Volume: 7, Issue: 1, Year: 2023

Scientific Research Journal of India

From the Desk of Editor-in-Chief

Dear esteemed colleagues, readers, and contributors,

As we unveil the first issue of the seventh volume of the Scientific Research Journal of
India (ScReJI), it brings me immense pride and satisfaction to see how far we have
journeyed since our inception in 2012. Over these years, ScReJI has steadfastly
positioned itself at the heart of the multidisciplinary scientific discourse, championing
not only pioneering research but also ensuring the propagation of quality, peer-
reviewed knowledge to our global academic community.

The ever-evolving nature of science demands continuous dialogue, collaboration, and

inquiry. The essence of ScReJI lies in facilitating such interchanges by bridging various
branches of sciences and thereby fostering an integrative understanding of the universe
and our place in it.

In this issue, we have curated a collection of articles that span an array of subjects -
from the fundamental building blocks of matter to the complexities of human behavior,
and from groundbreaking technological advances to intricate environmental dynamics.
Our authors, coming from various corners of the world, have showcased their deep-
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Impact Factor. Such recognitions affirm the relentless dedication and efforts of our
editorial team, reviewers, and of course, our contributors.
 Scientific Research Journal of India (ScReJI)

However, as we celebrate our achievements, we remain deeply aware of the challenges

ahead. The landscape of scientific publishing is rapidly changing. Open access, while
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peer review, combatting the scourge of predatory publishing, and navigating the
evolving digital landscape are all matters of paramount importance.

As we journey ahead, our commitment remains unchanged: To provide a platform for

authentic, high-caliber research that can shape the world of science and influence
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To our contributors, we express our deepest gratitude for entrusting us with your
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cornerstone of our growth. And to the countless reviewers and editorial team members,
your dedication ensures that ScReJI remains synonymous with excellence.

With warm regards,

Dr. Popiha Bordoloi

Editor-in-Chief

Scientific Research Journal of India

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Bridging the Interface Between Nanotechnology and

Neurotoxicology: An Emergent Multidisciplinary Field with
Profound Implications for Human Health

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
Rapid advances in nanotechnology have opened up new avenues for innovation and opportunity in a number of
industries, including materials science, electronics, medicine, and energy. However, there are worries about the
possible toxicological implications of increased exposure to nanoparticles (NPs) from both anthropogenic and
natural sources. Nano-neurotoxicology, which investigates the interactions and potential negative effects of
nanoparticles on the nervous system, is one of the emerging fields of study. This study provides a thorough
examination of nano-neurotoxicology, including its methodology, state of knowledge, and potential effects on
human health.
Keywords: Nanotechnology, Neurotoxicology, Nanoparticles, Human Health, Nano-neurotoxicology,
Toxicological effects.

INTRODUCTION Nano-neurotoxicology, an emerging

Numerous scientific and technological topic of study that has gained popularity
sectors have been transformed by over the past 10 years, focuses on
nanotechnology, which has provided comprehending how nanoparticles
fresh insights and solutions to age-old interact with the nervous system and
issues. Nanoparticles have been used in their possible neurotoxic effects (Feng
a variety of applications due to their et al., 2018).
special characteristics, which are
essentially explained by their high NANO-NEUROTOXICOLOGY - AN
surface-area-to-volume ratio (Kumar, INTERDISCIPLINARY NEXUS
Kim, Ranjan, & Ramalingam, 2020). But Nano-neurotoxicology is the study of
as these nanomaterials become more potential negative effects of
prevalent, it becomes necessary to nanoparticles on the structure and
address any potential toxicological operation of the nervous system. It is a
consequences on biological systems. convergence of nanotoxicology and
 Scientific Research Journal of India (ScReJI)

neurotoxicology. It is an example of an homeostasis, and interference with

interdisciplinary research area that neuronal signalling are a few of these
incorporates information from several (Win-Shwe & Fujimaki, 2011). Changes
disciplines, including neuroscience, in behaviour, cognition, and motor
pharmacology, toxicology, materials function may be signs of the neurotoxic
science, and nanotechnology effects of nanoparticles, which may also
(Rzigalinski & Strobl, 2009). Nano-main be a factor in the development of
neurotoxicology's goal is to clarify the neurodegenerative conditions like
processes of neurotoxicity brought on Alzheimer's, Parkinson's, and
by various types of nanoparticles in amyotrophic lateral sclerosis (Bakand,
order to guide risk analysis and Hayes, & Dechsakulthorn, 2012).
mitigation tactics.
EXPERIMENTAL APPROACHES IN
MECHANISMS OF NANO- NANO-NEUROTOXICOLOGY
NEUROTOXICITY Numerous in vitro and in vivo
Nanoparticles' distinctive experimental models are used in the
physicochemical characteristics, which research of nano-neurotoxicology.
permit their vast range of applications, Cellular and molecular reactions to
also have an impact on their nanoparticles can be studied in
toxicological profiles. The main factors controlled environments using in vitro
that affect nanoparticle behaviour in models, such as primary neuronal
biological systems and their potential cultures and cell lines (Wang & Liu,
neurotoxic effects are size, shape, 2014). For instance, they enable the
surface charge, and chemical thorough examination of oxidative
composition (Oberdörster, Elder, & stress and inflammation brought on by
Rinderknecht, 2009). nanoparticles, two important causes of
Inhalation is one of the main ways that neurotoxicity.
people are exposed to nanoparticles; The environment for studying
this results in direct deposition in the nanoparticle neurotoxicity is more
nasal cavity and probable transmission intricate and physiologically relevant
to the brain via the olfactory bulb. The when conducted in in vivo models.
blood-brain barrier, a barrier that Because of the genetic and physiological
prevents hazardous compounds from similarities between rodents and
the bloodstream from entering the humans, they are frequently utilised as
brain, is bypassed by this pathway models. They make it possible to
(Oberdörster, Sharp, Atudorei, Elder, examine the behavioural and cognitive
Gelein, Lunts, Kreyling, & Cox, 2004). impacts of nanoparticle exposure,
Adsorptive-mediated transcytosis and examine the distribution of
receptor-mediated transcytosis are two nanoparticles in the nervous system,
ways whereby nanoparticles can pass and find probable neuropathological
the blood-brain barrier, potentially abnormalities (Elder, Lynch, Grieger, &
endangering the central nervous system Chan-Remillard, 2019).
(Kreuter, 2014). The investigation of nanoparticle
Nanoparticles can cause neurotoxicity distribution and potential neurotoxic
through a variety of methods once they consequences in living creatures has
enter the neurological system. Direct also been substantially eased by the
physical contact with neural structures, application of improved imaging
the production of oxidative stress and techniques, such as magnetic resonance
inflammation, changes to calcium imaging (MRI) and positron emission

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 Scientific Research Journal of India (ScReJI)

tomography (PET) (Sosnovik, despite substantial advancements. For

Nahrendorf, & Weissleder, 2007). instance, risk evaluation is made more
Additionally, novel insights into the complicated by the variety of
molecular and cellular reactions to nanoparticles in terms of their
nanoparticle exposure are being physicochemical characteristics. It is
provided by methods like single-cell improbable that a one-size-fits-all
RNA sequencing and proteomics (Reyes, method can be used to assess the
Fossati, & Paradisi, 2019). neurotoxicity of nanoparticles.
Therefore, there is an urgent need for
IMPLICATIONS FOR HUMAN HEALTH the creation of thorough and consistent
The possible neurotoxic effects of testing protocols for nanoparticle
nanoparticles have important health neurotoxicity.
repercussions on people. The risk of Furthermore, it is yet unclear how
inhaling nanoparticles among workers nanoparticle neurotoxicity works. In
in sectors that use nanomaterials makes order to create safer nanoparticles,
occupational exposure to nanoparticles future research should focus on
a serious concern. Additionally, elucidating these pathways at the
consumer products and environmental molecular and cellular levels.
contaminants are increasing the general Finally, in the age of nanotechnology,
public's exposure to nanoparticles the study of nano-neurotoxicology is
(Hougaard, Hansen, Jackson, & crucial. We can ensure the safe and
Kyjovska, 2016). responsible use of nanotechnology by
There are worries that persistent improving our understanding of
nanoparticle exposure could aid in the nanoparticle neurotoxicity and
emergence of neurodegenerative informing risk assessment and
illnesses given the evidence of mitigation techniques.
nanoparticle neurotoxicity. Alzheimer's
sufferers' brain tissue has nanoparticles, ACKNOWLEDGMENTS
which may play a role in the disease's None.
development (Liu, Guan, Xu, Li, & Ruan,
2019). However, a definitive causal CONFLICT OF INTEREST
relationship between exposure to None.
nanoparticles and neurodegenerative
disorders is still being investigated. REFERENCES
Additionally, the use of nanoparticles in Bakand, S., Hayes, A., & Dechsakulthorn,
medicine, particularly for the delivery of F. (2012). Nanoparticles: a review
drugs to the brain, raises questions due of particle toxicology following
to their possible neurotoxic inhalation exposure. Inhalation
consequences. Although they can help Toxicology, 24(2), 125-135.
drugs traverse the blood-brain barrier, Elder, A., Lynch, I., Grieger, K., Chan-
nanoparticles may have neurotoxic Remillard, S., Gatti, A., Gnewuch,
adverse effects that need to be carefully H., Kenawy, E., Korenstein, R.,
studied and minimised (Khan, Imran, Kuhlbusch, T., Linker, F., Matias, S.,
Khan, & Khan, 2019). Monteiro-Riviere, N., Pinto, V.,
Rudnitsky, R., Savolainen, K., &
FUTURE DIRECTIONS AND Shvedova, A. (2019). Human
CONCLUSION health risks of engineered
The discipline of nano-neurotoxicology nanomaterials: Critical knowledge
still confronts a number of obstacles gaps in nanomaterials risk

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 Scientific Research Journal of India (ScReJI)

assessment. Nanotoxicology, Reyes, L. D., Fossati, S., & Paradisi, F.

13(6), 733-773. (2019). Single cell RNA sequencing
Feng, X., Chen, A., Zhang, Y., Wang, J., of blood–brain barrier cells
Shao, L., & Wei, L. (2018). elucidates the potential of scRNA-
Application of dental seq. Trends in Biotechnology,
nanomaterials: potential toxicity 37(11), 1135-1140.
to the central nervous system. Rzigalinski, B. A., & Strobl, J. S. (2009).
International Journal of Cadmium-containing
Nanomedicine, 10, 3547-3565. nanoparticles: Perspectives on
Hougaard, K. S., Hansen, J. S., Jackson, P., pharmacology and toxicology of
& Kyjovska, Z. O. (2016). Effects of quantum dots. Toxicology and
lung exposure to carbon Applied Pharmacology, 238(3),
nanotubes on female fertility and 280-288.
pregnancy. A study in mice. Sosnovik, D. E., Nahrendorf, M., &
Reproductive Toxicology, 61, 242- Weissleder, R. (2007). Molecular
251. magnetic resonance imaging in
Khan, I., Saeed, K., & Khan, I. (2019). cardiovascular medicine.
Nanoparticles: Properties, Circulation, 115(15), 2076-2086.
applications and toxicities. Arabian Wang, J., & Liu, Y. (2014). Use of
Journal of Chemistry, 12(7), 908- zebrafish embryos as a model for
931. assessing oxidative stress. Current
Kreuter, J. (2014). Drug delivery to the Protocols in Toxicology, 60(1),
central nervous system by 1.13.1-1.13.9.
polymeric nanoparticles: what do Win-Shwe, T. T., & Fujimaki, H. (2011).
we know?. Advanced Drug Nanoparticles and neurotoxicity.
Delivery Reviews, 71, 2-14. International Journal of Molecular
Kumar, S., Kim, Y., Ranjan, S., & Sciences, 12(9), 6267-6280.
Ramalingam, C. (2020).
Nanotechnology: A promising
approach for drug delivery. RSC
Advances, 10(47), 28037-28054.
Liu, B., Guan, X., Xu, C., Li, N., & Ruan, R.
(2019). Neurotoxicity of
engineered nanoparticles: focus on
the brain. Current Medicinal
Chemistry, 26(37), 6762-6777.
Oberdörster, G., Elder, A., &
Rinderknecht, A. (2009).
Nanoparticles and the brain: cause
for concern?. Journal of
Nanoscience and Nanotechnology,
9(8), 4996-5007.
Oberdörster, G., Sharp, Z., Atudorei, V.,
Elder, A., Gelein, R., Lunts, A.,
Kreyling, W., & Cox, C. (2004).
Translocation of inhaled ultrafine
particles to the brain. Inhalation
Toxicology, 16(6-7), 437-445.

ScReJI www.virtued.in/p/screji 4
 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Community-Based Research in Public Health: A Review of

Partnership Approaches

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
This article analyzes community-based research's (CBR) partnership approaches within the framework of public
health, shining light on their potential to alter public health research and practise. The paper examines the
background, tenets, advantages, and difficulties of CBR partnership techniques, highlighting practical examples to
shed light on the tactics that encourage fruitful community-researcher partnerships.
Keywords: Community-based research, Public Health, Partnership Approaches, Collaborative research.

INTRODUCTION CBR'S HISTORY AND PRINCIPLES

Due to its potential to close the gap CBR was developed in response to the
between academia and the community shortcomings of conventional research
and to build genuine partnerships in the approaches, which frequently ignore the
quest of long-term health improvement, knowledge and firsthand accounts of the
community-based research (CBR) has community members they are intended
attracted a lot of interest in recent years to assist (Green et al., 1995). CBR
(Israel, Schulz, Parker, & Becker, 1998). actively involves community members
As they push for a change from in all phases of the research process,
conventional "top-down" research from problem identification to data
paradigms to more collaborative and collecting, analysis, and dissemination,
participatory ones, public health with the goal of democratising
researchers are becoming more and knowledge generation and fostering
more aware of the importance of social change (Hacker, 2013).
include communities as active partners The creation of fair collaborations
in the research process (Minkler & between researchers and community
Wallerstein, 2010). This essay offers a members is a key component of CBR.
thorough analysis of the partnership These collaborations are governed by a
approaches used by CBR in public set of guiding principles that guarantee
health, outlining their tenets, the meaningful participation of all
advantages, drawbacks, and practical parties (Israel et al., 2005). These
implementations. principles include co-learning and
 Scientific Research Journal of India (ScReJI)

capacity building, which encourage the improving the outcomes for public
sharing of knowledge and the health, by encouraging the distribution
improvement of partners' capacities to and use of research findings within the
address community health issues, community (Cargo & Mercer, 2008).
mutual respect and reciprocity, which
call for acknowledging and appreciating CBR PARTNERSHIP APPROACHES'
the distinctive knowledge, skills, and CHALLENGES
resources that each partner brings to Although CBR partnership approaches
the table, and the dedication to have advantages, there are some
achieving long-term, sustainable results drawbacks as well. One of the biggest
that benefit the community (Minkler, obstacles is the possibility for power
2005). disparities between researchers and
community members, which might
CBR PARTNERSHIP APPROACHES' jeopardise the values of respect for one
BENEFITS another, collaborative learning, and fair
The advantages of CBR partnership participation (Israel et al., 2005).
approaches are numerous. By Differences in educational levels,
incorporating local knowledge and socioeconomic status, and cultural
contextual understanding into the origins, as well as the conventional
research process, these techniques can hierarchy that regards academics as
improve the relevance, quality, and experts and community people as
impact of research from a scientific subjects, can all lead to power
standpoint (Hacker, 2013). This could imbalances (Brydon-Miller, Kral,
result in the creation of initiatives, Maguire, Noffke, & Sabhlok, 2011).
policies, and procedures that are more The different expectations and
successful and better reflect the objectives that partners may have
requirements, preferences, and cultural present another difficulty. Group
values of the community (Wallerstein & members may be more interested in
Duran, 2010). producing immediate, concrete
CBR partnerships have the potential to advantages for their community than
empower communities on a social level researchers, who may place a higher
by developing their ability to address priority on scientific validity and
health inequities, encourage their active publishing outputs (Wallerstein &
participation in decision-making Duran, 2010). These discrepancies could
processes, and promote social change lead to tensions and disputes that could
(Israel et al., 2005). These endanger the collaboration and the
collaborations can also promote social research process.
justice and health equity by altering Furthermore, creating and maintaining
power dynamics and giving voice to effective CBR relationships takes a lot of
marginalised populations (Minkler, time, effort, and money, much more
2005). than is common for research
Furthermore, CBR partnerships can programmes (Minkler, 2005). Partners
establish ties between academia and the must invest in relationship
community and foster mutual trust, development, capacity building, and
opening the door for long-term knowledge co-creation, all of which
collaborations and learning require a long-term commitment that
(Christopher et al., 2008). These might not be compatible with the
collaborations can help hasten the frequent short-term financing cycles in
translation of research into practise,

