India is experiencing a rapidly escalating `epidemic' of Type II Diabetes and has an estimated population of around 25 million diabetic patients. This was revealed by a recent survey conducted by Dr CS Yajnik of KEM Hospital, Pune.

In his survey of six cities in the country, 12per cent were found to be diabetic and 14per cent had impaired glucose tolerance, representing a more than five-fold increase over the last 30 years. In the near future, he said, this number is also predicted to rise to 57 million by the year 2025.

Providing further details, he said, Indians as a group are insulin resistant compared to many other populations and manifest features of the insulin resistance syndrome (IRS). This is due to our characteristic body composition.

According to Dr Yajnik, the current diabetes epidemic in India is traditionally attributed to thrifty genes which helped survival in the past when food supply was intermittent but have become detrimental in the modern context of plentiful food and reduced physical work. "A recently proposed alternative explanation is the thrifty phenotype hypothesis, which proposes that persistent metabolic and structural changes caused by foetal under-nutrition increase the risk of type II diabetes,'' he clarified. This also gives rise to coronary heart disease which is also a rising epidemic in the country and is expected to be the leading cause of death in India by the year 2015, added he.

In several studies, low birth weight is used as an indicator of foetal under-nutrition. Indian babies are among the lightest in the world and might be expected to be at increased risk of type II diabetes and coronary heart disease.
As per his observations, Type II is mainly found in the urban adults, younger than 35 years of age. Besides the high genetic susceptibility as the possible cause for this, the migration from rural to urban areas imply additional powerful environmental influences on risks operating in adult life.

"However, the main environmental detriment of both diabetes and CHD in Indians is obesity, particularly when centrally located,'' he pointed out.

He further revealed, "At the KEM Hospital Diabetes Unit, we have been actively involved in studying the determinants of insulin resistance in Indians, especially the phenotype and body composition that might predispose the insulin resistance syndrome''

In his concluding remarks, Dr Yajnik expressed grave concern saying, `These observations imply a future risk of a major public health crisis with continuing rural-to-urban migration and progressive aging of the population as a result of increasing life expectancy.''