WHAT IS DIABETES?

Glucose is metabolised to generate energy for the normal functioning of every cell in our body. We know, this glucose is derived from digestion of carbohydrates we eat. Once absorbed, glucose is carried by the blood to every cell. Insulin, a critical hormone in our body, produced in the beta cells of pancreas, helps glucose to enter every cell for normal energy production. Thus, the amount of glucose in the blood is controlled primarily by the action of insulin.

So, if the human body fails to utilize glucose when insulin fails to push glucose into the cells (insulin resistance) or there is inadequacy of the insulin production by the beta cells of pancreas; as a result, blood glucose levels increase causing Diabetes. When diabetes (insulin resistance) is developed due to hereditary factors or lifestyle irregularities or due to the impact of other diseases / impact of other medicines, it is called Type 2 diabetes (the most common type). On the other hand, when diabetes happens due to destruction of beta cells by the body’s own immunity attack or due to some environmental reason is known as Type 1 diabetes (rare and serious type, quite often seen to develop from childhood).

How common is this?

Diabetes is on a global pandemic alert. In 2020, according to International Diabetes Federation (IDF), 46.3 Crores of people had diabetes in the world. India alone has around 7.7 Crore diabetics, making it the second largest in the world (next to China). This means, one in every six diabetics of the world is from India! More importantly, IDF projected the Indian diabetics number to reach as high as 13.4 Crores by 2045¹.

In India, type 1 diabetes is relatively less prevalent. Only about one-third of type 2 diabetics in India are overweight or obese². A 2004 study suggests that the prevalence of type 2 diabetes in Indians may be due to environmental and lifestyle changes resulting from industrialization and migration to urban environments from rural areas³.

How risky is this?

diabetes-symptoms

When diabetes remains uncontrolled, i.e., glucose remains at a high level in the blood (termed as hyperglycaemia) for a considerable time, it causes impairment to the blood vessels and blood flow. Thus, supply of oxygen and nutrient-rich blood gets curtailed to the vital organs and nerves of our body. That’s how hyperglycaemia / diabetes causes damage to the body and organ-failure.

People with diabetes have increased risk of developing many ‘associated health problems’ (comorbidity) of heart, blood vessels, eyes, kidneys, nerves. Researchers found through analysis of electronic health records (EMR) that 97.5% of patients of diabetes had at least one comorbid condition; 88.5% had at least two! Most common co-morbidities were:

  • Hypertension: 82% +
  • Overweight or Obesity: 78% +
  • Hyperlipidaemia: 77% +
  • Chronic kidney disease (CKD): 24% +
  • Cardiovascular disease: 22% approx.

Diabetes can also cause damage to the nerves throughout the body. The most affected areas are the extremities, in particular the feet. Peripheral neuropathy (nerve damage) can cause discomfort, pain, tingling, numbness, and loss of feeling. Loss of feeling is important as it can allow injuries to get overlooked, leading to serious infections and even amputations.

People with diabetes also develop some form of eye disease causing reduced vision or blindness. Consistently high levels of blood glucose (alone or together with high blood pressure) are the main cause of blindness.

Useful Nutraceutical Supplementation

Many nutraceuticals have been used and found to be impactful (favourably modulate biochemical and clinical endpoints) to the pathogenesis of diabetes, metabolic syndrome, and their complications⁴.

“In a new study from the University of South Australia, researchers have examined the efficacy of some of the most commonly used supplements (‘nutraceuticals’) to manage diabetes and its risk factors.

The review found that the nutraceuticals resveratrol (a compound from grapes), curcumin (from turmeric) and cinnamon were all effective in combatting various elements of diabetes, including regulating glucose, improving insulin resistance, and reducing cholesterol⁵”.

“Recent research has provided the scientific basis for “traditional” curcumin and confirmed the important role of curcumin in the prevention and treatment of diabetes and its associated disorders. Curcumin could favourably affect most of the leading aspects of diabetes, including insulin resistance, hyperglycemia, hyperlipidemia, and islet apoptosis and necrosis⁶”.

“Numerous in vitro and in vivo studies have provided strong evidence for investigating curcumin efficacy against type 2 diabetes mellitus. Data reported in this review show that curcumin has therapeutic potential to counteract diabetes and its complications. All the described studies have shown that doses of up to 12 g per day of curcumin are safe, tolerable, and non-toxic. The functional mechanism by which curcumin exerts its effect appears to be the modulation of many signalling molecules. However, this mechanism is not completely clear, due to the complexity of the disease. Based on clinical trials, the clinical efficacy of curcumin seems promising. However, this nutraceutical has poor bioavailability and limited adverse effects reported, representing a major limitation to the therapeutic utility⁷”.

"The clinical efficacy of the native curcumin is weak due to its low Bio-availability and high metabolism in gastrointestinal tract. During last decade, researchers have come up with different formulations with a focus on improving the bioavailability of curcumin. As a result, a significant number of bioavailable curcumin-based formulations were introduced with the varying range of enhanced bioavailability. Based on a review of these studies, it is evident that better bioavailability of formulated curcumin products is mostly attributed to improved solubility, stability and possibly low first-pass metabolism.⁸"

References:

1. Ramya Kannan , India is home to 77 million diabetics, second highest in the world, Nov 2019,

2. Diabetes in India

3. Mohan, V. (June 2004). "Why are Indians more prone to diabetes?". The Journal of the Association of Physicians of India. 52: 468–474. ISSN 0004-5772. PMID 15645957.

4. Nimesh S, Ashwlayan VD. Nutraceuticals in the management of diabetes mellitus. Pharm Pharmacol Int J. 2018;6(2):114‒120. DOI: 10.15406/ppij.2018.06.00166
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

5. Beating Diabetes: Is There a Role for Nutraceuticals?

6. Zhang DW, Fu M, Gao SH, Liu JL. Curcumin and diabetes: a systematic review. Evid Based Complement Alternat Med. 2013;2013:636053. doi: 10.1155/2013/636053. Epub 2013 Nov 24. PMID: 24348712; PMCID: PMC3857752.
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

7. Pivari F, Mingione A, Brasacchio C, Soldati L. Curcumin and Type 2 Diabetes Mellitus: Prevention and Treatment. Nutrients. 2019 Aug 8;11(8):1837. doi: 10.3390/nu11081837. PMID: 31398884; PMCID: PMC6723242.
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

8. Jamwal R. Bioavailable curcumin formulations: A review of pharmacokinetic studies in healthy volunteers. J Integr Med. 2018 Nov;16(6):367-374. doi: 10.1016/j.joim.2018.07.001. Epub 2018 Jul 4. Erratum in: J Integr Med. 2019 Jul;17(4):310. PMID: 30006023.

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