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 Scientific Research Journal of India (ScReJI)

academic research (Cacari-Stone, alternative funding sources, forming

Wallerstein, Garcia, & Minkler, 2014). alliances with groups that may support
The lack of systems to ensure that the alliance, and arguing for
research benefits flow back to the modifications to the policies and
community and academic publishing procedures governing research funding.
practises that may not value community Finally, by include community people in
voices and viewpoints make it difficult the dissemination process, using
to disseminate and utilise CBR findings accessible and culturally appropriate
(Cargo & Mercer, 2008). dissemination forms, and putting
mechanisms in place to guarantee that
STRATEGIES FOR EFFECTIVE CBR research benefits the community, the
PARTNERSHIPS dissemination and utilisation of CBR
Despite these obstacles, a number of findings can be encouraged (Cargo &
tactics can promote fruitful CBR Mercer, 2008).
partnerships. To guarantee that the
relationship remains in line with and EXAMPLES OF CBR PARTNERSHIP
responsive to the developing APPROACHES IN THE REAL WORLD
requirements of the community and the We showcase two effective examples to
research, it is first important to demonstrate the possibilities of CBR
establish clear, shared goals and partnership approaches. The first is the
expectations from the outset (Israel et Detroit Community-Academic Urban
al., 2005). Research Center (URC), a long-standing
Second, by encouraging co-learning and collaboration between educational
capacity building, encouraging mutual institutions and community-based
respect and reciprocity, and establishing organisations in Detroit with the goal of
shared decision-making processes, resolving health disparities in urban
power inequalities can be lessened areas (Israel et al., 2001). The URC has
(Minkler, 2005). This entails recognising designed and implemented various
and appreciating the expertise that each research projects and interventions
partner contributes, giving partners through a collaborative decision-making
chances to improve their abilities and process that have significantly improved
knowledge, and making sure that community health while also enhancing
everyone has a say in the research community capacity and promoting
process. social change.
Third, the success of CBR partnerships The second instance is the Nuka System
depends on developing trust and solid of Care in Alaska, a CBR collaboration
relationships. This necessitates regular between Alaska Native communities,
meetings and interactions, open and medical professionals, and researchers.
honest communication, and a dedication It is run by the Southcentral Foundation.
to resolving disagreements and This alliance has altered the region's
difficulties in a civil and constructive healthcare system, enhancing access,
way (Christopher et al., 2008). quality, and satisfaction while lowering
Fourth, while simultaneously assuring health inequities by fusing conventional
the partnership's longevity and the Alaska Native healing methods with
research's outputs, acquiring Western medicine (Gottlieb et al., 2013).
appropriate resources and adopting
flexible timelines can help to meet the CONCLUSION AND FUTURE
needs of CBR partnerships (Cacari-Stone DIRECTIONS
et al., 2014). This may entail looking for

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 Scientific Research Journal of India (ScReJI)

CBR's partnership approaches have a lot Lincoln (Eds.), The SAGE

of potential for public health research handbook of qualitative research
and practise because they provide a (4th ed., pp. 387–400). Sage
mechanism to incorporate community Publications.
viewpoints, promote social change, and Cacari-Stone, L., Wallerstein, N., Garcia,
enhance health outcomes. However, A. P., & Minkler, M. (2014). The
these strategies also come with Promise of Community-Based
difficulties that call for careful analysis, Participatory Research for Health
constant discussion, and creative Equity: A Conceptual Model for
answers. Bridging Evidence With Policy.
CBR collaborations will succeed in the American Journal of Public Health,
future if the values of respect for one 104(9), 1615–1623.
another, reciprocity, co-learning, and Cargo, M., & Mercer, S. L. (2008). The
shared decision-making are value and challenges of
progressively developed. This participatory research:
necessitates a persistent dedication to Strengthening its practice. Annual
creating equal collaborations, Review of Public Health, 29, 325–
encouraging capacity building, and 350.
guaranteeing the sustainability of Christopher, S., Watts, V., McCormick, A.
research outputs. In order to better K. H. G., & Young, S. (2008).
encourage CBR partnerships, systemic Building and maintaining trust in a
changes in research policies and community-based participatory
practises are also required. These research partnership. American
changes should affect funding models, Journal of Public Health, 98(8),
academic reward systems, and 1398–1406.
publishing standards. Gottlieb, K., Sylvester, I., & Eby, D.
It is critical to keep researching and (2008). Transforming your
capturing these individuals' practice: What matters most.
experiences, difficulties, and Family Practice Management,
accomplishments as public health 15(1), 32–38.
academics and practitioners turn more Green, L. W., George, M. A., Daniel, M.,
and more to CBR partnership Frankish, C. J., Herbert, C. P.,
approaches. This will help with the Bowie, W. R., & O’Neill, M. (1995).
continued development and Study of participatory research in
strengthening of CBR as a health promotion. Review and
transformative approach to public recommendations for the
health research and practise in addition development of participatory
to teaching important lessons for future research in health promotion in
collaborations. Canada. The Royal Society of
Canada.
ACKNOWLEDGMENTS Hacker, K. (2013). Community-based
None. participatory research. Sage
Publications.
REFERENCES Israel, B. A., Schulz, A. J., Parker, E. A., &
Brydon-Miller, M., Kral, M., Maguire, P., Becker, A. B. (1998). Review of
Noffke, S., & Sabhlok, A. (2011). community-based research:
Jazz and the Banyan tree: Roots Assessing partnership approaches
and riffs on participatory action to improve public health. Annual
research. In N. K. Denzin & Y. S.

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 Scientific Research Journal of India (ScReJI)

Review of Public Health, 19, 173–

202.
Israel, B. A., Eng, E., Schulz, A. J., &
Parker, E. A. (Eds.). (2005).
Methods in community-based
participatory research for health.
Jossey-Bass.
Israel, B. A., Lichtenstein, R., Lantz, P.,
McGranaghan, R., Allen, A.,
Guzman, J. R., Softley, D., & Maciak,
B. (2001). The Detroit
Community–Academic Urban
Research Center: Development,
implementation, and evaluation.
Journal of Public Health
Management and Practice, 7(5), 1–
19.
Minkler, M. (2005). Community-based
research partnerships: Challenges
and opportunities. Journal of
Urban Health, 82(2), ii3–ii12.
Minkler, M., & Wallerstein, N. (2010).
Community-based participatory
research for health: From process
to outcomes (2nd ed.). Jossey-Bass.
Wallerstein, N., & Duran, B. (2010).
Community-based participatory
research contributions to
intervention research: The
intersection of science and
practice to improve health equity.
American Journal of Public Health,
100(S1), S40–S46.

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S Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Dietary and Lifestyle Contributions to Diabetes Onset in

Indian Populations

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
With an estimated 77 million individuals dealing with the condition as of 2019, diabetes has emerged as a
significant public health issue in India (International Diabetes Federation, 2021). Even if genetics are involved,
research shows that nutrition and lifestyle choices have a big impact on the development of diabetes in Indian
people. The studies on dietary habits, food preferences, physical activity, obesity, and other lifestyle factors that
affect diabetes risk and onset in India are summarised in this review. Evidence suggests that sedentary lifestyles
and diets heavy in refined carbs and lipids have been linked to a rise in diabetes prevalence, particularly in
metropolitan areas of India. Diabetes may be prevented or delayed by dietary and lifestyle changes. It is
necessary to conduct more study on the best public health practises for reducing diabetes risk in Indian
communities through dietary and lifestyle modifications..
Keywords: Diabetes onset, Indian populations, Nutrition impact, Lifestyle choices, Diabetes prevention.

INTRODUCTION India projected to cost $40 billion

Diabetes is spreading rapidly over the annually (Shivashankar et al., 2017).
world and has become a major chronic There are cases of both type 1 and type
medical burden. As of 2019, there were 2 diabetes in India, while type 2
77 million adults in India who were accounts for 90–95% of occurrences
expected to have diabetes (International (Anjana et al., 2011). In India, the
Diabetes Federation, 2021). By 2030, prevalence of type 2 diabetes is rising
this population is predicted to increase quickly, and this is attributed to a
to 101 million. In 2021, the variety of environmental and lifestyle
International Diabetes Federation. Over variables, such as altered eating habits,
1 million deaths per year in India are urbanisation, sedentary employment,
caused by diabetes, which is a leading and longer life expectancies (Mohan et
cause of sickness and mortality (Mohan al., 2018). Despite the fact that heredity
et al., 2018). The financial ramifications is a risk factor, research consistently
are as severe, with diabetes treatment in demonstrates that modifiable lifestyle
factors related to nutrition and physical
 Scientific Research Journal of India (ScReJI)

activity are important drivers of Drinking a lot of sugar-sweetened

diabetes risk and onset, especially for beverages raises the risk of acquiring
type 2 diabetes. diabetes in both rural and urban parts of
Research on significant dietary and India (Dhaka et al., 2021).
lifestyle elements that influence
diabetes prevalence and onset in Indian FATS
communities is summarised in this Increased diabetes prevalence is
publication. These modifiable risk associated with high intake of saturated
variables must be considered in fats, primarily from ghee (clarified
population-level diabetes preventive butter), vegetable oils, and animal
strategies that are effective. Given that products (Misra et al., 2011). However,
food and lifestyle treatments are dietary patterns higher in unsaturated
promising for lowering the risk of fats from nuts, seeds, and plant oils have
developing diabetes, this research protective effects (Misra et al., 2011).
suggests evidence-based objectives for Consumption of trans fats is positively
public health programming in India. correlated with diabetes markers as
well (Lutsey et al., 2008).
DIETARY RISK FACTORS
Studies consistently demonstrate that FRUITS/VEGETABLES
Indians' dietary habits influence their Increased diet of fruits, vegetables, and
risk of developing diabetes and its fibre has been shown in research to
consequences. While others may be reduce the risk of developing diabetes
protective, some eating habits and food (Lakshmipriya et al., 2021). Vegetables
patterns appear to promote the with green leaves appear to be
development of diabetes.. particularly healthy. On the other hand,
several studies have found that starchy
CARBOHYDRATES vegetables and tubers, such white
Eating foods with a high glycemic index, potatoes, had neutral or harmful impact
refined carbohydrates, and added on diabetes risk indicators
sugars is associated with a higher risk of (Lakshmipriya et al., 2021).
diabetes among Indians (Mohan et al.,
2018). For instance, increasing white MEAT
rice consumption was associated with a Consuming more red meat and
higher risk of diabetes in numerous processed meat raises your risk of
cohorts, but brown rice had either developing diabetes, although plant
positive or neutral effects (Vennila et al., proteins have conflicting consequences
2016; Lakshmipriya et al., 2021). The (Agrawal & Ebrahim, 2013).
advancement of diabetes and poorer
glycemic control have both been linked DIETARY PATTERNS
to regular use of items manufactured Dietary pattern analyses, which go
from refined wheat flour (maida), such beyond specific foods and nutrients,
as white bread and fried snacks (Gupta shed light on general eating habits
et al., 2011). associated with outcomes for people
The consumption of added sugars from with diabetes. Numerous studies show
table sugar, sweets, and sugar- that when compared to more
sweetened beverages is positively contemporary, processed, high fat, and
correlated with insulin resistance, high sugar diets, a traditional whole
metabolic syndrome, and diabetes in food, plant-based Indian diet is related
Indian diets (Gupta et al., 2012). with decreased diabetes prevalence and

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 Scientific Research Journal of India (ScReJI)

incidence (Misra et al., 2011). For OBESITY

instance, following a sensible dietary Overweight and obesity are on the rise
pattern that included eating more fruits, in India, which is a major risk factor for
vegetables, whole grains, nuts, and plant type 2 diabetes (Mohan et al., 2018).
protein reduced the incidence of Insulin resistance is a result of obesity
diabetes in an urban South Indian through a number of metabolic
cohort (Lakshmipriya et al., 2021). processes. In both urban and rural areas
Indian urban diets have changed away of India, data repeatedly linked higher
from traditional plant-based staples and BMI and central adiposity to higher
toward packaged snacks, fast meals, and diabetes incidence (Pradeepa et al.,
foods heavy in fat and sugar from the 2015). Diabetes prevention should
west (Misra et al., 2011). It is prioritise reducing rising obesity rates
hypothesised that these dietary through dietary and physical activity
modifications, together with decreased initiatives.
complex carbohydrate and fibre intake,
have a substantial impact on the rising SLEEP DURATION
diabetes incidence in India's urban Recent data points to a possible risk
areas. factor for diabetes development in
Indians: insufficient sleep duration. In
LIFESTYLE RISK FACTORS multiple large cohorts, shorter self-
Beyond diet, a number of alterable reported sleep duration was linked to
lifestyle factors affect the risk of increased insulin resistance and
diabetes. The following are important diabetes prevalence (Agrawal &
factors: Ebrahim, 2013). Getting enough sleep
each night could keep your metabolism
PHYSICAL INACTIVITY in good shape.
Diabetes prevalence and incidence are
independently linked to low levels of SMOKING
physical activity and sedentary lifestyles After controlling for confounders,
tobacco use is an independent risk
in rural and urban Indian people
factor for the development of type 2
(Anjana et al., 2011). Regular moderate- diabetes in both men and women (Willi
to-vigorous exercise can reduce the risk et al., 2007). The biochemical processes
of diabetes and increase insulin that have been proposed involve
sensitivity. Unfortunately, India's levels oxidative damage, insulin resistance,
of physical exercise are dropping as the and inflammation. With over 100
country becomes more urbanised and million smokers in India, tobacco
control measures have the ability to
modernised. For example, the ICMR-
prevent diabetes on a population-wide
INDIAB national survey revealed that level.
more than 54% of Indian adults said
they did not engage in any leisure DISCUSSION
physical activity (Anjana et al., 2011). The evidence compiled in this review
Interventions to encourage shows how the risk and burden of type
participation in organised exercise, 2 diabetes in India are driven by
unhealthy diets, insufficient physical
sports, and daily movement are
activity, obesity, and other modifiable
necessary. lifestyle factors. These results
underscore the need for health

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 Scientific Research Journal of India (ScReJI)

programming and policy efforts to delay in areas like the ideal macronutrient
the onset of diabetes by altering compositions for preventing diabetes.
lifestyle. Guidelines for the prevention of
A high intake of refined carbs, added diabetes can be improved by developing
sugars, saturated fats, and low fibre evidence unique to India.
diets, together with a poor intake of
fruits and vegetables, increase the risk In conclusion, a variety of dietary and
of developing diabetes. Conversely, lifestyle factors significantly contribute
to the rising prevalence of diabetes in
traditional diets that are higher in plant-
India's rural and urban areas. While
based foods, unsaturated fats, and
enhancing general public health,
complex carbs look protective. Promote population-level lifestyle modifications
the return to traditional dietary and focused preventative interventions
mainstays like dals, whole grains, and a may be able to help reverse this
variety of vegetables while reducing tendency. But to promote surroundings
your intake of processed foods to and systems that encourage healthy
improve your nutrition. Public health eating and active living, coordinated
campaigns, altered agricultural initiatives across policy, healthcare,
subsidies, and food pricing policies may industry, and civil society are crucial.
all help bring about these adjustments.
ACKNOWLEDGMENTS
India also needs better programmes and None.
infrastructure to encourage physical
activity and cut down on idle time. REFERENCES
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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

The rising prevalence of Type 2 Diabetes Mellitus (T2DM) in

urban and rural India

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
The prevalence of type 2 diabetes mellitus (T2DM) has increased dramatically in India over the past few decades.
Rapid urbanization, nutrition transition, sedentary lifestyles and aging have primarily contributed to escalating
diabetes burden. This narrative review synthesizes recent epidemiological data on T2DM prevalence, incidence
and secular trends across urban and rural parts of India. Analysis of large national surveys, cohort studies and
modeled estimates are presented by geographical region. Key drivers of rising T2DM rates including obesity,
adverse dietary patterns and physical inactivity are examined. Urban areas show higher prevalence but rural
regions are catching up. Projections forecast continuing increases in national diabetes prevalence underscoring
prevention imperative. More research on effective diabetes control strategies tailored to Indian context is
warranted.
Keywords: Type 2 Diabetes Mellitus (T2DM), Prevalence trends, Urbanization, Epidemiological data, Diabetes
control strategies

