Diabesity is a complex syndrome whereby obesity progresses to diabetes with overlapping symptoms of insulin resistance, hyperinsulinemia, hyperglycaemia, dyslipidaemias and inflammation.

The passage from obesity to diabetes mellitus is made by a progressive defect in insulin secretion coupled with a progressive rise in insulin resistance. Both insulin resistance and defective insulin secretion appear very prematurely in obese patients and both worsen similarly towards diabetes.

The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases.

As per study coded in Functional Foods in Health and Disease 2017; 7(1): 1-16. Diabesity has emerged as a major threat. This condition has been described as a slow poison, whose influence cannot be controlled or cured.

Risk Factors:  

• Waist circumference (more than 35 and 40 inches in females and males respectively),
• BMI (more than 25),
• Hypertensive and
• Family history of diabetes were found to be correlated with pre-diabetes.

In recent years, the prevalence of diabetes, as well as pre-diabetes, has significantly increased in India. The prevalence of pre-diabetes — also known as “impaired glucose tolerance” is a precursor to diabetes.

People with Pre-diabetes are at a very high risk of developing Type 2DM and as per recent updates in addition to the 425 million diabetics worldwide, there are 352.1 million adults with impaired glucose tolerance (IGT) or Pre-diabetes, who have a very high chance of developing full blown diabetes in the future. Though out of these, not all become diabetic, the conversion rate varies from population to population and from region to region.

In India, The ICMR INDIAB Study, which included both urban and rural population across 4 major Indian states (8.3% in Tamilnadu, 12.8% in Maharashtra, 8.1% in Jharkhand and 14.6% in Chandigarh) identified a conversion rate from pre-diabetes to diabetes, ranging between 7.1 % - 15.2%..

The overall prevalence of pre-diabetes in all 15 states* was 10·3% (10·0–10·6). The prevalence of pre-diabetes varied from 6·0% (5·1–6·8) in Mizoram to 14·7% (13·6–15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance.

(Data source: Lancet Diabetes Endocrinol., 1-12, 2017)

{*States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the north eastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015.}

For non-clinical management of Diabesity, weight control is an important part. Diet and exercise intervention should be initiated early and should continue throughout the duration of the treatment.

A combo approach through exercise, diet and medicine is needed to save trapping lives in pre diabetes, borderline diabetes. The condition can never be cured but can be controlled with early diagnosis.

The individuals who are prone to diabetes should avoid the following factors in order to prevent the pre-diabetes:

1. Di- Dietary irregularities
2. a- attitude irregularities.
3. be- behavioural irregularities
4. te- tension creating atmosphere.
5. s- Sickness leading/originating factors.

Cytokine TNF- α has been implicated in insulin resistance.  Insulin resistance is primary metabolic defect in type 2 Diabetes mellitus. Pterocarpus marsupium (Vijaysar) extract decreases elevated TNF- α levels along with its potential blood glucose lowering effect. Keeping in view an Ayurvedic formulation BGR -34 was launched by CSIR research units (NBRI & CIMAP). BGR-34 contains Pterocarpus marsupium (Vijaysar) along with five more potent anti-diabetic herbs viz Berberis aristata (Daruharidra), Tinospora cordifolia (Giloe), Gymnema sylvestre (Gudmar), Rubia cordifolia (Manjistha) and Trigonella foenum graecum (Methi) which are efficient to control pre-diabetes / impaired glucose tolerance.

Recommendations

• Eat nutritious high fibre food.
• The designing of a smart diet (i.e. healthy diet)
• Walk fast, run, and swim or play at least 30 minutes a day.
• Keep healthy weight & Waist to hip ratio.
• Keep blood sugar under control, if diagnosed.
• Select gut microbiota having probiotic influence on the host can target in the weight reduction/ management.