Prediabetes Alert: India's Youth at Crossroads

A recent stat of 2023 highlighted the dark fact that over 100 million Indians (77 million earlier) are now in the clutches of Diabetes - a disease that prevents your pancreas to either not produce enough insulin in order to break down (metabolise) the sugar that body receives through food intake, or restricts it's effective usage. This is just the number of identified cases who have been officially diagnosed, i.e. through either a lab test or by a doctor's consult. If one was to believe the unofficial projections of various reliable agencies, over 140 million additional cases exists in India where people are unknowingly or ignorantly sliding into the clutches of 'pre-diabetes' and they are mostly clueless of its repercussions.

A study by Indus Health Plus revealed that 26% of young India, i.e. people under the age of 40, are grappling with pre-diabetes.

Do we understand the depth, seriousness and impact of this?

Prediabetes is characterised by elevated blood sugar levels that are not high enough to be classified as diabetes but indicate a high risk of developing the disease in the future. Experts believe unhealthy diet patterns, physical inactivity, and obesity are the prime catalysts to this menace. What's unnerving is the sheer lack of seriousness towards acknowledging the potential health risks and socio-economic burden, the youth of this country are gradually progressing towards.

Let's understand some critical gaps

Diabetes or Prediabetes is categorised as a lifestyle disease. In simplest terms, it would mean diseases whose occurrence is primarily based on the daily habits of people. Here are those few much needed habits that the millennials (25 - 40 year age) ignorantly are keeping away from:

• Healthy choices of food - If you are a working professional in your 30s, living in a metropolitan of India, having a slight to modest potbelly, try remembering an entire week when you skipped ordering a meal from a food delivery app or didn't eat a quick lunch snack at a food joint. You're rare if you have a memory of such a week from your recent past. The reason why rural ageing and obesity has been progressing much slower in our country is predominantly because of their unadulterated, clean and simple eating choices (other reason is their routine physical exertion levels). Its important that we find our staple set of meal items that adds to our lives and not deducts in long term in return of that instant joy to our tastebuds. It's really not that difficult choosing a glass of Sattu over Aloo Paratha, or a bowl of Plain Dalia over Anda Bhurji. I guess our worst fear is the scare that our hunger won't be quenched if we break away from the cliched roaster we have been following since childhood. Well, the truth is, besides your age, the shape and size of your body, your power to metabolise also has changed, and we simply have somehow missed to get a pulse of that.
• Bare minimum physical activity - Gone are those days, especially in a crowded cosmopolitan city, when after the daily chores folks used to go for some outdoor sweating. Be it sports, or cycling, the core habits have taken a back seat. The OTTs and mobile in the world of internet has surely given us a new age of informed civilisation, but what it is seen to be dominantly taken away from our younger generation is the will or the motivation to move out their beds and cozy living rooms once they retire from their daily chores. Its very hard to find a rickshaw-puller, a coolie or a farmer in his 30s or 40s with lifestyle ailments, and its not too hard to guess why! In today's world its very easy to blame sedentary lifestyle on your work stress, and other complexities of your daily lives, but is it really so? I guess the way many see it is, when the challenge seems too big a hurdle to crossover, we fold. Perhaps the way ahead would be to break your daily fitness regime in a way that you start really small, yet remain 'consistent'. Small tiny steps with consistency will take you a level up in no time, and that's just it! Don't look at the 6 pack abs guy in the gym, and then curl back to your bed in agony. Instead, start small, and repeat!
• Tracking key health metrics regularly - In the past decade, especially since the cultural dawning of fast-food and junk consumption, OTT binging, untenable work life balance, fragmented family structures (shift towards nuclear families), early addiction to smoking and 2 minute noodles have become staple and disturbingly common in our livelihoods, whereas the need to start monitoring own bodily, health (physical and mental) and lifestyle changes at a younger age remains an unrealised necessity among the younger strata. Most of us understand how to keep track of our height, and weight but seldom one realises the importance of understanding their current Body Mass Index (BMI) and how it acts as a indicator for losing or gaining weight. Many of us wear smart health watches but how often you try wrapping it on your wrist a take a 2 floor stair climb while tracking your respiration rate and heart rate? That can actually tell us a lot about our ever decreasing fitness levels due to almost negligible movement other than during getting transported at work everyday. Work from home post pandemic has diminished the already minuscule physical activity to a larger extent. Tracking what and how much we eat, against how much calories we burn daily is a basic equation that can save a lot of agony and pain in the latter halves of our lives, as long as we have maintained required deficit or surplus needed by our body. Every phone (iOS or Android) offers these tracking mechanism in today's world, and there are accessible health apps that are available for free on the internet. Diabetes (commonly called as sugar) has creeped into almost every household in India, so we commonly do understand 120 mg/dL is a normal sugar reading, but knowing there is a family history of this disease do we find the awakening among ourselves to prick our finger just once and check what does the glucometers say?

"60% of patients undergoing bypass surgery in hospital had diabetes as the underlying cause", says Dr. Ambrish Mittal, Head of Endocrinology at Medanta.