INTRODUCTION This narrative review synthesizes recent

India has witnessed an explosive rise in data from large epidemiological studies
type 2 diabetes mellitus (T2DM) rates and national health surveys on T2DM
over the past three decades. Previous prevalence, incidence, trends and
perception of T2DM as an urban projections in urban and rural India.
phenomenon has changed with Drivers of increasing T2DM rates are
increasing rates across rural India too. examined and prevention/control needs
Today India is often described as the highlighted. This analysis provides an
"diabetes capital of the world" with an overview of the evolving diabetes
estimated 77 million people living with landscape to inform health systems
the disease, projected to rise to 101 planning and policy responses.
million by 2030 (IDF, 2019). The
escalating T2DM burden has major SEARCH STRATEGY
public health and economic implications A literature search was conducted in
needing urgent policy attention.. PubMed, IndiaMed and Google Scholar
 Scientific Research Journal of India (ScReJI)

databases using the keywords “type 2 specific prevalence from 30-39 years
diabetes”, “prevalence”, “epidemiology”, onwards.
“trends”, “urban”, “rural”, “India”.
Relevant articles from 2010-2022 Regional Data
reporting T2DM prevalence, incidence There is considerable heterogeneity in
or modeling estimates in national or T2DM prevalence across different parts
large regional samples were retrieved. of India attributed to variations in
Bibliographies of shortlisted articles urbanization, lifestyle changes and
were hand-searched for additional genetic susceptibility. Looking at
resources. regional data from large cohort studies
and surveys reveals divergent trends:
T2DM PREVALENCE - South India shows a high diabetes
burden particularly in urban regions.
National Data The Chennai Urban Rural Epidemiology
Successive national health surveys Study (CURES) reported an age-
demonstrate rising T2DM prevalence standardized T2DM prevalence of
across India. The National Family Health 15.5% in Chennai city during 2001-
Survey (NFHS) is a large multi-round 2004 (Mohan et al., 2008). Another
survey conducted by the Indian study in Vellore district, Tamil Nadu
government providing health estimates recorded a prevalence of 12.3% among
at national/state levels. Per NFHS-4 adults ≥20 years in urban and 8.3% in
(2015-16), diabetes prevalence among rural areas (Kutty et al., 2014).
adults ≥15 years was 7.3% in rural and - Western states like Maharashtra and
13.2% in urban areas, reflecting ~2 Gujarat are experiencing rising T2DM
percentage points rise from NFHS-3 prevalence linked to rapid urbanization
conducted a decade earlier and economic transitions. Diabetes
(Shivashankar et al., 2017). prevalence among adults ≥20 years in
The WHO Study on Global Ageing and urban Pune was 12.8% versus 6.5% in
Adult Health (SAGE) Wave 1 (2007-10) rural areas as per recent estimates
found a diabetes prevalence of 5.0% and (Shinde et al., 2018).
12.1% among adults ≥18 years in rural - Northern states have generally shown
and urban India respectively (Prenissl et lower but increasing T2DM prevalence.
al., 2019). A follow-up SAGE survey in Delhi recorded diabetes prevalence of
2016-18 showed significant increases to 11.6% versus 5.3% in urban and rural
8.3% in rural and 15% in urban areas Delhi in a population-based cross-
indicating rising trends (Prenissl et al., sectional study during 2010-2013
2019). (Kumar et al., 2015).
The Indian Council of Medical Research - Prevalence in Eastern/North-eastern
- INdia DIABetes (ICMR-INDIAB) study states is comparatively lower but
conducted across 15 states during 2008- growing. A study across urban Assam
2015 found an overall weighted documented T2DM prevalence of 5.4%
prevalence of 7.3% in individuals ≥20 among adults ≥20 years (Mahanta et al.,
years, varying from 5.6% in rural to 2013). In rural Tripura, prevalence was
12.1% in urban residents (Anjana et al., 4.5% among tea garden workers
2017). The ICMR-INDIAB data (Choudhury et al., 2016).
demonstrates higher T2DM rates across
all age groups in urban versus rural MODEL PREDICTIONS
areas, with sharp increases in age- Mathematical modelling provides
national projections on future diabetes

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 Scientific Research Journal of India (ScReJI)

trends. A study by Basu et al. predicted nutrition transition characterized by

an increase in age-standardized imbalanced macronutrient profile, low
diabetes prevalence in India from 7.3% complex carbohydrate intake, and high
in 2010 to 11.4% by 2030 among adults omega-6 fat is implicated in escalating
≥20 years (Basu et al., 2013). Another obesity and T2DM.
analysis forecast national prevalence
rising from 8.7% in 2017 to 11.4% by SEDENTARY LIFESTYLES
2045 (Bommer et al., 2018). Modeling Lack of physical activity is
highlights continuing escalations in independently associated with
diabetes prevalence across urban and increased T2DM risk. Only 9.3% Indian
rural India underscoring the imperative adults ≥18 years met WHO
for prevention strategies. recommended activity levels as per a
multi-state study (Dixit et al., 2019).
DIABETES INCIDENCE Sedentary occupations have risen with
Limited data exists on national modernization. Leisure time physical
incidence rates. An analysis of pooled activity is low due to lack of
data from prospective urban cohorts by parks/playgrounds and focus on
Gupta et al. estimated an annual academics.
incidence of 9.2 per 1000 person-years
among adults ≥20 years during 1990- OBESITY
1999 (Gupta et al., 2012). Incidence rose India is experiencing steady rises in
in 2000-2008 to 14.2 per 1000 person- overweight/obesity attributed to poor
years indicating increasing annual risk. diet and inactivity. A meta-analysis
Age-specific incidence was notably found obesity prevalence increased
higher from age 40 onwards. Rural from 11.8% to 22.9% between 1990-
estimates are scarce but an early study 2015, with higher rates in urban areas
documented lower incidence of 2.77 per (Ranjani et al., 2016). Obesity is an
1000 person-years in Tamil Nadu village established risk factor for insulin
cohorts during 1995-2000 versus urban resistance and T2DM.
rates (Mohan et al., 2003). More robust
longitudinal data across regions is AGING POPULATION
needed going forward.
Drivers of Rising T2DM in India. India's elderly population ≥60 years is
projected to rise from 8% in 2010 to
URBANIZATION AND NUTRITION 19% by 2050 (UN, 2019). Aging is an
TRANSITION important demographic change
India is urbanizing rapidly with 34% contributing to diabetes increases as
population residing in cities in 2017 prevalence rises with age.
projected to reach 50% by 2050 (UN,
2018). Urban living is linked to reduced Recommendations for T2DM Prevention
physical activity, weight gain, and and Control
unhealthy diets - all T2DM risk factors.
Urban adults have higher diabetes The following strategies are
prevalence versus rural (Anjana et al., recommended to curb rising T2DM
2017). burden:
Traditional diets high in whole grains
and fiber are shifting towards diets - Lifestyle modification programs
richer in oils, animal products, and promoting healthy diets, physical
processed foods (Shetty, 2002). This activity and weight management should

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 Scientific Research Journal of India (ScReJI)

be expanded especially targeting high ACKNOWLEDGMENTS

risk groups. Yoga sessions, worksite None.
wellness initiatives and community
health campaigns can promote REFERENCES
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tracking metropolitan, tier 2 and rural Ghosh, S., Saha, A., Pal, S.K., Basu,
trends are essential to monitor the A. and Maji, D., 2016. Prevalence of
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other states of India. Journal of
CONCLUSION Social Health and Diabetes, 4(01),
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urban and rural areas. Further increases S., 2019. National multi centric
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Indian contexts. A multidimensional medicine and primary care, 8(6),
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prospective analysis of registry

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data. The Lancet, 371(9622), to 49 years. BMJ open, 9(5),

pp.1435-1442. p.e026314.
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Pisharody, R. and Vijayakumar, K., Patravale, V.B. and Deshmukh, P.S.,
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and control in India: a nationally
representative cross-sectional
study among individuals aged 15

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Gestational diabetes in India: Prevalence, outcomes, and

interventions

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
Glucose intolerance that is first noticed during pregnancy is known as gestational diabetes mellitus (GDM). In
India, GDM is becoming more widespread in tandem with the continuing diabetes epidemic. This narrative review
summarises the research on the prevalence of GDM, its negative effects, and India-specific preventative and
management strategies. Numerous studies show increased prevalence in both urban and rural areas of India,
with urban areas showing greater rates. If left untreated, GDM raises the risk of maternal and newborn problems.
Therefore, screening and prompt management are important but currently subpar. The expansion of GDM
services through improved health systems, task sharing, standardised procedures, and integrated care, increased
screening rates, and the application of context-specific control strategies are major priorities. In order to scale up
evidence-based, culturally acceptable GDM programmes, more implementation research is required. Attacking
India's GDM problem can boost mother and child health while halting the transmission of hyperglycemia risk
between generations
Keywords: Gestational Diabetes Mellitus (GDM), Prevalence, India-specific Strategies, Maternal and Newborn
Outcomes, Intervention Programs.

INTRODUCTION screening and care are still insufficient

One of the most prevalent metabolic (Guariguata et al., 2014).
consequences of pregnancy is The diabetes problem in India is
gestational diabetes mellitus (GDM). becoming worse. GDM has consequently
Any level of glucose intolerance, first become a significant public health
identified during pregnancy, is referred concern. If untreated, GDM and the
to as GDM (Seshiah et al., 2016). hyperglycemia in pregnancy it signals
Globally, the prevalence of GDM is have serious short- and long-term
increasing along with the current effects on mother and child health. This
diabetes epidemic, with narrative review summarises the
disproportionate burdens in low- and research on the prevalence of GDM, its
middle-income countries where negative effects, and
prevention/management strategies that
 Scientific Research Journal of India (ScReJI)

are pertinent to India. For India's health this investigation, prevalence was
systems to be strengthened in order to higher (13.4%) in urban areas than in
address the GDM problem, it is critical rural ones, which is noteworthy (7
to look at the gaps and priorities. percent ).

SEARCH STRATEGY LOOKING AT SELECT REGIONAL

The terms "gestational diabetes," STUDIES:
"India," "prevalence," "interventions," According to a 2015 study using ADA
"screening," and "management" were criteria, Tamil Nadu's rates of GDM
used in a literature search in the prevalence in rural and urban areas
PubMed, Google Scholar, and Ovid were 10.4% and 13.4%, respectively
databases. On GDM in India, pertinent (Kumar et al., 2017).
peer-reviewed research articles, review - In Haryana, the prevalence of GDM
papers, and guidelines from 2010 to among pregnant women screened
2022 were located. By hand-searching between 2015 and 2016 was estimated
reference lists, additional sources about to be 14% using both updated ICMR and
India were found. WHO criteria (Gambhir et al., 2018).
- Using modified ADA criteria, a
GDM BURDEN AND PREVALENCE IN hospital-based study in Maharashtra
INDIA found that 18.9% of urban pregnant
According to recent data, GDM has women had GDM (Agarwal et al., 2010).
become a significant health issue in Modeled projections based on region-
India, impacting a sizable number of specific statistics indicate a national
births every year. However, variations GDM prevalence of about 10%, or over
in screening and diagnostic criteria limit 3.5 million cases per year (Jain et al.,
the reliability of prevalence estimations. 2018). GDM, which has bigger loads in
The 1990s saw the first multicenter urban areas but is becoming more
studies that used WHO criteria to prevalent in rural areas as well, thereby
document India's significant GDM impacts a sizable number of births in
prevalence. In diverse places, India. Moving forward, more consistent
prevalence ranged from 3.8% to 21%; estimations are required..
higher rates were seen in metropolitan
areas (Seshiah et al., 2004). Community- ADVERSE OUTCOMES OF GDM
based screening in Tamil Nadu Importantly, GDM increases the risk of a
discovered a prevalence of 16.2% in number of adverse maternal and infant
urban areas and 9.9% in rural regions outcomes if it is not effectively
(Seshiah et al., 2004). diagnosed and treated throughout the
More recent research has revealed gestational period. The key outcomes
varying but rising incidence across are as follows:
India, which is connected to rising
obesity and diabetes rates. According to MATERNAL OUTCOMES
suggestions made by the ICMR expert - Preeclampsia: Gestational diabetes
group, most centres diagnose GDM mellitus increases the risk of
using either the WHO 1999 criteria or preeclampsia and gestational
modified variants (Seshiah et al., 2016). hypertension (Padmanabhan et al.,
Using several criteria, a meta-analysis of 2019).
research from 2009 to 2015 discovered - Cesarean delivery: High rates of
that the national prevalence of GDM was emergency caesarean sections are
10.2%. (Bhavadharini et al., 2017). In

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 Scientific Research Journal of India (ScReJI)

associated with poor glycemic control in - Hyperbilirubinemia: It has been shown

GDM (Muthukumar et al., 2013). that GDM increases the likelihood of
- Future diabetes: Women with GDM newborn jaundice (Hussain, 2015).
had a more than seven-fold greater risk
of postpartum diabetes, and by the end - Fetal hyperinsulinemia has been linked
of the 10-year follow-up, more than to long-term negative cardio-metabolic
70% of them have type 2 diabetes effects in children, emphasising the
(Seshiah et al., 2008). significance of intrauterine glycemic
management (Damm et al., 2016).
FETAL OUTCOMES
- Macrosomia: Hyperglycemia increases
the chance of giving birth to large-for- GDM Prevention and Management in
gestational-age and macrosomic India
newborns by boosting foetal insulin
production and fat buildup (Balaji et al., SCREENING AND DIAGNOSIS
2007). GDM universal screening is advised by
- Birth trauma, shoulder dystocia, and expert organisations like FIGO, ADA,
other associated newborn problems are WHO, and ICMR. In India, coverage is
all made more likely by macrosomia still insufficient. Based on feasibility and
(Stotland et al., 2004). cost considerations, the ICMR has
Poor glycemic management increases recommended a one-step technique
the risk of prenatal mortality, stillbirth, employing 75 gm oral glucose with a
and neonatal death (Jain et al., 2018). 126 mg/dl cut-off for diagnosis (Seshiah
- Congenital anomalies: Pre-existing et al., 2016). However, applicability
undiagnosed diabetes or early varies and many centres continue to use
hyperglycemia during organogenesis outdated two-step processes. A crucial
stages may be associated with higher requirement is to increase screening
incidence of congenital abnormalities using streamlined, consistent
(Jain et al., 2007). techniques.
- Exposure to maternal hyperglycemia
increases the long-term risk of obesity, GLYCEMIC CONTROL
insulin resistance, and type 2 diabetes in The first-line treatment for GDM is
children (Damm et al., 2016). lifestyle modification through medical
nutrition therapy and exercise. When
NEONATAL OUTCOMES objectives are not accomplished with
- Hypoglycemia: Fetal hyperinsulinemia lifestyle changes alone and for speedier
is a typical cause of transient control in higher risk women, insulin is
hyperinsulinemic hypoglycemia, which advised (Seshiah et al., 2016). However,
necessitates monitoring/management there are difficulties in ensuring patient
in newborns (Hussain, 2015). education and adherence as well as
implementing appropriate GDM
- Respiratory distress: Deficits in management across various Indian
surfactant synthesis and delayed lung healthcare settings.
maturation make infants more
susceptible to respiratory distress DELIVERY PLANNING
syndrome (Kc et al., 2015). Good maternal-fetal outcomes depend
on coordinated planning for the timing
and style of delivery based on glycemic
control trends, foetal growth patterns,
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 Scientific Research Journal of India (ScReJI)

and obstetric concerns. For GDM with and other anti-diabetic medications for
signs of macrosomia or uncontrolled best control.
hyperglycemia, lower limits for elective Electronic medical records, clinical
delivery are advised (Seshiah et al., registries, and notification systems for
2016). following women throughout the care
continuum are all examples of health IT
POSTPARTUM CARE systems.
Lack of longitudinal follow-up of women
with GDM histories and low postpartum RESEARCH PRIORITIES
glucose testing rates in India make it More research on India is required to
difficult to prevent the development of inform evidence-based GDM policy and
overt diabetes (Gambhir et al., 2018). On programming.
the other hand, effective postpartum - Epidemiological studies:
surveillance offers the chance for Comprehensive, multicenter
interventions to lower the risks of investigations of representative
diabetes and cardio-metabolic disease populations utilising accepted standards
in this high-risk group and their to improve national estimates.
offspring in the future. Implementation studies to find the best
Health Systems Strengthening Needs GDM screening and management
In order to effectively reduce the burden strategies for various Indian settings are
of GDM in India, health systems must be part of health services research. For
strengthened: instance, assessing the efficacy of
- Developed national consensus providing GDM care through frontline
guidelines on standards, procedures, staff.
and timelines to direct consistent - Intervention research: Creating and
practises. evaluating Indian-specific nutritional
- Diagnostic infrastructure: Antenatal interventions, lifestyle/exercise
facilities should be outfitted with the counselling methods, and health
necessary equipment for on-site glucose education materials that are culturally
testing for one-step procedures. relevant.
- Coordinating referrals between - Postpartum research: Cohort studies
primary, secondary, and tertiary levels tracking women with GDM who acquire
for the management of GDM. diabetes in the future to help guide
- Increasing GDM services: Educating follow-up procedures.
healthcare professionals on screening
and management; including nurses, CONCLUSION
midwives, and community health In conclusion, GDM has grown to be a
workers (Sneha-India programme significant public health problem in
exemplar). India, impacting millions of pregnancies
- Integrated care: In the existing every year and becoming more severe,
disjointed systems, it is advantageous especially in urban areas. The
but difficult to coordinate care across importance of widespread screening
doctors, nurses, nutritionists, diabetic and prompt management is highlighted
educators, and counsellors. Tools for by the fact that untreated GDM can have
clinical decision support and care an amplified negative impact on both
templates can make team-based care short- and long-term outcomes. India's
easier. health systems must be thoroughly
- Medication accessibility: Increasing the strengthened if GDM services are to be
accessibility and affordability of insulin provided with higher levels of

