Globalization has posed a heavy burden upon the developed and developing countries, with an increasing prevalence of chronic non-communicable diseases like diabetes. The latest report by the International Diabetes Federation (IDF) in October 2009 said India leads the world in the looming epidemic of diabetes. According to this report, India tops the list of countries with the highest number of diabetic people (50.8 million) followed by China (43.2 million), and has become the ‘Diabetes Capital’ of the world. By 2030, over 8.4 per cent of the Indian population will suffer from diabetes. The prevalence of type 2 diabetes in children is increasing in parallel with the increase in childhood obesity.

Definition of diabetes in youth is same as that for adults. But fasting plasma glucose (FPG) is preferred test for diagnosis of diabetes in children because of its easy reproducibility. Oral glucose tolerance test (OGTT) is the ‘gold standard’ for diagnosis because of its high sensitivity and specificity than FPG alone. Another advantage of OGTT is that it can detect ‘pre-diabetes’ stage where strategies for primary prevention can be applied to delay the onset of diabetes.

As per American Diabetes Association, screening for type 2 diabetes in youth is recommended only in high-risk population. As Indians are at high risk, this should be interpreted as:

• All overweight Indian (with high BMI and weight)

• Children more than ten years of age with any one of the following risk factors:

a) Family history of type 2 diabetes in first or second degree relatives

b) Signs of insulin resistance (Acanthosis Nigricans, hypertension, dyslipidemia or PCOS [polycystic ovarian syndrome])

c) Maternal history of diabetes or gestational diabetes mellitus

Fasting plasma glucose is the recommended test for screening but whenever possible GTT should be done.

Goals of therapy:

• Normalization of blood sugar

• Control of co-morbidities

• Physical activity and diet counselling

• Patient and family education

• Monitoring for complications

Non-pharmacological methods for diabetes management includes medical nutrition therapy (MNT), exercise, yoga therapy, pharmacotherapy, etc. Pharmacotherapy is considered in the management of type 2 diabetes when life style modification fails (after trial for three months) to achieve desired glycemic goal.

Oral medications: There are different groups of oral medications, which can be used singlely or in combinations.

Insulin: Insulin still remains the gold standard in managing diabetes. There are various myths and wrong notions regarding insulin use which the patients should discuss with their treating physician.

Preventive measures are important to protect economically productive group and to reduce the morbidity and mortality. It should be considered at two stages — Primary prevention and secondary prevention. Primary prevention is aimed at prevention or delaying the onset of diabetes. It mainly includes life style modification and awareness about the disease. Secondary prevention is aimed at delaying or preventing occurrence of diabetes related complications. Good blood sugar control and timely intervention is the key.

Prevalence of type 2 diabetes in Indian youth is rising at an alarming rate. Because of genetic predisposition Indians are at risk for diabetes even at lower BMI and are more insulin resistant. Apart from genetic susceptibility, low birth weight, sedentary life style, increased calories intake make individuals more prone to type 2 diabetes. Early detection and treatment remains the cornerstone to prevent complication, which causes morbidity and mortality in youth population. Nutrition therapy and physical exercise remains the first line of management. Whenever these measures fail pharmacological intervention should be considered to optimize glycemic control and to treat the complications. This awareness has to be created as a collective effort by all health care providers, family organizations, non-government organizations, government agencies and religious organizations. We all need to protect the Indian youth.

Dr Rupam Das