Diabetes Awareness Month: Why diabetes doesn't spare active, lean people? Doctor gives reasons

In simple terms, diabetes is a condition that occurs when blood glucose is too high. However, it is a heterogeneous metabolic disorder. This means that it's not a single disease with a single cause. Diabetes is actually a diverse group of issues, which look the same - high blood sugar - on the surface. They can be driven by very different mechanisms underneath. On this Diabetes Awareness Month, Dr Johns T Johnson, Consultant Endocrinologist of Mar Sleeva Medicity, Palai, explains why the condition is being recognised in people who look healthy, lean and are even physically active.

Why being active isn't complete protection
Physical activity and a healthy body weight can reduce the risk of diabetes, but they do not provide complete protection against diabetes, says Dr Johns. He gives the following reasons for the same.

Genetic predisposition: Family history and genetic susceptibility play a significant role in diabetes. Some individuals have an inherently limited capacity to compensate for insulin resistance (diminished beta cell reserve)
Excess abdominal and abnormal fat deposition: A person may have excess visceral fat despite a normal BMI. Fat accumulation in the liver and pancreas can impair metabolic function.

Early-life programming: Intrauterine malnutrition, low birth weight and adverse early-life exposures may influence future metabolic risk.
Other diabetes phenotypes: LADA (Latent Autoimmune Diabetes in Adults), MODY(Maturity-Onset Diabetes of the Young) and other forms of diabetes can occur in people who are physically active and not obese. LADA is a type 1 autoimmune diabetes that develops in a person's adulthood. It's a slow-progressing form of the disease, which happens due to miscommunication in a person's system, mistaking its own healthy tissues as a foreign threat. Meanwhile, MODY is an inherited type of diabetes caused by a mutation of a single gene.

Why Keralam is labelled the diabetes capital
According to the ICMR-INDIAB (Indian Council of Medical Research - India Diabetes) study, Keralam has approximately 24% diabetes prevalence. And as per the National Family Health Survey (NFHS) - 6, 31.9% men and 28.9% of Kerala women have high blood sugar, or are taking diabetes medication. These factors make Kerala among the states with the highest burden in India.

Dr Johns says Keralam's diabetes burden is due to multiple reasons. "It's likely the result of an interaction between genetic susceptibility, visceral adiposity, dietary transition, physical inactivity, ageing and improved disease detection.

We should also move beyond the traditional perception that diabetes is exclusively a disease of obesity and sedentary individuals," he explains. As for why there is higher diabetes prevalence among men, he says, "It's likely multifactorial and involves differences in fat distribution, lifestyle, hormonal influences and healthcare-seeking patterns. However, as NFHS-6 is a cross-sectional survey, we cannot establish which of these factors is responsible for the difference."