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 Scientific Research Journal of India (ScReJI)

consistency, quality, and coverage. To evaluation of risk factors in urban

direct programme extension, Haryana: A community-based
implementation research is essential to study. The Indian Journal of
create scalable, context-appropriate Medical Research, 148(6), pp.749.
GDM care models. By preventing the Guariguata, L., Linnenkamp, U., Beagley,
transmission of hyperglycemia risk, life J., Whiting, D.R. and Cho, N.H.,
course treatments that reduce the 2014. Global estimates of the
burden of GDM can benefit multiple prevalence of hyperglycaemia in
generations. pregnancy. Diabetes research and
clinical practice, 103(2), pp.176-
ACKNOWLEDGMENTS 185.
None. Hussain, A., 2015. Screening for
hyperglycaemia in pregnancy in
REFERENCES south Asian women attending
Agarwal, M.M., Dhatt, G.S. and Shah, S.M., antenatal services: a systematic
2010. Gestational diabetes review of current practice.
mellitus simplifying the Diabetic Medicine, 32(4), pp.414-
international association of 423.
diabetes and pregnancy diagnostic Jain, R., Mathur, V.P., Kannan, A.T. and
algorithm using fasting plasma Jeevaratnam, K., 2018. Gestational
glucose. Diabetes care, 33(9), diabetes: Perinatal and maternal
pp.2018-2020. outcome in diabetics and non-
Balaji, V., Balaji, M.S., Datta, M., diabetics. The Journal of Obstetrics
Radhakrishnan, R., Tandon, N. and and Gynecology of India, 68(2),
Seshiah, V., 2007. A1C in pp.85-89.
gestational diabetes mellitus in Jain, V., Jain, C.K. and Jain, K., 2007,
Asian Indian women. Diabetes November. Congenital
care, 30(7), pp.1865-1867. malformation in newborns of
Bhavadharini, B., Mahalakshmi, M.M., diabetic mothers. In Research
Maheswari, K., Kalaiyarasi, G., Society for Study of Diabetes in
Anjana, R.M. and Deepa, M., 2017. India Conference (Vol. 44, pp. 5-
Prevalence of gestational diabetes 10). Jaypee Bros Med Pub Limited.
mellitus in urban and rural Tamil Kc, K., Shakya, S. and Zhang, H., 2015.
Nadu using IADPSG and WHO Gestational diabetes mellitus and
1999 criteria (WINGS 6). Clinical macrosomia: a literature review.
diabetes and endocrinology, 3(1), Annals of nutrition and
pp.1-8. metabolism, 66(Suppl. 2), pp.14-
Damm, P., Houshmand-Oeregaard, A., 20.
Kelstrup, L., Lauenborg, J., Kumar, C.R., Fong, D.F. and Biswas, A.,
Mathiesen, E.R., Clausen, T.D. and 2017. Gestational diabetes
Danish National Birth Cohort, mellitus in South Indians:
2016. Gestational diabetes prevalence and risk factors.
mellitus and long-term Diabetic Medicine, 34(6), pp.778-
consequences for mother and 784.
offspring: a view from Denmark. Muthukumar, K., Vijayakumar, A.,
Diabetologia, 59(7), pp.1396-1399. Sureshkumar, J. and Menon, A.S.,
Gambhir, N., Dhaliwal, L.K., Anand, P. 2013. Incidence and predictors of
and Sekhon, P.K., 2018. Prevalence cesarean sections among women
of gestational diabetes mellitus & with gestational diabetes mellitus

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 Scientific Research Journal of India (ScReJI)

in a tertiary care hospital in South

India. Diabetes and Metabolic
Syndrome: Clinical Research and
Reviews, 7(4), pp.211-214.
Padmanabhan, S., Shafiullah, M.M.,
Mukherjee, R., Vlok, M., Vora, K.,
Zacko, T. and Hawley, C., 2019.
Women with gestational diabetes
mellitus are at increased risk of
adverse outcomes from pre-
eclampsia. Journal of Diabetes and
its Complications, 33(9), p.107281.
Seshiah, V., Balaji, V., Balaji, M.S.,
Paneerselvam, A., Kapur, A. and
Arthi, T., 2008. Pregnancy and
diabetes scenario around the
world: India. International journal
of gynaecology and obstetrics, 102,
pp.S35-S38.
Seshiah, V., Balaji, V., Madhuri, S.B.,
Sanjeevi, C.B., Green, A. and Group,
D.I.P.S., 2004. Gestational diabetes
mellitus in India. JAPI, 52, pp.707-
711.
Seshiah, V., Das, A.K., Balaji, V., Joshi,
S.R., Parikh, M.N. and Gupta, S.,
2016. Gestational diabetes
mellitus–guidelines. Journal of the
Association of Physicians of India,
64(7), pp.46-57.
Stotland NE, Caughey AB, Breed EM,
Escobar GJ. Risk factors and
obstetric complications associated
with macrosomia. International
journal of gynaecology and
obstetrics. 2004 Dec 1;87(3):220-
6.

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Childhood and adolescent-onset diabetes in India:

Unraveling the epidemiological shift

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
Children and adolescents who develop diabetes present significant clinical and public health challenges. Early-
onset diabetes epidemiology in India is changing in tandem with quick changes in diet and lifestyle. The trends,
risk factors, and distinctions between type 1 diabetes (T1D) and type 2 diabetes (T2D) onset in Indian youngsters
are examined in this narrative review. Incidence of T1D is increasing, particularly in urban areas. T2D rates, on
the other hand, are also rising and can occasionally surpass T1D in people under 20. The main causes of T2D in
young people are obesity, family history, sedentary lifestyles, and diets high in calories and lipids. Differentiating
diabetes types in this age group is crucial, however unusual presentations make it challenging. Key concerns for
the prevention of obesity and type 2 diabetes in Indian children and adolescents include developing consistent
classification frameworks, tracking incidence patterns, increasing registries, and adopting focused primary
prevention..
Keywords: Childhood Diabetes, Adolescent-Onset Diabetes, Type 1 Diabetes (T1D), Type 2 Diabetes (T2D),
Epidemiological Shift.

INTRODUCTION SEARCH STRATEGY

Type 1 diabetes (T1D) with A literature search was done using the
autoimmune -cell destruction has terms "diabetes," "children,"
historically been the most common type "adolescents," "youth," "paediatric,"
of diabetes to start in infancy and "incidence," "prevalence," and "India" in
adolescence. However, due to weight the databases PubMed, IndiaMed, and
and lifestyle changes, type 2 diabetes Google Scholar. From 2000 to 2022,
(T2D) rates are rising among young pertinent original research papers on
people worldwide. In light of the diabetes epidemiology and classification
changing Indian context, this narrative in Indian children and adolescents (20
review gathers data on trends, risk years) were included, as well as registry
factors, and classification issues linked data reports and review papers.
to children and adolescent diabetes.
 Scientific Research Journal of India (ScReJI)

GLOBAL TRENDS IN YOUTH - In Karnataka, the incidence of T1D

DIABETES among 0–14-year-olds was estimated to
The incidence of T1D, which can start in be 10–13 per 100,000 in 1999–2008,
childhood or adolescent, is rising compared to 4 per 100,000 previously
globally. According to projected (Somannavar et al., 2011).
estimates, the prevalence of T1D - Rises are especially noticeable in urban
increased globally from 4.4 per 100,000 areas. Incidence of paediatric T1D in
person-years in 1990 to 6.5 per 100,000 Delhi registry was 18 per 100,000 from
in 2020, affecting more than 1.2 million 2006 to 2010. (Bhardwaj et al., 2015).
children and adolescents (Patterson et
al., 2021). T2D prevalence among T2D TRENDS
children and adolescents is rising Limited information also points to rising
concurrently in several areas. For T2D trends in Indian children and
instance, the frequency of T2D in the adolescents. Small studies have
United States increased from 0.34 per described sporadic urban situations
1000 in 1990 to 2.1 per 1000 young when youth-onset T2D is comparable to
people in 2015. (Lee et al., 2018). risk of or worse than T1D:
hyperglycemia exposure. According to clinical classification,
34.7% of Delhi's instances of childhood
EPIDEMIOLOGICAL SHIFT IN INDIA diabetes were T2D cases (Bhardwaj et
With increases in both T1D and T2D, the al., 2011).
early-onset diabetes picture in India is - In a centre in Chennai, T2D accounted
evolving. Data, however, is still scarce. for 45% of diabetes cases diagnosed in
patients younger than 20. (Amutha et
T1D TRENDS al., 2017).
There are few systematic - In Cuttack, T2D was the diagnosis for
epidemiological data on the temporal 37% of urban and 20% of rural diabetic
patterns and incidence of T1D in India. children (Mishra et al., 2011).
Incidence rates were greater than Such numbers are alarming and
previously thought, at 10.5 and 4.6 per highlight the necessity of more
100,000 children (under 15 years) in comprehensive representative
Delhi and Karnal registries, respectively, investigations. T1D and T2D are
throughout the 1990s (Bhardwaj et al., becoming more prevalent in Indian
2015). youth, particularly in urban areas where
More recent studies indicate rising lifestyles are changing. Going forward, it
pediatric T1D incidence: will be crucial to track incidence
T1D incidence among children under patterns using standardised registries.
the age of 15 increased from 3.7 per Risk Factors for Early-Onset Diabetes in
100,000 in 1990 to 10.5 per 100,000 in India
2000, according to a pooled study of
data from several registries T1D RISK FACTORS
(Ramachandran et al., 2012). Many T1D risks are explained by genetic
- A registry in Cuttack recorded a T1D vulnerability affecting HLA haplotypes.
incidence of 8 per 100,000 children Only about 40% of monozygotic twins
aged 5 to 14 between 2003 and 2005, agree, showing that environmental
which is greater than the previous factors are also significant (Rewers and
prevalence of 2 per 100,000. (Mishra et Ludvigsson, 2016). The following
al., 2011). potential factors are being studied:
- Viral illnesses

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- Changes in gut microbiome - Increased adiposity in T1D: Probably

- Dietary variables, such as early reflects increased obesity prevalence
exposure to cow's milk overall (Bhardwaj et al., 2011).
- A lack of vitamin D - Reports of T1D without autoantibodies
Further research is needed on or T2D with ketosis are examples of
determinants of T1D onset in Indian atypical types (Kumar et al., 2017).
children. - Late autoimmune T1D: Islet antibodies
T2D Risk Factors may develop later in young people with
The main risk factors for children and insulin insufficiency (secretion 0.8
teenage T2D in India are similar to those nmol/L) who were initially antibody-
for adult-onset T2D. negative (Pozzilli and Buzzetti, 2007).
- Obesity: Dramatic increases in the More fat Indian youngsters are being
incidence of overweight and obesity are reported as having this variation.
contributing to early T2D development. - Hybrid forms: Identified by both
- Family history: T2D risk is increased if autoimmune and insulin resistance
one or both parents have diabetes symptoms. accelerated development of
(Amutha et al., 2017). T1D is hypothesised to be caused by the
- Urban setting: Reflects diet/lifestyle superimposition of early -cell stress
changes and obesogenic environments. (obesity/metabolic syndrome) on
- Physical inactivity: prolonged screen hereditary T1D propensity.
time, diminished outside play, and It is difficult to categorise a patient with
absence of sports. such a wide range of unusual symptoms
- Changing one's diet to one that is into T1D or T2D based simply on clinical
calorie-dense, heavy in carbohydrates characteristics, as has been observed in
and fats, and low in fibre (Little et al., Indian clinics. It is crucial but currently
2018). lacking to create standardised
Targeting these modifiable risk factors, classification frameworks and
particularly childhood obesity, is diagnostic standards appropriate for
important for preventing T2D in India.
children.
RESEARCH AND POLICY NEEDS
COMPARISON OF T1D VERSUS T2D Key imperatives emerging include:
ONSET
Differential diabetes type diagnosis in - Creating a nationally representative
children and adolescents might be surveillance system to track incidence
difficult, but it is crucial for the best care trends and risk factors for T1D and T2D
and instruction. in Indian children and adolescents.
It is typical for T1D to start out with a
normal weight, positive islet - Increasing registry coverage by
autoantibodies, an insulin deficit, and a requiring doctor notice. It is crucial to
propensity for ketoacidosis. Conversely, standardise diagnostic definitions and
persons who are overweight or obese registry procedures.
and have insulin resistance but no
- More investment in and study of the
autoimmune disease or ketoacidosis
distinctive genetic, immunological, and
have T2D. (Kapoor and Sankar, 2019).
On the other hand, overlaps are seen in phenotypic features of early-onset
India: diabetes in India. Risk stratification,
predictive classification, and targeted

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 Scientific Research Journal of India (ScReJI)

prevention/management should all be Bhardwaj, S., Misra, A., Khurana, L.,

based on studies. Gulati, S., Shah, P. and Vikram, N.K.,
2015. Childhood obesity in Asian
- Creating and distributing guidelines Indians: a burgeoning cause of
for the diagnosis and treatment of insulin resistance, diabetes and
diabetes among Indian youth that are sub-clinical inflammation. Asia Pac
specific to their situation. J Clin Nutr, 24(1), pp.172-175.
Kapoor, R.R. and Sankar, R.J., 2019. Type
- Implementing primary prevention 1 Diabetes Mellitus in India.
strategies, such as policies and Frontiers in endocrinology, 10.
programmes that encourage a healthy Kumar, S., Raheel, M., Crowley, V.B.,
diet and physical activity in schools and Gowda, A., Coyaji, K. and Krishna,
address sociocultural factors that P., 2017. 'The changing face of
contribute to childhood obesity. diabetic ketosis'. Diabet Med. doi,
10, pp.1163-1171.
CONCLUSION Lee, J.M., Wu, E.L., Tarini, B., Herman,
In conclusion, India is seeing an increase W.H. and Yoon, E., 2018. Diagnosis
in both T1D and T2D along with an of diabetes using hemoglobin A1c:
epidemiological change in early-onset should recommendations in adults
diabetes. Representative statistics, be extrapolated to adolescents?.
however, are scarce. Urgent policy goals The Journal of pediatrics, 192,
should include focusing on paediatric pp.22-29.
obesity and T2D prevention and trend Little, M., Humphries, S., Patel, K. and
monitoring via registries using Dodd, L., 2018. Factors associated
standardised frameworks. In the end, with glucose tolerance, pre-
risk-based strategies to limit the twin diabetes, and type 2 diabetes in a
threat can be made possible by rural community of south India: a
unravelling India-specific drivers and cross-sectional study. Diabetology
diagnostic intricacies of & metabolic syndrome, 10(1),
childhood/adolescent diabetes. pp.1-12.
Mishra, A., Amutha, A., Datta, V., Singh,
ACKNOWLEDGMENTS S.K., Sinha, I., Bhaktha, G. and
None. Chandradeo, P.K.B., 2011.
Incidence of type 1 diabetes
REFERENCES mellitus in children below 14 yrs
Amutha, A., Datta, M., Unnikrishnan, I.R., in eastern regional India. Indian J
Anjana, R.M., Rema, M., Narayan, Pediatr, 78(3), pp.307-310.
K.M. and Mohan, V., 2017. Clinical Patterson, C.C., Karuranga, S., Salpea, P.,
profile of diabetes in the young Saeedi, P., Dahlquist, G., Soltesz, G.
seen between 1992 and 2009 at a and IDF Diabetes Atlas Committee,
specialist diabetes centre in south 2021. Worldwide estimates of
India. Prim. Care Diabetes, 11(1), incidence, prevalence and
pp.51-59. mortality of type 1 diabetes in
Bhadada, S.K., Kochhar, R. and Bhansali, children and adolescents: Results
A., 2011. Epidemiology of from the International Diabetes
childhood type 1 diabetes mellitus Federation Diabetes Atlas.
in north western India. Indian Diabetes research and clinical
journal of endocrinology and practice, 179, p.109042.
metabolism, 15(Suppl3), p.S208.