• Healthy management of stress - The more you run away from, the heavier it blows over you - that's what they say about stress. Today, in such a mechanised world, stress comes in various forms. The ever lasting hunger to become the 0.1% of the food chain has eaten upon the 7 hour good night sleeps of millions. The peer pressure is so high among kids (forget the adults), that school kids are seeing puffing fags outside schools hiding behind the panwallah shop. If you have a bike, you want a car, and if you have a flat then you are in the race to buy a bunglow or something else. Don't get me wrong, I am all for striving to be the best and have a luxury filled life. BUT, I guess the point is taking a pause and understand the fact that while we exert and take pressure in our lives to have a better future, it is equally critical to figure out channels to de-stress, un-learn, unwind and reboot. Talking to a specialist, e.g. counsellor or behavioural psychologist, remains as much a taboo in India, is becoming more common than it was a decade ago. There are applications that allows you to de-stress by taking you through breathing exercises, mental evaluations and more. Expert counsellors are now a click away, ready to guide you through your mental blockade. Have friends and family around always has that special rebooting effect. Point is, we often take the simplest and shortest route - biting our nail, stressing for while, thinking binge-watching shows will take us out of it. How about we do it right, for all our sakes?

"One of the vital organs of our body which is affected by long standing stress is our heart. In response to stress, our body releases the stress hormone known as catecholamines. These stress hormones increase the oxygen demand of our body to enable our body to proactively respond to the stressor. Prolonged need for increased oxygen demand means the heart is overworking for prolonged duration." says Dr. Trideep Choudhury, Consultant Psychiatrist - Fortis Hospital

In my almost decade and a half years of career in healthcare and technology, solving diabetes management for India has been the most unique and challenging one. The fundamental question that I ask myself, being in my mid 30s and significantly exposed to the lifestyle nuances of this century, is - what is that fundamental missing mantra? Something that addresses the following questions:

1. Is there a super simple way to build awareness in India about - diabetes, pre-diabetes, its types, catalysts, ways of delaying it or prevention, and eventually ways to control it?
2. How do we convey the importance of what people eat and its long term impact on their health? Is there a way we can assist in deciding what to eat and what to avoid? Like a personal diet assistant (digital maybe?) that answers our questions as and when we are doubtful around our food, almost instantly?
3. Is there a way we can help in habit formation among Indians so that they start tracking their key vitals and health metrics, e.g. blood pressure, weight, BMI, sugar levels, etc on a regular time interval? Can we figure out an effective way to educate people on how these impact their personal, professional and social standing in short and long term?
4. How can we make diabetes management super economical and convenient for masses? Current average spend on Diabetes for India is about 24,000 INR per year (min 6K - max 65K INR) as per a survey done by one of the leading consulting firms in India. How do we bring it down considerably?
5. Is there a way the gap between a health care provider (doctors) and a diabetic person be abridged? Can we have a seamless interaction and information exchange between care giver and receiver so that even the minutest of the fluctuations and shifts can be understood by the doctors well in advance allowing them to intervene proactively?
6. Can we instill motivation, courage and consistency in a diabetic's journey towards managing their condition by making it a joyful, reward driven journey, and not like a typical patient journey where a person is half-heartedly trying to get rid of a disease?

Pondering over all this, and after bringing in the stalwarts and heroes of this speciality and science, we dug in for over 2 years and came out with a simple solution.

The Diabetes Self Management Tool (DSMT) designed by the experts at Apollo HealthCo Ltd (Apollo 24/7 - India's largest integrated healthcare digital ecosystem) has emerged as an answer to all these questions above. It all started with patient zero in 2023, and today it helps lakhs of diabetics across India at no cost. The fundamentals are well crafted:

• it allows people to log and track their sugar values, and your food intake in a simplified manner. (via "Logbook" feature)
• it tells you what to eat and what to skip (via "Know Your Food" feature)
• it allows you to connected with your doctor, by giving you a simple report and insight sharing option with your care giver. (via "Report Sharing" feature)
• it has an intelligently designed personalisation engine, that lets you know how much to eat in a day, and how much to work out (all home and basic workouts), without spending money on gym or trainers. (via "Profiling and Personalised Recommendations" feature)
• it allows you to stay informed on most recent updates around diabetes management, easy tips and tricks and much more. (via "HealthBites" feature)
• it gives you rewards in terms of credits for regularly tracking your sugar levels, which you can use to bring down your monthly or yearly spends on management of diabetes. (via "Rewards" feature)
• it gives you insights around your Average Sugar Level, Post Meal Spikes, Overnight Metabolism etc. absolutely free, if you consistently track your sugar. (via "Insights" feature)
• it allows you to synchronise your bluetooth enabled glucometers, so seamlessly log and analyse your fluctuations in sugar. (via "Smart Pairing" feature)
• it allows you to synchronise your google fit or apple health with the tool, which allows you track your daily calorie burn through walking, workouts and more. (via "Smart Sync" for Apple and Android Mobile)
• it alerts you if you are overshooting your daily calorie allowance by considering your daily calorie burn status. Basically, it tells you when to stop eating, and when to start working out to balance over eating. (via "Meal and Calorie Recommendation" feature)

If this tool helps you in any manner as you take on diabetes or pre-diabetes head on, know that at that very point, somewhere in this world we would have succeeded tad bit more, in our crusade.

Remember, Your strength is greater than any blood sugar spike! Diabetes or Prediabetes doesn't define you; your resilience, consistency and actions does.

The author leads the digital therapeutics division at Apollo HealthCo Limited (Apollo 24/7) and has led organisations and people in the past who have been instrumental in innovating and crafting solutions around some of the critical health conditions as we know. Opinion in this article are personal and based on due research, and does not reflect that of any organisation, or person whatsoever. The idea behind this article is to nudge and awaken the youth - the human capital of India, in order for them to see their health and wellbeing from a different perspective and do their best to remain away from the grasps of chronic ailments like Diabetes and Pre-diabetes.

To err is human. Please pardon the typos, if any.