Diagnosing Diabetes Early: For Ourselves and For Those Around Us

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The Book - Atmasvasth - A Guide to Ageing Healthfully

A 15-point guide to living long, healthy

AtmasvasthBhavin Jankharia

The Detailed 15-Point Guide to Live Long, Healthy

The 15-Point Guide - Detailed

The detailed 15-points guide to live long, healthy

AtmasvasthBhavin Jankharia

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Diabetes significantly increases mortality through multiple pathways…not just vascular causes, but also cancers, infections, and other complications [1]. The impact is stark: a 50-year old man with diabetes faces a reduced lifespan of 6 years compared to someone without the disease.

Can early diagnosis and treatment mitigate this risk? Evidence suggests yes. The landmark UKPDS trial shows that early intensive blood sugar control (using sulfonylurea, insulin, or metformin) significantly reduces the lifelong risk of death and heart attacks, with follow-up data spanning from 2008 (10 years follow-up) [2] to 2024 (24 years follow-up) [3].

This means that early diagnosis and early treatment of diabetes is crucial to our atmasvasth quest to live long, healthy. I wrote about this first in Sep 2021.

Screening for Diabetes - When, How and How Often

All Indians above the age of 30 years should be screened for diabetes with fasting plasma glucose, OGTT and/or HbA1c, preferably every year.

AtmasvasthBhavin Jankharia

The ICMR guidelines in India mandate that everyone above age 30 should undergo regular diabetes screening with a fasting blood sugar (FBS) test. However, India faces a critical testing gap. According to the National Family Health Survey (NFHS-5) [4], one in every four diabetics remains undiagnosed…especially in the 15-49 age group.

The recent NCD Risk Factor Collaboration (NCD-RisC) study published in the Lancet [5] describes the scale of this problem.

• 212 million adults (15% of the population) have diabetes.
• An estimated 53 million have undiagnosed diabetes.
• Nearly 28% of individuals over 15 years old (1 in 4) are diabetic.
• 133 million people over 30 are untreated diabetics (9.5% of the population).

Two recent studies have further emphasized the critical importance of early diagnosis and intensive treatment. The first is The Emerging Risk Factors Collaboration study published in the Lancet that found that individuals diagnosed with diabetes at a younger age face a significantly higher risk of mortality. Specifically, for every decade earlier that diabetes develops, there is a 3-4 year reduction in life expectancy [6]. To put this in perspective: assuming regular annual screening, someone diagnosed with diabetes at age 30 faces a 9-12 year greater reduction in lifespan compared to someone diagnosed at age 60. 

A recent JACC study [7] reveals that cardiovascular damage begins long before the diagnosis of diabetes, with double the risk of heart events starting three decades before their diabetes is actually detected.

These findings deliver a clear message: we must screen everyone for diabetes. Early diagnosis enables early intervention to mitigate the risk of diabetes related morbidity and mortality.

And unlike cancer screening, where tests may be equivocal and carry significant downsides, FBS testing is simple, cheap (less than Rs. 150 or 2 USD), definitive, and low-risk.

What does this mean for you and I? I assume that everyone who reads this column gets their FBS and HbA1c tested regularly, at least once a year if not more frequently.

However, beyond your own health, consider your sphere of influence…friends, family, workers, co-workers, household staff, and drivers. Of every four people you know, one will be diabetic, and among diabetics, one in four remains undiagnosed. This makes it imperative to advocate FBS testing among everyone you know, even if it means covering the cost yourself.

In fact, we can significantly impact the healthspan and lifespan of those around us through three simple interventions with minimal cost and effort: two blood tests (lipids and FBS), blood pressure monitoring, and road safety awareness (helmets, seatbelts, and traffic laws).

Footnotes

1. Rao Kondapally Seshasai S, et al. N Engl J Med. 2011 Mar 3;364(9):829-841. 

2. Holman RR et al. N Engl J Med. 2008 Oct 9;359(15):1577-89. 
3. Adler, Amanda I et al. The Lancet 2024; 404: 145 - 155. 
4. Sahadevan P et al J Glob Health. 2023 Dec 8;13:04135. 
5. NCD Risk Factor Collaboration (NCD-RisC). Lancet. 2024 Nov 23;404(10467):2077-2093. 
6. Emerging Risk Factors Collaboration. Lancet Diabetes Endocrinol. 2023 Oct;11(10):731-742. 
7. Gyldenkerne C et al. J Am Coll Cardiol. 2024 Dec 3;84(23):2251-2259.