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Pozzilli, P. and Buzzetti, R., 2007. A new

expression of diabetes: double
diabetes. Trends in Endocrinology
& Metabolism, 18(2), pp.52-57.
Ramachandran, A., Ma, R.C. and
Snehalatha, C., 2012. Diabetes in
Asia. Lancet (London, England),
375(9733), pp.2140-2152.
Rewers, M. and Ludvigsson, J., 2016.
Environmental risk factors for
type 1 diabetes. The Lancet,
387(10035), pp.2340-2348.
Somannavar, S., Lanthorn, H., Pradeepa,
R., Narayanan, V., Kapoor, R.R.,
Anjana, R.M., Jain, A., Singhi, S.,
Kumar, A.A., Shridhar, A. and
Rema, M., 2011. Incidence rates of
childhood-onset type 1 diabetes in
India. J Diabetes Sci Technol, 5(4),
pp.932-935.

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

The role of Indian-specific genetic markers in T2DM

susceptibility

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
The epidemic of type 2 diabetes mellitus (T2DM) has become most prevalent in India. While environmental and
lifestyle factors are mostly to blame for the increased prevalence of T2DM, genetic predisposition also
considerably increases risk. Key findings from candidate gene and genome-wide association studies on T2DM-
associated genetic variations in Indian populations are summarised in this narrative overview. TCF7L2, KCNQ1,
and FTO are a few risk alleles that are repeated in Indians and have been linked to risk in Europeans. But
frequency and effect sizes frequently vary. Importantly, research reveals population-specific risk loci with
possible founder effects, including GCK, CAPN10, AKT2, IRS1, and APOC3, which are reflective of India's own
diabetogenic genome formed by evolutionary processes. Identification of risk alleles offers biological
understanding of pathophysiologic mechanisms. Ongoing initiatives to integrate genetic data, clinical profiles, and
environmental exposures can lead to tailored preventative programmes that are optimised for Indian ethnic
groups and stratified disease prediction. However, addressing modifiable lifestyle variables through sociocultural
changes and governmental actions is eventually necessary to reverse the rising incidence of T2DM..
Keywords: Type 2 Diabetes Mellitus (T2DM), Genetic Markers, Indian-Specific, Population-Specific Risk Loci,
Disease Susceptibility..

INTRODUCTION Significant heritability for T2DM is

In India, type 2 diabetes mellitus demonstrated by twin studies and
(T2DM), which affects an estimated 77 family histories. Indians are one group
million people as of 2019 and is that has heightened sensitivity that
expected to affect 134 million people by cannot be explained by lifestyle
2045, has epidemic proportions (IDF variables alone. The main conclusions
Diabetes Atlas, 2021). While changes in from genetic association studies on
diet and lifestyle are essential T2DM-related polymorphisms
contributors, genetic susceptibility is especially undertaken in Indian ethnic
also a significant factor that confers groups over the past 20 years are
distinct demographic risks. summarised in this narrative review.
Combining the available data on risk
 Scientific Research Journal of India (ScReJI)

alleles can shed light on the biology of

diabetes in Indians and help guide CANDIDATE GENE STUDIES
future translational uses, such as Early research centred on potential
personalised therapy and predictive genes thought to play metabolic roles in
testing. the aetiology of T2DM. Numerous case-
control studies using Indian cohorts
SEARCH STRATEGY AND SELECTION have been undertaken to look at
CRITERIA variations in specific genes including
The phrases "diabetes," "India," PPARG, KCNJ11, TCF7L2, IRS1, CAPN10,
"genetics," "genome-wide association and ADRB3. Key findings are
research," and "case-control" were used summarised via meta-analyses:
in a PubMed search. We chose articles PPARG: Similar to Europeans, the
from original research on T2DM Pro12Ala variation significantly reduced
genetics in Indian populations that were the risk of T2DM in Indians (OR 0.82).
published between 2000 and 2022. (Radha et al., 2006). However, the
Bibliographies were cross-referenced to frequency of the less frequent mutant
find more studies. The studies involved Ala allele was lower in Indians (8%
both candidate genes and genome-wide against 15% in Europeans).
initiatives to link genetic variations such KCNJ11: The Glu23Lys K allele was
single nucleotide polymorphisms linked to a 1.2-fold increased risk of
(SNPs) with T2DM risk. T2DM in Indians, which was slightly
higher than the effect in East Asians but
HERITABILITY AND POPULATION lower than Europeans (1.7-fold),
DIFFERENCES showing some variation between groups
Even after accounting for established (Narayanan et al., 2019).
hazards like obesity, family-based The strongest connection between
research on T2DM heredity among T2DM and Europeans was seen for
Indians show that it is higher (between TCF7L2, a transcription factor that
50 and 70 percent) than that of controls proinsulin expression. While
Europeans (40 percent) (Das et al., construct-specific haplotypes showed
2010). Monozygotic twin concordance higher effects highlighting ethnic
rates are 30% higher than dizygotic differences, the rs7903146 T risk allele
twin concordance rates, underlining the similarly raised susceptibility in Indians,
importance of genetic variables but with a smaller effect size (OR 1.2)
(Ramachandran et al., 1999). compared to Europeans (1.7). (Bodhini
Such information suggests a significant et al., 2007).
genetic vulnerability that is exclusive to CAPN10: SNPs in the calpain 10 gene,
Indian ethnic groups. This is probably a which controls insulin production,
result of long-term evolutionary increased the incidence of T2DM only in
pressures that gave rise to "thrifty Indians and not in Europeans or East
genotypes," which helped people adapt Asians. Evolutionary selection pressure
to historical famines but are currently may have influenced India's CAPN10
maladaptive (Neel, 1962). This variability, according to population-
underlying, population-specific genetic specific effects (Bodhini et al., 2014).
risk is being made apparent by APOC3: Indian-specific promoter
urbanisation and excessive feeding. variations in this important lipid
Understanding diabetogenic alleles can metabolism gene, such as -455T>C and -
offer biological understanding and 482C>T, increased T2DM susceptibility
opportunity for risk assessment. most likely through associations with

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 Scientific Research Journal of India (ScReJI)

dyslipidemia and insulin resistance and reproduced in Sikhs, suggesting that

(Reddy et al., 2011). adaptive selection may have been at
Overall, candidate gene research shows work (Sanghera et al., 2011).
that effects of putative T2DM loci differ IRS1: Only among Indo-Europeans was
between Indians and Europeans based the rs1801278 G972R mutation of the
on ethnicity. Additionally, some risk insulin receptor substrate IRS1 linked to
alleles, such as those in CAPN10, seem insulin resistance and T2DM,
to be unique to Indian genomes. particularly severe in cases of young-
onset (Pratibha et al., 2013).
GENOME-WIDE ASSOCIATION Future polygenic risk prediction,
STUDIES (GWAS) stratification, and prevention in Indian
The development of GWAS using array- groups could potentially be improved by
based genome scanning made it possible utilising population-specific alleles
to identify new T2DM connections through tailored arrays and machine
without making assumptions. The learning techniques. Modifying
majority of T2DM risk loci found in environmental risk factors is still
European and East Asian GWAS, essential for reducing the prevalence of
including CDKAL1, CDKN2A/B, T2DM at the community level, though.
IGF2BP2, SLC30A8, HHEX, KCNQ1, and
TCF7L2, were duplicated in Indian CHALLENGES AND FUTURE
GWAS (Sanghera and Blackett, 2012). DIRECTIONS
However, the frequency and impact Studies also discovered variation in risk
sizes of these risk alleles commonly allele frequencies and effects within
showed demographic disparities. The several Indian ethnic subgroups, such as
biggest signal is consistently TCF7L2 North, South, East, and Sikh clustering
SNP rs7903146, however Indians based on ancestry, in addition to
experience less of an impact than emphasising demographic disparities
Europeans (Chauhan et al., 2010). South (Tabassum et al., 2013). For instance,
Indians were more affected by the unique allele patterns and founder
KCNQ1 mutation rs2237892 than were effects were observed in quite remote
Europeans (C.R. et al., 2012). In Indians, Sikh communities (Sanghera et al.,
polygenic risk score could be improved 2011).
by adjusting for known susceptibility Such variation highlights the
SNPs (Narayanan et al., 2019). requirement for extensive GWAS,
Notably, European approaches targeted sequencing, and
overlooked certain T2DM loci epidemiological correlation to catalogue
discovered primarily in Indian GWAS risk loci specific to regional contexts
through population-specific signals. within India. Machine learning
These can be founder effects or techniques used to huge cohorts of data
particular drifts. Key illustrations can untangle complicated connections
include: to predict stratified diabetes risk and
GCK: T2DM was solely linked to the enable customised prevention.
rs1799884 promoter variant (-30G>A) However, to stop the present T2DM
of the glucokinase gene in Indians, not epidemic, which is mostly due to
in Europeans (Chidambaram et al., lifestyle changes, drastic modifications
2010). in food, activity, and weight must be
AKT2: AKT2 is an actor in the insulin made through socioeconomic
signalling system. The mutation at development and policy-level measures.
rs8100970 was found only in Indians Genomic research must focus on

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 Scientific Research Journal of India (ScReJI)

establishing structural treatments that variants of PPARG, KCNJ11,

address the food systems, physical TCF7L2, SLC30A8, HHEX, CDKN2A,
environments, and socio-cultural factors IGF2BP2, and CDKAL1 on the risk
that heavily influence lifestyle choices of type 2 diabetes mellitus in 5,164
and obesity, not on uncovering Indians. Diabetes, 59(8), 2068-
population-specific biology. Effective 2074.
remedies must go beyond specific risk Chidambaram, M., Radha, V., & Mohan,
factors. V. (2010). Replication of recently
described type 2 diabetes gene
CONCLUSION variants in a South Indian
In conclusion, Indians show distinct population. Metabolism, 59(12),
genetic variations linked to diabetes 1760-1766.
that are a result of a long-evolved C.R., M., Praveen, E. P., Ramaiah, A.,
diabetogenic genome. If properly Amutha, A., Anjana, R. M., Deepa,
combined with lifestyle data, M., ... & Venkatesan, R. (2012).
cataloguing this population-specific Association of the KCNQ1
genetic architecture can offer biological rs2237892 variant with type 2
insights and the possibility for risk- diabetes in South Indian
strategization applications. But in order Population. Journal of Genetics,
to stem the tide of the public health 91(3).
issue, multi-level interventions aimed at Das, S. K., Elbein, S. C., Wang, W.,
socio-economic and environmental Hasstedt, S. J., Rao, P. V., Duggirala,
factors of weight, physical activity, and R., ... & Elston, R. C. (2010).
nutrition are eventually needed. Dissecting the underlying genetic
architecture of diabetes related
ACKNOWLEDGMENTS traits in selected founder
None. populations of Andhra Pradesh,
India. The Journal of Clinical
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Bodhini, D., Radha, V., Dhar, M., 95(10), E86-E96.
Narayani, N., & Mohan, V. (2007). International Diabetes Federation. IDF
The rs12255372(G/T) and Diabetes Atlas, 10th edn. Brussels,
rs7903146(C/T) polymorphisms Belgium: International Diabetes
of the TCF7L2 gene are associated Federation, 2021.
with type 2 diabetes mellitus in https://diabetesatlas.org.
Asian Indians. Metabolism, 56(9), Narayanan, L., Fuchsberger, C., Prakash,
1174-1178. S., Ali, S., Nanditha, A., Anjana, R.
Bodhini, D., Gaal, S., Shatwan, I., Ramya, M., ... & Mahajan, A. (2019). Type 2
K., Ellahi, B., Surendran, S., ... & diabetes genetic loci informed by
Lovegrove, J. A. (2014). multi-trait associations point to
Association of calpain10 SNP43 disease mechanisms and subtypes:
and SNP19 haplotypes with type 2 A soft clustering analysis. PLoS
diabetes, obesity and heart disease medicine, 16(9), e1002654.
risk in south Indians. Diabetes & Neel, J. V. (1962). Diabetes mellitus: a
metabolism, 40(3), 156-161. “thrifty” genotype rendered
Chauhan, G., Spurgeon, C. J., Tabassum, detrimental by “progress”?.
R., Bhaskar, S., Kulkarni, S. R., American journal of human
Mahajan, A., ... & Dwivedi, O. P. genetics.
(2010). Impact of common

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 Scientific Research Journal of India (ScReJI)

Pratibha, V., Kari, U. R., Mishra, R. N., Tabassum, R., Chauhan, G., Dwivedi, O.
Patkar, D. R., Kakkar, N., Singh, R. P., Mahajan, A., Shah, S., Mathai, A.
K., ... & Sharma, A. K. (2013). Novel J., ... & Indian Genome Variation
diabetes risk loci and associated Consortium. (2013). Genome-wide
underlying mechanisms implicated association study for type 2
by an Indian whole-genome diabetes in Indians identifies a
association study of young-onset new susceptibility locus at 2q21.
type 2 diabetes. Journal of human Diabetes, 62(3), 977-986.
genetics, 58(5), 300-307.
Radha, V., Vimaleswaran, K. S., Babu, H.
N., Abate, N., Chandalia, M., Satija,
P., ... & Mohan, V. (2006). Role of
genetic polymorphism peroxisome
proliferator-activated receptor-γ2
Pro12Ala on ethnic susceptibility
to diabetes in South-Asian and
Caucasian subjects: Evidence for
heterogeneity. Diabetes Care,
29(4), 1046-1051.
Ramachandran, A., Das, A. K., Joshi, S. R.,
Yajnik, C. S., Shah, S., & Kumar, K. P.
P. (1999). Current status of
diabetes in India and need for
novel therapeutic agents. Journal
of the Association of Physicians of
India, 48, 971-4.
Reddy, S. S., Bharathi, T. V., Nazar, M.,
Rao, R., Anne, S. R., Kumar, A. A., ...
& Murthy, K. J. (2011). Association
of APOC3 gene variants with type
2 diabetes, insulin resistance and
hypothyroidism in T2DM subjects
with Vitiligo. Journal of Diabetes
and its Complications, 25(6), 355-
362.
Sanghera, D. K., Ortega, L., Han, S., Singh,
J., Ralhan, S. K., Wander, G. S., ... &
Tyler-Smith, C. (2011). Impact of
nine common type 2 diabetes risk
polymorphisms in Asian Indian
Sikhs: PPARG2 (Pro12Ala),
IGF2BP2, TCF7L2 and FTO
variants confer a significant risk.
BMC medical genetics, 11(1), 1-12.
Sanghera, D. K., & Blackett, P. R. (2012).
Type 2 diabetes genetics: beyond
GWAS. Journal of diabetes &
metabolism, S1.

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

An overview of monogenic diabetes in the Indian

subcontinent

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
Monogenic diabetes refers to a variety of uncommon types of diabetes brought on by single-gene mutations that
impair pancreatic beta-cell activity. The three main subtypes of diabetes are neonatal diabetes, maturity-onset
diabetes of the young (MODY), and mitochondrial diabetes. An overview of the epidemiology, genetics, clinical
characteristics, and diagnosis of monogenic diabetes that is pertinent to the Indian subcontinent is provided in
this narrative review. Monogenic diabetes is rare (2%), however mutations in the MODY genes HNF1A, HNF4A,
GCK, and mitochondrial variations have been found in Indian individuals. Accurate molecular diagnosis is
advantageous for family screening and individualised treatment. Genetic testing, however, is still in its early
stages. Precision diabetes management based on genotypic profiling can be made possible in India by raising
knowledge and capacity for detecting monogenic diabetes. It is also necessary to conduct more study on the
prevalence of genetic screening across the population, founder effects, and its financial viability.
Keywords: Monogenic Diabetes, Indian Subcontinent, Neonatal diabetes, Maturity-Onset diabetes of the Young
(MODY), Genetic Testing..

