KOCHI: Alarmed by the rising rate of diabetes among youngsters, experts have advised extreme care to avoid complications including amputation. Out of the total diabetic patients who underwent major amputations at the Amrita Hospital in Kochi, the percentage of those below 50 years was only 7.9 per cent in 2012. This shot up to 15.1 per cent in 2016 and 24.3 per cent in 2019.
"There has been a three-fold increase in the number of major amputations in diabetic patients below the age of 50 over the last decade," said Dr Harish Kumar, head of the department of endocrinology and diabetes at Amrita.
"It takes about 10-15 years of poorly controlled diabetes to develop complications like peripheral neuropathy and peripheral vascular disease. If one develops diabetes at 50, then the risk of major foot complications emerges at around 65. However, if diabetes starts earlier at 30-35 years, then the patient is at risk of major foot complications and amputations by 45-50," he said.
Also, many are not aware of safe insulin injection techniques. "Patients must be aware and opt only for single-use pen needles and insulin syringes to curb the risk of complications and poor glycemic management due to incorrect injection technique," said Dr Mathew John, consultant endocrinologist, Providence Endocrine and Diabetes Specialty Centre, Thiruvanathapuram.
According to Dr Harish, about 15 per cent of diabetic patients will go on to develop foot complications at some time in the course of their disease.
Complications of long-standing, uncontrolled diabetes like peripheral neuropathy (resulting in loss of sensation in the feet) and peripheral vascular disease (resulting in loss of blood supply to the feet) set the stage for diabetic foot ulcers which may be associated with severe infections leading to multi-organ failure and a life-threatening situation.
In the COVID pandemic, diabetic patients were one among the worst affected, even post-Covid issues looms them at large. "COVID infections certainly have an outcome in patients with diabetes, they are at high risk of developing serious health problems. Patients with long-standing diabetes of 10-20 years would already have some degree of certain comorbidities or health conditions in heart, lungs, kidneys, and so on. Also, Covid infections become very severe in diabetic patients as their immunity will be already compromised," said Dr Harish.
"Even after the recovery from covid, diabetes patients tend to face a lot of prolonged illnesses, like persistent body pain, and low stamina. Many of the patients with diabetes have also reported that their diabetic level controls significantly gone up even after a mild attack of COVID. The reason for this is not very clear to medical science yet. There have been a number of new diabetes cases which have been reported following covid infections in Kerala. Research in these areas is still ongoing on the cause for this. Since there is a high risk for diabetic patients, they should get vaccinated on time and observe all the protocols to prevent covid infections and not to take this matter lightly," said Dr Harish.
DDRC SRL Diagnostics, an advanced path lab chain, did a retrospective data analysis of over 4, 76,440 samples that were tested for HbA1c over a four-year period. Individuals who had performed the glycosylated or glycated hemoglobin (HbA1c) test in the past 4 years were considered for this analysis. HbA1c is used for both screening and diagnostic purposes and is used widely by clinicians to assess glycaemic control in diabetic individuals.
Of the 4, 76,440 samples that were tested for HbA1c at DDRC SRL Diagnostics over a period of four years, 18 per cent reported normal values, 22% were found to be prediabetic and 60% were diabetic.
Amongst males, 22 per cent of samples were found to be prediabetic and 62 per cent were found to be diabetic. Amongst females, 23 per cent of samples were found to be prediabetic and 57 per cent were found to be diabetic.
Amongst the samples tested in the age group between 31 and 45, 24 per cent of samples were found to be prediabetic and 44 per cent were found to be diabetic.
"Kerala has the highest incidence rate for Diabetes in India. Genetic risk plays a smaller role when compared to lifestyle parameters that contribute to the onset of diabetes. HbA1c is the most reliable test in the management of diabetes as multiple variables affect the result analysis of fasting and post-prandial blood sugar tests," said Dr Ajith Joy, director, DDRC SRL Diagnostics, Kerala.
"The 90-120 days average blood sugar values indicated by the HbA1c test enable doctors and patients to work towards attaining good diabetic control. Statistics point out that over 65 per cent of diabetics on medication are out of control in Kerala. Uncontrolled diabetes leads to multiple long-term complications like increased risk of heart disease and stroke, loss of eyesight kidney, and liver issues. Our goal is to spread awareness on good control of blood sugar levels to prevent complications and lead a healthy life," he added.