, managing director – Bayer Zydus Pharma.
The STARCH Study provides information on the dietary carbohydrate, fat and protein contribution in food consumed by diabetes participants and also shows how it compares with non-diabetes participants across India.
The study enrolled 796 participants, from March 2012 to September 2012, from 10 sites across all regions of India. The participants enrolled in the study were divided in two groups - a) diabetes group and b) Non – diabetes group. In the study, the diabetes population was matched with the non-diabetes population with respect to age, sex, and site. Participants who were 18 years and above, of either sex and diagnosed with diabetes for atleast 12 months, were eligible in the diabetes group. A 3-day dietary recall (2-typical days in the week plus 1-Sunday) data was used to analyze the dietary findings in this study.
According to Dr. Shashank Joshi “The STARCH study highlights the fact that carbohydrates are consumed widely across India and not only in South of India. This is contrary to the myth that people in the Southern part of the country consume higher carbohydrates in their meals. Even if diabetes participants know that they have diabetes and need to follow certain diet patterns, they do not necessarily adhere to it.” In the diabetes group, the mean percentage of total energy intake from carbohydrates was 64.1%, which is much higher than the upper limit of 60% as recommended by the National Institute of Nutrition. High carbohydrate consumption amongst people with diabetes is associated with abnormal blood sugar levels, particularly the post-meal blood sugar levels.
Region wise data showed that carbohydrate consumption is more than recommended at 60% across all 5-zones, with the highest being reported in central India (67.2%).
Dr. Satinath Mukhopadhyay, Professor, Department of Endocrinology, IPGME&R and SSKM Hospital, Kolkata, also one of the investigators of the study says, “The STARCH study is an eye opener as far as the widely varying dietary habits of persons with diabetes in different parts of the country is concerned. A 'one size fits all' approach to medical nutrition therapy is unlikely to succeed in India.”
Prof Dr Anil Bhansali, Professor &Head, Department of Endocrinology, PGIME&R Chandigarh & Chairman Organizing Secretory ESICON 2014, investigator from North India says “The STARCH study substantiates our belief about carbohydrates consumption. A startling observation in our study was that our patient consumes “good” carbohydrates and reasonable amount of proteins. By this observation, anti-diabetes drugs which target dietary carbohydrates may be the first choice to treat patients.”
In conclusion to the study results, Dr Joshi says, “As clinicians, we need to ensure that the patients are provided with proper diet counselling with support from a dietician if required.”