INTRODUCTION impact -cell metabolism is

While type 1 and type 2 diabetes make mitochondrial diabetes.
up the majority of cases, monogenic Monogenic diabetes is unusual in each
diabetes, a group of rarer single-gene occurrence, but it accounts for about 1-2
variants, is being identified. Neonatal percent of all diabetes cases, therefore
diabetes, which is diagnosed within the there are probably many people who
first six months of life, and maturity- are affected. For the best course of
onset diabetes of the young (MODY), treatment, prognostication, and family
which normally develops before age 25 screening, a precise genetic subtype
and is inherited autosomally diagnosis is crucial. This narrative
dominantly, are important subtypes (De review provides an overview of the
Franco & Ellard, 2015). Another genetics, clinical characteristics, and
monogenic variant associated with diagnosis of monogenic diabetes forms
mitochondrial gene alterations that with a particular focus on studies and
 Scientific Research Journal of India (ScReJI)

cases from the Indian subcontinent, detecting uncommon monogenic types

where diabetes is a serious problem yet necessitates clinical suspicion and
monogenic variants are still poorly confirming molecular testing, neither of
understood. which are generally accessible at the
moment in India.
SEARCH STRATEGY AND SELECTION
CRITERIA NEONATAL DIABETES IN INDIA
The phrases "monogenic diabetes," The prevalence of neonatal diabetes is
"neonatal," "MODY," "India," and believed to be 1 in 100,000 live births,
"Indian" were used in a PubMed search. but it is probably underdiagnosed (De
On monogenic forms of diabetes Franco & Ellard, 2015). There haven't
reported from India and the been many cases from India reported so
subcontinent for the period 2000–2022, yet. Seven patients with KCNJ11 gene
pertinent original publications, case mutations, which account for almost
reports, and reviews were chosen. 50% of all cases of persistent neonatal
Through citation cross-referencing, diabetes worldwide, were discovered in
other relevant papers were found. a cohort of 31 neonatal diabetes
patients (Sharma et al., 2017). A
OVERVIEW OF MONOGENIC frequent mutation was E322K.
DIABETES In another Indian dataset, ABCC8
Pathogenic mutations in a single gene mutations were found in 3 out of 20
that affect pancreatic beta-cell activity neonatal diabetes probands (Kumar et
cause monogenic diabetes. Key al., 2017). For diagnosis and
subcategories based on clinical management, it is crucial to distinguish
characteristics include: between transitory and permanent
- Neonatal diabetes: Initiation of forms. An child with an unique INS gene
hyperglycemia within the first six mutation that caused temporary
months of life. further split into neonatal diabetes was documented in a
permanent and temporary types that case report (Prasad et al., 2011). Overall,
resolve after 18 months. mostly as a Indian instances show genetic variation
result of mutations in the INS, ABCC8, that is comparable to global trends, but
and KCNJ11 genes, as explained below. bigger, more comprehensive
- MODY: Autosomal dominant investigations are needed.
inheritance, typically 25 years of age of
onset. mostly brought on by mutations MODY IN INDIA
in the INS, GCK, HNF1A, HNF4A, and MODY prevalence is believed to be
HNF1B genes, which are discussed between 1% and 2% among diabetic
subsequently. youth, but it is probably
- Mitochondrial diabetes: Linked to underdiagnosed (Anik et al., 2015).
defects in the -cell respiratory chain Variable prevalence across groups,
brought on by mutations in the mutations in the GCK, HNF1A, HNF4A,
mitochondrial DNA. onset can occur at HNF1B, and INS genes are the primary
any age, from birth through adulthood. causes of MODY.
Making precise monogenic diagnosis is There are still few studies identifying
essential for directing treatment. For MODY mutations in Indian patients.
instance, the majority of KCNJ11/ABCC8 HNF1A mutations were most prevalent
mutation carriers with neonatal (40%) in the Indian MODY Registry,
diabetes can switch from insulin followed by GCK (20%), HNF4A (15%),
injections to oral sulfonylureas. But and HNF1B abnormalities (Anik et al.,

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 Scientific Research Journal of India (ScReJI)

2015). A research from Chennai indicators for MODY and neonatal

discovered HNF4A mutations in 7 out of diabetes include autosomal dominant
the 36 probable MODY families inheritance spanning at least three
evaluated (13%) (George et al., 2016). A generations and early onset
founder mutation led to the creation of hyperglycemia. De novo mutations,
another HNF4A pedigree (Parthsarathy however, happen in about 50% of MODY
et al., 2010). (Shields et al., 2010). It might be
From infancy to maturity, case reports challenging to distinguish between the
have identified GCK-MODY patients who normal type 1 and type 2 diabetes
can be distinguished by asymptomatic, presentations in children.
stable mild hyperglycemia without A molecular genetic analysis is needed
consequences (Kota et al., 2012; for a definitive diagnosis, however it is
Shivaprasad et al., 2018). MODY in currently difficult to obtain in India. The
Indians is primarily caused by cost and throughput of testing
uncommon INS gene coding mutations numerous potential genes are both high.
(Kandaswamy et al., 2012). In general, Targeted gene panels and next-
MODY patients from India exhibit generation sequencing offer the high-
genetic variability, however HNF1A and throughput testing required to quickly
GCK are more prevalent than in other find uncommon harmful variants. There
ethnicities. However, for more accurate are continuing efforts to create verified,
prevalence estimates, more sequencing- affordable targeted sequencing panels
based screening is required. for Indian populations with monogenic
diabetes (Prasad & Tiwari, 2021).
MITOCHONDRIAL DIABETES IN INDIA In India, expanding genetic testing
According to a Chinese study, the availability and capability is essential
prevalence of mitochondrial diabetes is for accurate diagnosis and treatment of
estimated to be 0.6%. (Ma et al., 2014). monogenic diabetes. The crucial first
In India, very few cases have been step, however, is raising physician
thoroughly characterised to yet. Out of awareness of clinically questionable
31 probands examined, Tiwari et al. monogenic variations and ordering
(2013) found 3 individuals with the pertinent genetic testing. Wider
m.3243A>G MTTL1 mutation, the most screening can be made possible by the
prevalent mitochondrial diabetes creation of streamlined diagnostic
variant. Finding a rare SLC2A2 mutation algorithms that use clinical factors,
affecting mitochondrial pyruvate entry autoantibody testing where available,
in a young child with mitochondrial and strategic gene sequencing.
diabetes but distinctive characteristics
highlights diverse presentations RESEARCH AND POLICY NEEDS
(Kandaswamy et al., 2013). Given the Key imperatives emerging include:
variability of possible variations, more - Population-based investigations:
comprehensive testing is required to extensive epidemiological studies to
identify prevalence and molecular determine the prevalence and molecular
patterns in India. make-up of MODY subtypes and
newborn diabetes at the national level.
CHALLENGES IN DIAGNOSIS - Genotype-phenotype analyses:
Due to overlap with type 1 and type 2 Extensive research connecting
diabetes, which often manifest in young mutations to clinical manifestation can
age, clinical diagnosis of monogenic improve genotype-based disease course
diabetes is difficult. Key historical prediction.

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 Scientific Research Journal of India (ScReJI)

- Founder effect analysis: Determine young (MODY) in India. Clinica

whether mitochondrial diabetes and Chimica Acta, 457, 110-114.
MODY have founder mutations that are Kandaswamy, R., Iafridi, M.A. and
more prevalent in specific Indian Metallinos, D.L., 2013. SLC2A2
subpopulations. gene deletion causative for Non-
- Screening recommendations: autoimmune diabetes in young
consensus recommendations made by adults. Pediatric diabetes, 14(1),
Indian experts on diagnostic standards, pp.71-75.
screening procedures, and testing Kandaswamy, R., Nimaga, S., Iafridi, M.A.
methodologies that are resource- and Metallinos, D.L., 2012. INS
constrained. mutation identified in an Indian
Building capacity for pre- and post-test family with maturity-onset
counselling, clinical interpretation, and diabetes of the young (MODY).
family screening is part of the Indian journal of endocrinology
infrastructure for genetic counselling. and metabolism, 16(Suppl 2),
- Policy frameworks: Recommendations p.S413.
and funding sources to facilitate fair Kota, S. K., Gayatri, K., Jammula, S., Kota,
access to genetic testing for monogenic S., Krishna, S. V., Modi, K. D.
diabetes when clinically necessary (2012). Clinico-investigative,
genetic and therapeutic aspects of
CONCLUSION glucokinase-maturity onset
In conclusion, monogenic variations are diabetes of young (GCK-MODY)
underappreciated contributors to early- patients in India. Indian journal of
onset diabetes in India. For the best endocrinology and metabolism,
possible care, awareness and diagnostic 16(3), 400.
abilities need to be strengthened. Kumar, J., Gill, G. V., & Neogi, S. G.
Personalized diabetes treatment that is (2017). Monogenic diabetes in
in line with underlying genetic causes India: Clinical characteristics and
can be made possible by converting identification beyond neonatal
genomic insights into clinical practise. diabetes. Indian pediatrics, 54(12),
ACKNOWLEDGMENTS 1013-1018.
None. Ma, L., Huang, S., Huang, D., Chen, X.,
Deng, Y., Yan, W., ... & Fang, F.
REFERENCES (2014). Prevalence of
Anik, A., Çatli, G., Abaci, A., & Böber, E. mitochondrial diabetes in adults
(2015). Maturity-onset diabetes of with type 2 diabetes in China.
the young (MODY): An update. Diabetes Care, 37(5), e77-e78.
Journal of pediatric endocrinology Parthsarathy, V., Raghupathy, P., &
& metabolism, 28(3-4), 251-263. Amutha, A. (2010). Pedigree
De Franco, E., & Ellard, S. (2015). analysis of HNF4A MODY mutation
Transient and permanent neonatal (R127W) in South India. Diabetes
diabetes. Endocrinology and research and clinical practice,
Metabolism Clinics, 44(3), 445- 89(3), e39-e41.
462. Prasad, R. B., & Tiwari, A. K. (2021).
George, L., Nair, T., Patel, Z., Menon, U., Monogenic diabetes in India:
Edghill, E. L., Stanik, J., ... & Ellard, Challenges and way forward.
S. (2016). Molecular analysis of Indian Journal of Medical
maturity onset diabetes of the Research, 153(2), 124.

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 Scientific Research Journal of India (ScReJI)

Prasad, R. B., Groop, L., & Bharadwaj, R.

G. (2011). Transient neonatal
diabetes mellitus type 1: a rare
presentation. BMJ case reports,
2011, bcr0120113697.
Sharma, S., Jain, R., Tiwari, S., Perkins, B.,
Arumugam, R., Elbein, S. C., ... &
Prasad, R. B. (2017). KCNJ11
activating mutation R201H is
prevalent across different
ethnicities in patients diagnosed
with neonatal diabetes before 6
months. Journal of diabetes, 9(9),
788-795.
Shields, B. M., Hicks, S., Shepherd, M. H.,
Colclough, K., Hattersley, A. T., &
Ellard, S. (2010). Maturity-onset
diabetes of the young (MODY):
how many cases are we missing?.
Diabetologia, 53(12), 2504-2508.
Shivaprasad C., Asha H. S., Dinesh V. S.,
Jayashree R. (2018). Maturity-
onset diabetes of the young in
infancy and childhood: A report
from India. Journal of Family
Medicine and Primary Care, 7,
757-60.
Tiwari, A., Kumar, A., & Jain, V. (2013).
m. 3243A> G MTTL1 mutation as a
common cause of maternally
inherited diabetes and deafness
(MIDD) in Indian population.
Biochemical genetics, 51(11), 831-
841.

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Metabolomics and biomarkers: Predicting diabetes risk in

Indian populations.

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
Comprehensive small molecule metabolite profiling is done by metabolomics, which can reveal systemic
pathology. Amino acid, lipid, carbohydrate, and other metabolic investigations of intermediates can provide
information about the metabolic processes underlying the onset of diabetes. This narrative review looks at the
most important results from metabolomics research on the correlations between different metabolites and
metabolic signatures and the likelihood of developing diabetes in Indian cohorts. Similar to other ethnic groups,
certain metabolite markers such branched-chain and aromatic amino acids, bile acids, ceramides, and
acylcarnitines frequently indicate incidence diabetes among Indians. Variations are seen, nonetheless,
highlighting the necessity of developing metabolite biomarker panels designed especially for precise diabetes
prediction in various Indian communities. For properly stratifying diabetes risk and prognosis, metabolomic
profiling offers a functional readout in addition to genetic and clinical characteristics. Metabolomics has promise
for translational applications, but larger, longer-term research are required to develop reliable, generalizable
models of Indian diabetes risk.
Keywords: Metabolomics, Biomarkers, Diabetes risk, Indian Populations, Metabolite Pfofiling..

INTRODUCTION beyond well-established clinical

In India, type 2 diabetes (T2DM) has a indicators.
high morbidity rate and is becoming Prior to the onset of diabetes, dynamic
more and more common as a result of metabolic aberrations underlying
alterations in lifestyle and genetic impaired glucose homeostasis can be
predisposition. Early risk assessment captured by metabolic profiling,
can support focused prevention producing useful biomarkers of diabetes
initiatives to control rising incidence. risk. The main conclusions from
High-throughput 'omics technologies metabolomics research that examined
like metabolomics, which test hundreds metabolic signatures linked to
of compounds in blood/urine, are progression and linked metabolite
emerging as viable techniques for markers to future diabetes development
improving T2DM risk assessment in cohort studies from India are
 Scientific Research Journal of India (ScReJI)

discussed in this narrative review. A pathophysiological phenotyping and

synthesis of the data on metabolomic diabetes risk prediction.
diabetes risk prediction, specifically in
Indians, can guide the transition to AMINO ACIDS
precision prevention. Across the major ethnic groupings,
amino acids have emerged as important
SEARCH STRATEGY AND SELECTION predictors of future diabetes (Walford et
CRITERIA al., 2014). Leucine, isoleucine, valine,
The phrases "metabolomics," "diabetes and phenylalanine and tyrosine
risk," "biomarkers," and "India" were elevations appear to have the highest
used in a PubMed search. We chose connections and frequently occur prior
pertinent original research publications to the development of hyperglycemia,
that described potential relationships showing underlying insulin resistance.
between metabolites or metabolomic After controlling for covariates, Indian
panels and incidence T2DM in Indian studies also discovered links between
cohorts. Through citation cross- branched-chain amino acids, aromatic
referencing, other relevant papers were amino acids, alanine, glutamate, and
found. Studies on metabolomics that glycine and 5–10 year diabetes
were both targeted and untargeted were incidence in community cohorts
included. (Narayanan et al., 2019; Peddinti et al.,
2017). Effect sizes were equivalent to
OVERVIEW OF METABOLOMICS Western populations or slightly lower.
Utilizing analytical methods like mass Urban and rural groups' different amino
spectrometry coupled to liquid/gas acid relationships probably reflect
chromatography or nuclear magnetic dietary differences.
resonance spectroscopy, metabolomics
entails the thorough measurement of LIPIDS
hundreds of low molecular weight Diabetes risk and lipid markers are
metabolites that represent substrates, frequently associated. Increases in
intermediates, and products of cellular phospholipids, cholesterol esters,
metabolism. Since metabolites triglycerides, acylcarnitines, and fatty
represent the accumulated effects of acids are implicated (Walford et al.,
interactions between genes, proteins, 2014). In Indians, some lipid species,
and the environment, metabolomics such as palmitoyl-sphingomyelin, have
offers a functional snapshot of metabolic been found to be biomarkers of diabetes
status (Putri et al., 2020). risk (Dutta et al., 2018).
Studies on metabolomics can be: 1) An Indian cohort that was comparable
Targeted, which quantifies specific to Europeans' projected T2DM using
subgroups of known metabolites like desaturase activity calculated from fatty
lipids or amino acids; or 2) Untargeted, acid ratios (Arnold et al., 2014).
which profiles all detectable analytes in Sphingomyelins, phosphatidylcholines,
a sample objectively. On metabolomic and lysophosphatidylcholines were
datasets, statistical techniques like positively linked with incident T2DM in
machine learning are used to find novel the Indian Migration Study, whereas
metabolite biomarkers linked to phosphatidylethanolamines showed
outcomes of interest, such as the onset negative relationships (Ziyyat et al.,
of diabetes, or uncover disturbed 2017). Such investigations reveal lipid
metabolic pathways. Metabolomics is diabetes risk markers that are both
being used more frequently to improve universal and population-specific.

