The incidence of diabetes in increasing in India and worldwide. Type 2 diabetes is the most prevalent form of diabetes in the world, and commonly associated with overweight or obesity. In type 2 diabetes, there is a relative reduction of the amount of insulin produced in the body (insulin deficiency), but also an inability of the body to use the insulin to full benefit (insulin resistance). Insulin is required for the body to handle glucose, and either insulin deficiency and/or insulin resistance can lead to an increase in blood glucose levels and diabetes. However, in India, it is not unusual to see diabetes in younger, normal weight or thin individuals. This type of diabetes is called Lean Diabetes.
These individuals can have a Body Mass Index or BMI (the ratio of height to weight) lesser than 25, but have higher insulin resistance. This is also called the ‘thin-fat phenotype’ or ‘metabolically obese normal weight’. In this case, people can present with a normal weight or BMI, and yet have increased intra-abdominal and sub-cutaneous abdominal adipose tissue (fat inside the abdomen and under the abdominal skin rather than under the skin elsewhere).
This distribution of fat happens within the body clusters in unusual sites around vital organs such as the liver, pancreas, and within the muscle, which increases insulin resistance and can lead to diabetes.
Sarcopenia, the loss of muscle mass, may also be of particular significance in the Indian population. Research also suggests that individuals with lean diabetes may progress to require treatment with insulin earlier, indicating that there may also be a component of insulin deficiency as well.
We know much less about lean diabetes than about the traditionally well-recognized type 2 diabetes associated with obesity. Up to one out of every three people diagnosed with diabetes in urban India may have lean diabetes. Some research suggests that the risk of lean diabetes is increased due to poverty or poor socio-economic status, malnutrition during childhood, or if it occurs at a younger age.
There may also be genetic factors associated with this increased risk. These individuals can present without the other conditions called metabolic syndrome that we associate with type 2 diabetes like high blood pressure, abnormal cholesterol profile (especially raised triglycerides), and an increased waist circumference.
Despite this, those with lean diabetes may have an increased risk of health issues such as cardiovascular events like heart attacks, and increased risk of fatty liver disease called NAFLD or NASH.
It is important to identify individuals with lean diabetes, as this may allow treating doctors to adapt the lifestyle and medication prescribed to address the specific issue of insulin resistance.
Although individuals with diabetes are usually advised to lose weight, those with lean diabetes may benefit from exercise even if they do not lose weight, as exercise is recognized to improve insulin resistance.
Exercise, especially resistance training, will also increase muscle mass and improve insulin sensitivity in the muscle. There are also certain specific medicines used for diabetes, called insulin sensitizers, that may reduce insulin resistance and may be particularly suitable for use in lean diabetes.
If you have a family history of any kind of diabetes, but especially diabetes occurring at a younger age, or in individuals who are normal weight or thin, there are certain precautions you can take to reduce the risk of diabetes or delay the onset of diabetes.
* Stay active
* Exercise regularly
* Keep your body weight in the normal range
* Do some strength training exercises to preserve muscle mass
* Eat healthy
* Have a healthy sleep schedule
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