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 Scientific Research Journal of India (ScReJI)

developed from metabolomics in India

OTHER METABOLITES and around the world (Putri et al.,
Beyond amino acids and lipids, several 2020):
metabolites have predictive value. For - Limited generalizability due to a lack of
instance, in the Chennai Urban Rural fully verified, standardised biomarker
Epidemiology Study, greater serum bile panels.
acids added value above clinical - There is a need for large, prospective,
predictors for the 5-year incidence of multi-site cohorts with serial sampling
diabetes (Praveen et al., 2015). T2DM at scale, which are absent.
risk was different in South Asians and - Population-specificity of metabolic
Europeans according to microbial biomarker patterns calls for research
cometabolites (Pedersen et al., 2016). including India's many ethnic groupings.
Overall, metabolomics regularly - There is little representation in the
enhances diabetes prediction compared studies that are accessible from rural,
to using only clinical factors, but low-income areas.
racial/ethnic biomarker panels can - Despite declining, metabolomics
further improve performance, as seen in expenses are still significantly higher
Native American populations (Jin et al., than those of standard clinical tests.
2019). Large-scale prospective Wider usage will be possible when
metabolomics research in various proven panels receive regulatory
Indian populations are still required. approval.
For practical adoption, research that
METABOLIC SIGNATURES addresses these limitations and shows
Metabolomics can find collective real advances in risk prediction over
metabolic patterns linked to the less sophisticated options is essential.
development of diabetes in addition to However, metabolomics bears promise
individual metabolites. A small targeted for population-scale stratified precision
metabolomics investigation identified diabetes prevention in India.
variations between urban and rural
Asian Indians and rural Chinese in CONCLUSION
amino acid and phosphatidylcholine Summary: In addition to genetic and
metabolism linked to diabetes incidence clinical predictors, metabolomics has
(Chen et al., 2011). identified promising markers of
Novel metabolic characteristics diabetes risk in Indians that offer
associated with glutamine/glutamate functional readouts. To develop
modulation and bile acid metabolism in validated biomarker signatures suited
a population-based Indian cohort for accurate diabetes screening and
markedly distinguished diabetic prevention in this high-risk population,
progressors from non-progressors there is a need for broader, systematic
(Dutta et al., 2016). Metabolomics can application in various Indian cohorts.
shed light on the metabolic processes
driving the rising diabetes risk in ACKNOWLEDGMENTS
communities of Indian migrants in None.
transition.
REFERENCES
CHALLENGES AND FUTURE Arnold, R., Kwak, D., Liu, Z., Qin, Q., Jing,
DIRECTIONS X., Hofman, A., & Dullaart, R. P.
Current restrictions prevent the clinical (2014). Plasma phospholipid
translation of diabetes indicators transfer protein activity is

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 Scientific Research Journal of India (ScReJI)

independently determined by onset type 2 diabetes is associated

obesity and insulin sensitivity in a with elevated amino acid levels
healthy population. Journal of and hepatic glucose output: a
internal medicine, 275(5), 523– targeted clinical metabolomics
532. study. Scientific reports, 7(1), 1-
Chen, L., Magliano, D. J., Balkau, B., 14.
Colagiuri, S., Zimmet, P. Z., Tonkin, Pedersen, H. K., Gudmundsdottir, V.,
A. M., Mitchell, P., & Phillips, P. J. Nielsen, H. B., Hyotylainen, T.,
(2011). AUS2 risk factors for Nielsen, T., Jensen, B. A. H., ... &
incident Type 2 Diabetes in a Oresic, M. (2016). Human gut
national cohort of initially healthy microbes impact host serum
55-84 year old Australians: the metabolome and insulin
Australian diabetes, obesity and sensitivity. Nature, 535(7612),
lifestyle study (AusDiab). 376-381.
Diabetologia, 54(9), 2338–2345. Praveen, E. P., Fahim, G., Makhdoom, P.,
Dutta, S., Kong, J., Li, Y., Hasan, M., Wang, Raghavapriya, R., Rajendiran, K.,
L., Nair, R., Bouchard, C., Krischer, Idiculla, J., Mohan, V., &
J. P., & Prakash, A. (2018). Plasma Balasubramanyam, M. (2015).
ceramides predict cardiovascular Association analysis of nineteen
death in patients with diabetes bile acid concentrations in serum
and acute coronary syndrome. with fasting glucose and diabetic
Diabetes, 67(9), 1945-1949. status. Metabolism, 64(11), 1461-
Dutta, S., Pant, N., Kumar, S., Bhandari, 1469.
B., Mani, K., Tiwari, S., Salunke, B., Putri, W. C., Yamada, K., Matsuo, H.,
Sawlani, V., Vikram, N. K., Shinmura, K., Honda, K., &
Dandona, P., & Tripathi, K. L. Fukusaki, E. (2020). Recent
(2016). Divergent metabolic metabolomics-based diagnostic in
signature between North Indian Type 2 diabetes mellitus.
and South Indian type 2 Diabetic Metabolites, 10(11), 457.
Individuals: results from cross- Walford, G. A., Ma, Y., Clish, C., Florez, J.
sectional phenotyping. Scientific C., Wang, T. J., Gerszten, R. E., &
reports, 6(1), 1-11. Diabetes Prevention Program
Jin, Y., Shi, B., Da, M., Drong, A. W., Ying, Research Group. (2014).
Z., Liu, T., ... & Snyder, M. (2019). Metabolite profiles of diabetes
Innovative Personalized Precision incidence and intervention
Medicine With Population-wide response in the Diabetes
Generalizability Based on an Prevention Program. Diabetes,
ImbalancedMachine Learning and 65(5), 1424-1433.
a Randomized Clinical Trial. JAMA Ziyyat, A., Phan, C., Boulat, O., Vo Phuoc,
network open, 2(9), e1911055- T., Monsila, N., Maubert, M. A., ... &
e1911055. Bouchard, C. (2017).
Narayanan, S. P., Wung, S., & Munusamy, Sphingomyelin and ceramide are
S. (2019). Metabolomics of type 2 associated with metabolic
diabetes mellitus and the syndrome in obese subjects. PloS
predictive value of amino acids. one, 12(3), e0174293.
Cureus, 11(7), e5257.
Peddinti, G., Cahill, F., Chandar, A. K.,
Geisler, J. G., Maiolica, A., Nalpas, N.
C., ... & Zelezniak, A. (2017). Early-

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Diabetic nephropathy in India: Epidemiology, challenges, and

future directions

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
Globally, diabetic nephropathy has become one of the main causes of end-stage renal disease. As the prevalence
of diabetes rises, there is an increasing burden of diabetic kidney disease in India. The studies on epidemiology,
risk factors, and outcomes of diabetic nephropathy in India are summarised in this narrative review. Due to
variations in staging techniques, reported prevalence rates range substantially from 2.2 percent to 27 percent
among studies. Poor glycemic control, hypertension, smoking, obesity, and duration of diabetes are among the
major risk factors. Significant mortality and morbidity are brought on by diabetic nephropathy, particularly when
it progresses to ESRD. Late diagnosis, inadequate risk factor management, and limited access to dialysis and
transplantation are among the problems with care delivery. The improvement of early screening and prevention
through integrated primary care models, the implementation of standard staging protocols, increasing access to
pharmacotherapy, and clinical decision support for risk-based management are highlighted as key priorities.
Additional epidemiological studies with strong definitions are also required to accurately track trends in diabetic
nephropathy and to guide effective health policy in India.
Keywords: Diabetic nephropathy , Ebpidemiology , India, risk factors , Care delivery.

INTRODUCTION This narrative review gathers important

By 2045, the anticipated 77 million research and data on the epidemiology,
diabetics in India will have increased to risk factors, difficulties in diagnosing,
134 million (IDF Diabetes Atlas, 2021). clinical results, and methods for
With such a wide patient base, diabetic preventing diabetic nephropathy in the
nephropathy has become a significant Indian context. It is possible to develop
microvascular consequence, the strategic health system responses
significantly increasing the burden of required to successfully address this
end-stage renal disease (ESRD). Diabetic expanding public health issue by
nephropathy causes enormous synthesising research on diabetic
mortality and financial expenses as it kidney disease in India.
evolves from a preclinical condition to
overt nephropathy and then ESRD.
 Scientific Research Journal of India (ScReJI)

SEARCH STRATEGY studies are required to clarify the illness

The phrases "diabetic nephropathy," burden and trends and to guide
"India," "prevalence," "risk factors," and governmental responses.
"ESRD" were used in a PubMed search.
The epidemiology, risk factors, and RISK FACTORS
outcomes of diabetic nephropathy in Multivariate analysis have revealed
Indians from 2000 to 2022 were studied some significant risk factors for diabetic
in relevant original research articles and nephropathy in Indians (Rahelic, 2016;
review papers. Singh et al., 2013):
- Poor glycemic control: Nephropathy
EPIDEMIOLOGY OF DIABETIC risk is consistently correlated with
NEPHROPATHY IN INDIA elevated HbA1c and longer diabetes
Various definitions and staging methods duration.
have resulted in vast variations in the - Hypertension: A significant factor,
reported prevalence rates for diabetic particularly for advancement. Up to
nephropathy in India, ranging from 2.2 40% of people with diabetes also have
percent to 27 percent among studies hypertension.
(Rajapurkar et al., 2012). According to - Dyslipidemia: Proteinuria and
modest clinic-based research, the hypercholesterolemia are related.
prevalence of microalbuminuria ranges - Obesity: A higher BMI increases the
from 16 to 36%. (Unnikrishnan et al., incidence of albuminuria.
2017). - Smoking: Nephropathy risk is about
Looking at some key findings from 1.5 times higher for smokers than for
community-based datasets: non-smokers.
Based on a single urine sample, the - Genetics: ACE, ApoE, and ELMO1
WHO Multi-Country Survey Study found variants have been related to
that 39.9% of individuals in India with nephropathy risk, although further
self-reported diabetes had study is required.
microalbuminuria (Unnikrishnan et al., The key to nephropathy prevention and
2014). control is focusing on these modifiable
- A Phase I ICMR-INDIAB nationwide risk factors through integrated diabetes
study revealed that people with known treatment and lifestyle modification.
diabetes had a microalbuminuria
prevalence of 26%. (Anjana et al., 2014). OUTCOMES AND PROGNOSIS
- The CURES study found that among Significant morbidity and mortality are
diabetic inhabitants of Chennai, 20.6 brought on by diabetic nephropathy,
percent had microalbuminuria and 5.3 particularly ESRD. Data on results that
percent had overt nephropathy are unique to India are few. observed
(Premalatha et al., 2002). findings:
- Sub-analyses show differences in Even after accounting for cardiovascular
proteinuria frequency across rural and risks and age, mortality rates for
urban areas (7.7% rural versus 14.9 diabetics with renal disease are
urban), emphasising inequalities (Singh significantly greater than those for
et al., 2012). individuals without nephropathy
Overall, the prevalence of diabetic (Prasad et al., 2015).
nephropathy appears to be high, despite - One study indicated that for ESRD
the absence of reliable national data induced by diabetes, 50% of deaths
using uniform definitions. Moving occurred 30 months after the start of
forward, accurate epidemiological hemodialysis (Rajapurkar et al., 2012).

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 Scientific Research Journal of India (ScReJI)

- Diabetes patients had ESRD incidence

rates that range from 2 to 150 per RECOMMENDATIONS AND FUTURE
100,000 patient-years, demonstrating DIRECTIONS
variability between cohorts (Rajapurkar Key imperatives to tackle the rising
et al., 2012). burden of diabetic nephropathy in India
- According to registry data, diabetes include:
accounted to 45% of cases among ESRD - Expanding the scope of screening by
patients receiving renal replacement using low-cost point-of-care urine
therapy (RRT), a significant burden albumin detection techniques in
(Rajapurkar et al., 2012). primary care settings.
Beyond renal impairment, diabetic - Supporting integrated care models that
nephropathy is related with greater span primary, secondary, and tertiary
incidence of cardiovascular events, such facilities for ongoing screening, early
as coronary artery disease, detection, and prevention.
cerebrovascular disease, and peripheral - Establishing national chronic kidney
vascular disease (Rahelic, 2016). disease registries to enable thorough
surveillance using agreed-upon criteria.
CHALLENGES FOR CARE DELIVERY IN - Increasing the availability of
INDIA pharmacotherapy and maximising the
The best prevention and treatment of use of sodium-glucose co-transporter-2
diabetic kidney disease are hindered by (SGLT2) inhibitors, angiotensin
a number of health system issues: converting enzyme
- Late diagnosis: As a result of inhibitors/angiotensin receptor
insufficient screening, many individuals blockers, and high-risk patients.
present with advanced nephropathy. In - Clinical decision support technologies
one study, only 19% of diabetics had that offer evidence-based screening and
urine microalbumin testing management cues at the point of care
(Unnikrishnan et al., 2017). and are integrated into electronic health
- Gaps in primary care: There is a lack of records.
coordination between the various levels - Task sharing with nurses, pharmacists,
of healthcare for the management and and frontline staff for the best possible
surveillance of diabetes and renal self-management in the areas of foot
disease. care, kidney health education, and self-
- Risk factor management includes poor monitoring support.
blood pressure control, inadequate - Increasing the rate of kidney
glycemic control, and the use of renin- transplantation through improved
angiotensin-aldosterone system allocation procedures for organs from
inhibitors, particularly at the primary deceased donors.
care level.
- Dialysis costs: Catastrophic health CONCLUSION
expenditures is fueled by high out-of- In conclusion, diabetic nephropathy has
pocket costs for dialysis. Limited become a significant microvascular
coverage is provided through consequence in India, with a significant
government insurance. cost on morbidity and mortality. To
- Transplant accessibility: Although improve prevention, early identification,
cadaveric transplants from deceased and evidence-based care to prevent
donors are more common in some poor kidney outcomes, the entire health
places, such as Tamil Nadu, they are still system must work together.
rare.

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 Scientific Research Journal of India (ScReJI)

ACKNOWLEDGMENTS diabetic nephropathy. Nature

None. reviews. Nephrology, 4(4), 216–
226.
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Anjana, R. M., Ali, M. K., Pradeepa, R., Subramanian, K. K., Reddy, S. R.,
Deepa, M., Datta, M., Unnikrishnan, Acharya, V. N., ... & Singh, R.
R., ... & Narayan, K. V. (2014). The (2013). Epidemiology and risk
need for obtaining accurate factors of chronic kidney disease
nationwide estimates of diabetes in India–results from the SEEK
prevalence in India-rationale for a (Screening and Early Evaluation of
national study on diabetes. The Kidney Disease) study. BMC
Indian journal of medical research, nephrology, 14(1), 1-10.
139(4), 569. Unnikrishnan, R., Rema, M., Pradeepa, R.,
International Diabetes Federation. IDF Deepa, M., Shanthirani, C. S.,
Diabetes Atlas, 10th edition, 2021. Deepa, R., & Mohan, V. (2007).
https://diabetesatlas.org Prevalence and risk factors of
Prasad, N., Kumar, S., Manjunath, R., diabetic nephropathy in an urban
Bhadauria, D., Kaul, A., Sharma, R. South Indian population: the
K., ... & Jha, V. (2015). The Chennai Urban Rural
determinants of mortality on Epidemiology Study (CURES 45).
hemodialysis in patients with Diabetes care, 30(8), 2019-2024.
diabetes and end-stage renal Unnikrishnan, R., Pradeepa, R., Joshi, S.
disease. Saudi journal of kidney R., & Mohan, V. (2017). Type 2
diseases and transplantation, diabetes: demystifying the global
26(4), 775. epidemic. Diabetes, 66(6), 1432-
Premalatha, G., Shanthirani, S., Deepa, R., 1442.
Markovitz, J., & Mohan, V. (2002). Unnikrishnan, R., Rema, M., Pradeepa, R.,
Prevalence and risk factors of Deepa, M., Shanthirani, C. S.,
peripheral vascular disease in a Deepa, R., & Mohan, V. (2007).
selected South Indian population: Prevalence and risk factors of
the Chennai Urban Population diabetic nephropathy in an urban
Study. Diabetes care, 25(8), 1272- South Indian population: the
1278. Chennai Urban Rural
Rahelic, D. (2016). Chapter 48 - Diabetic Epidemiology Study (CURES 45).
nephropathy in Indians. In M. Diabetes care, 30(8), 2019-2024..
Mohan (Ed.), RSSDI Textbook of
Diabetes Mellitus (Third Edition)
(pp. 877-894). Jaypee Brothers
Medical Publishers.
Rajapurkar, M. M., John, G. T., Kirpalani,
A. L., Abraham, G., Agarwal, S. K.,
Almeida, A. F., ... & Modi, G. (2012).
What do we know about chronic
kidney disease in India: first
report of the Indian CKD registry.
BMC nephrology, 13(1), 1-11.
Singh, D. K., Winocour, P., & Farrington,
K. (2012). Mechanisms of disease:
the hypoxic tubular hypothesis of

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

The growing challenge of diabetic retinopathy in the Indian

healthcare system

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
In the backdrop of India's rising diabetes epidemic, diabetic retinopathy has become a significant factor in vision
impairment and blindness. The epidemiology, screening, diagnosis, treatment, and public health issues associated
with reducing the incidence of diabetic retinopathy in India are examined in this narrative review. According to
reported prevalence statistics, which can range from 7.7% to 33 percent depending on screening techniques and
population variables. Hyperglycemia, hypertension, and duration of diabetes are significant risk factors. Due to
subpar routine screening and limited infrastructure, diabetic retinopathy is still underdiagnosed, with late
detection being typical. If used in a timely manner, laser photocoagulation can avert blindness, however access
restrictions restrict penetration. Anti-vascular endothelial growth factors administered intravitreally offer
interesting therapeutic alternatives. The deployment of cost-effective screening models integrated into primary
care, bolstering ophthalmic capacity and staff training, extending service access outside of large cities, and
enhancing coordination across different tiers of healthcare are key imperatives that are addressed. The growing
problem of diabetic retinopathy must be addressed if India wants to reduce preventable blindness and the
related financial consequences.
Keywords: Diab etic Retinopathy, Epidemiology, India, Screening, Treatment Access.

INTRODUCTION The evidence on the epidemiology, risk

By 2045, 134 million adults in India are factors, diagnosis, and treatment of
expected to have diabetes, up from the diabetic retinopathy in India is compiled
present estimate of 77 million (IDF in this narrative review. The growing
Diabetes Atlas, 2021). Chronic problem of diabetic retinopathy-related
hyperglycemia causes microvascular blindness can be addressed by
problems, such as diabetic retinopathy, strengthening health systems by
which is a common cause of new identifying important gaps and
blindness. With an increasing number of prioritising these areas for
people in India having diabetes, the improvement.
burden of diabetic retinopathy is
growing and severely affecting vision.
 Scientific Research Journal of India (ScReJI)

SEARCH STRATEGY Nephropathy: This association is

The phrases "diabetic retinopathy," probably due to a common
"prevalence," "India," "screening," and microvascular disease.
"therapy" were used in a PubMed - Obesity: Potential link driven by
search. We found and analysed concurrent metabolic problems.
pertinent original research articles and - Lifestyle choices like drinking alcohol
reviews with information on the and smoking may also be an influence.
epidemiology, risk factors, diagnosis,
and treatment of diabetic retinopathy in SCREENING AND DIAGNOSIS
Indians. Although essential, routine retinal
screening for early detection is being
EPIDEMIOLOGY AND RISK FACTORS performed insufficiently in India. Only
According to several studies, the one-third of known diabetics who had
reported prevalence of diabetic gotten an eye exam in the previous year,
retinopathy among diabetics in India according to a nationally Representative
ranges widely between 7.7 percent and poll (Mahapatra & Bachani, 2018). The
33 percent, reflecting variations in following are significant obstacles to
settings, screening procedures, and retinopathy screening (Raman et al.,
diagnostic criteria (Raman et al., 2012). 2012):
Some key observations from - Lack of understanding of the
population-based datasets: significance of screening.
Retinopathy prevalence was 17.6% in - Limited access to screening resources
rural areas, 26.8% in urban clinic and qualified staff, particularly outside
patients, and 10.3% in diabetic camps of major cities. Reorienting the basic eye
utilising dilated examinations, according care paradigm is necessary.
to Sankara Nethralaya investigations - Problems with affordability and
(Rema & Pradeepa, 2007). significant out-of-pocket expenses.
Based on fundus photography, the - Deficits in clinician ability to recognise
Aravind Comprehensive Eye Survey early non-proliferative alterations
found that retinopathy prevalence was during evaluation.
10.3% in rural individuals and 21.7 As a result, many individuals who later
percent in urban participants (Raman et present with vision loss due to severe
al., 2007). proliferative disease are
- SN-DREAMS: According to dilated underdiagnosed. To increase early
exams, the prevalence of type 2 diabetes detection, screening techniques must be
was 18% overall, while only 10.3% of incorporated into basic healthcare
newly diagnosed cases had the services and regular diabetes care
condition (Raman et al., 2012). routes. New strategies include:
Key risk factors for diabetic retinopathy - Fundus photography by qualified
in Indians include (Raman et al., 2012; technicians, either with or without
Rea & Pradeepa, 2007): mydriasis, has a high sensitivity and
- The most reliable connections between specificity for identifying referable
hyperglycemia and a longer duration of diabetic retinopathy (Silva et al., 2018).
diabetes point to the significance of - After proper training of healthcare
glycemic management. professionals, digital retinal imaging
- Hypertension: Supports growth and employing smartphone-based adaptor
advancement. devices is feasible for retinopathy
- Dyslipidemia: The risk of retinopathy screening at the primary care level
is correlated with high cholesterol. (Rani et al., 2018).

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 Scientific Research Journal of India (ScReJI)

- Handheld, portable cameras: Facilitate - Scaling specialised services: To handle

screening in rural and distant areas and the growing case load, it is crucial to
offer fair diagnostic accuracy, while increase the availability of specialised
picture quality issues require care personnel (retina surgeons,
(Sengupta et al., 2013). optometrists) and equipment (lasers) in
- Tele-ophthalmology models and various regions.
centralised grading: These solutions aid - Problems with coordination: To assure
in addressing the shortage of a continuity of screening, diagnosis, and
ophthalmologists in various areas. treatment, link worker models for
- Diagnostic algorithms that combine bidirectional coordination between
clinical assessment, imaging, and risk primary care and tertiary facilities are
stratification may increase effectiveness required.
and save costs (Srinivasan et al., 2015). - Health financing: Access is impacted by
high out-of-pocket expenses and
TREATMENT MODALITIES insufficient insurance coverage for eye
When used as soon as possible, laser treatment. Studies on screening and
photocoagulation, the gold standard of treatment cost-effectiveness are
therapy for diabetic retinopathy that required.
poses a threat to vision, can avoid - Health information systems:
blindness (Raman et al., 2012). Access is Monitoring and registry-linked care are
constrained outside of big cities. Higher hampered by the lack of surveillance
prevalence of visual impairment is databases integrating diabetes and eye
related to lower laser therapy care data.
penetration.
Intravitreal anti-vascular endothelial CONCLUSION
growth factor (anti-VEGF) medicines are In conclusion, India faces a significant
more recent, evidence-based therapies burden of preventable blindness caused
for proliferative retinopathy and by diabetic retinopathy. There is an
advanced diabetic macular edoema that urgent need for coordinated public
improve visual acuity in a manner health initiatives to reduce management
equivalent to or superior than laser and early detection gaps. The expenses
therapy while causing fewer adverse imposed on both health and the
effects (Raman et al., 2016). However, economy can be reduced by making
utilisation in India is now constrained investments to increase the capability of
by expensive costs, a necessity for the health systems on several fronts.
frequent dosage, and a lack of
regulations. ACKNOWLEDGMENTS
None.
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Rema, M., & Pradeepa, R. (2007).
Diabetic retinopathy: an Indian
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310.
Sengupta, S., Gulati, A. M., Thakur, S.,
Lakshminarayanan, V., Venkatesh,
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primary care setting. Indian

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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

Cardiovascular complications in Indian diabetics: A review of

unique risk factors

Ankita Kashyap *, Krishna Nand Sharma **

*Head of Department (Medicine), Maha Mrityunjay Hospital, Azamgarh, Uttar Pradesh, India
**Managing Director, Virtued Academy International, Azamgarh, Uttar Pradesh, India

ABSTRACT
The most common cause of death among Indian diabetic patients is cardiovascular disease, which has become
one of their major comorbidities. While traditional risk factors have a role, studies also show that the Indian
environment has particular characteristics that increase cardiovascular vulnerability. The evidence on diverse
cardiovascular risk factors observed among Indian diabetics, such as food patterns, lipid abnormalities,
thrombogenic variables, and hereditary susceptibilities, is summarised in this narrative review. Lower cutoffs for
overweight/obesity are suggested for determining Indians' cardiometabolic risk. Dietary patterns with high
intakes of refined carbohydrates and low intakes of omega-3 fatty acids are common, as are dyslipidemia
phenotypes with high serum triglyceride levels and low HDL. Susceptibility is also increased by prothrombotic
inclinations, hypertension, sedentary lifestyles, and particular genetic variations. For the purpose of reducing
cardiovascular burden, targeted screening and management of these risk factors specific to India are necessary.
However, the first goal should continue to be reducing the rising incidence of diabetes through dietary and
lifestyle changes.
Keywords: Cardiovascular complications, Indian diabetics , Unique risk factors , Cardiovascular vulnerability ,
Dietary patterns..

INTRODUCTION hypertension, research has also

The prevalence of diabetes is increasing revealed particular characteristics that
rapidly in India as a result of increase cardiovascular vulnerability in
socioeconomic shifts, dietary changes, the Indian environment. In order to
and underlying genetic predispositions. offer insights on customised screening
Due to the rise in diabetes-related and management approaches, this
vascular problems, cardiovascular narrative review highlights the
disease (CVD) is now the leading cause information on specific clinical, lifestyle,
of death for Indian diabetic patients and genetic CVD risk factors observed
(Mohan & Pradeepa, 2009). among Indian diabetics.
In addition to more common risk factors SEARCH STRATEGY AND SELECTION
like dyslipidemia, smoking, and CRITERIA
 Scientific Research Journal of India (ScReJI)

The terms "diabetes", "cardiovascular", - Men and women with waist-hip ratios
"India", and "risk factors" were used in a greater than 0.88 and 0.81, respectively,
PubMed search. Selected were pertinent exhibited good sensitivity and
original research papers and reviews on specificity for predicting coronary risk
CVD risk variables, specifically in (Dudeja et al., 2001).
diabetic people from India. Citation Therefore, evaluation of central
cross-referencing helped find further adiposity is crucial for CVD screening in
studies. High-risk cohort analyses and Indians beyond BMI.
population-based research were also
covered. DIETARY PATTERNS
Some eating habits among Indian
LOWER BMI CUTOFFS FOR OBESITY diabetics may increase their risk of CVD:
Even though obesity is a recognised CVD - High carbohydrate intake: Metabolic
risk factor, determining the right weight problems have been associated to diets
cutoffs for Indians has been the subject that contain more than 65 percent of
of research. Indians have been shown to their calories as refined grains like rice
have high body fat at lower BMI levels, and wheat flour (Radhika et al., 2009).
which is probably due to hereditary and Low omega-3 polyunsaturated fatty acid
environmental factors (Chandalia et al., consumption has been linked to an
1999). increased risk of cardiovascular events
- The CURES study indicated that South (Pella et al., 2003).
Indians had higher cardiovascular risk - Hyperhomocysteinemia, a risk factor
over the 25 kg/m2 BMI threshold than for vascular problems, is connected with
did Caucasians, suggesting lower cutoffs vitamin B12 insufficiency, which is a
for defining overweight and obesity prevalent condition (Khanduri et al.,
among Indians (Deepa et al., 2007). 2015).
- Based on links with cardiometabolic - Magnesium, zinc, and antioxidant
risks, recent consensus guidelines deficiencies are also common and may
define overweight as 23-24.9 kg/m2 increase one's risk of developing
and obesity as 25 kg/m2 for Indians cardiovascular disease (Kamble et al.,
(Misra et al., 2009). These revised 2016).
criteria enable the detection of risks
associated with obesity. DYSLIPIDEMIA
While atherosclerotic lipid
CENTRAL OBESITY abnormalities are common in diabetics,
Given the limitations of BMI, it has been some specific patterns have been
demonstrated that in Indian diabetics, observed in Indians:
measures of abdominal and truncal - Hypertriglyceridemia: Compared to
adiposity, such as waist circumference Caucasians, fasting and postprandial
and waist-hip ratio, correlate more hypertriglyceridemia are more common
significantly with the risk of CVD (Joshi, 2003). Triglyceride
(Mohan et al., 2007). overproduction is encouraged by insulin
- In CURES, males with waist resistance.
circumferences of 90 cm or less and - Low HDL: A feature with a possible
women with waist circumferences of 80 hereditary and behavioural connection
cm or less had significantly greater is low baseline HDL (Enas et al., 1996).
cardiovascular mortality (Pradeepa et - Small dense LDL phenotype is another
al., 2008). typical and atherogenic variant.

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 Scientific Research Journal of India (ScReJI)

- Hypoalphalipoproteinemia: Severe al., 2014). The key is establishing active

premature CVD is associated with living conditions.
familial insufficiency of apo-AI and HDL.
Population founder effects probably CONCLUSIONS AND
have a role (Kulkarni et al., 2013). RECOMMENDATIONS
In conclusion, Indians have unique
THROMBOGENIC RISK FACTORS clinical, metabolic, nutritional, and
According to studies, diabetics from genetic characteristics that increase
India have an increased tendency to cardiovascular vulnerability in diabetes,
clot: in addition to the usual risk factors.
- Greater amounts of fibrinogen relative - In order to screen for obesity and
to Caucasians, regardless of other risk adiposity, lower cutoffs should be used.
factors (Patel et al., 2015). Compared to BMI, central obesity
Homocysteine levels that are elevated correlates better.
when B12 levels are low (Khanduri et - Lowering triglycerides and increasing
al., 2015). HDL coupled with lowering LDL should
- Central obesity and hypercoagulability be the top priorities in managing
indicators such PAI-1 (Vikram et al., dyslipidemia.
2003). - More active consideration of
- The presence of antiphospholipid antithrombotic therapy in high-risk
antibodies in approximately 20% of subsets with thrombogenic indicators.
diabetic patients is associated with an - It is advantageous to increase sources
increased risk of atherothrombosis of omega-3 fatty acids while decreasing
(Vadivelan et al., 2015). refined carbohydrates in the diet.
- Promoting physical exercise need to be
GENETIC PREDISPOSITION a key component of diabetes treatment.
Indian diabetics are more likely to have However, controlling the burden of
certain genetic polymorphisms cardiovascular problems requires
associated with increased halting the ongoing diabetes epidemic
cardiovascular risks, such as factor V by societal changes in lifestyle and the
Leiden, APOE, ACE, PON1, IL-6, and IRS- removal of barriers.
1 variations, which have been linked to
thrombosis, dyslipidemia, inflammation, ACKNOWLEDGMENTS
and insulin resistance (Kumar et al., None.
2017; Raju et al., 2011).
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- High dietary salt intake, obesity, and Deepa, M., Bhansali, A., Joshi, S. R.,
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low. According to a multi-center study, Gundersen, J., & Grundy, S. M.
just 9% of urban adults engage in (1999). Relationship between
moderate to vigorous activity (Anjana et generalized and upper body

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obesity to insulin resistance in Kumar, V., Yadav, U., Kumar, V., Gupta,
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artery disease. Journal of cerebrovascular events in Asian
postgraduate medicine, 59(3), 240. Indians with type-2 diabetes.

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Journal, Indian Academy of Clinical adults in urban North India.

Medicine, 16(1), 20-23. Atherosclerosis, 168(2), 305-313.
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 Volume: 7, Issue: 1, Year: 2023
Scientific Research Journal of India
Review Article

The Role of Dry Needling in Musculoskeletal Pain

Chakshu Bansal
Director, PhysioNeeds Academy, New Delhi, India

ABSTRACT
Myofascial pain syndrome caused by trigger points is a prevalent yet underdiagnosed condition. Dry needling,
which involves inserting a needle into trigger points, is an emerging treatment technique used by physicians and
physical therapists to manage this type of pain. This article provides an overview of dry needling including the
different needling techniques such as superficial vs deep needling and paraspinal needling. Research shows dry
needling can provide marked pain relief, likely due to the mechanical needle stimulus, although additional
placebo-controlled studies are warranted. Documented side effects are mild and incidence of significant adverse
events is less than 0.03% when performed by well-trained professionals. Introductory dry needling workshops
range from 24-32 hours followed by supervised clinical training. Regulatory eligibility varies but basic
competency requires a licensed clinical degree and training specific to dry needling. In conclusion, dry needling is
an effective and safe adjunct treatment for trained providers managing patients with myofascial trigger point
pain. Further research can help refine patient selection and define precise mechanisms underlying its benefits.

Keywords: Dry Needling, Trigger Points, Myofascial trigger point.

INTRODUCTION provides an overview of dry needling,

Myofascial pain syndrome, caused by including the different techniques,
myofascial trigger points (MTrPs), is a effectiveness, physiologic effects,
common condition seen in primary care adverse events, and training
settings. MTrPs can be the primary requirements.
source of pain in 30-85% of patients
presenting with musculoskeletal pain DRY NEEDLING TECHNIQUES
(Fishbain et al., 1986; Fricton et al, Dry needling initially evolved from an
1985; Skootsky et al., 1989). Despite its empirical observation that needling of
high prevalence, MTrPs often go trigger points provides pain relief
undiagnosed and untreated leading to independent of any substances injected
chronic pain (Feinberg & Feinberg, (Lewit, 1979). Several conceptual
1998; Gerwin, 1995; Ingber, 1989). Dry models and needling techniques have
needling, which involves inserting an since developed. Two common
acupuncture needle directly into an approaches are the radiculopathy
MTrP, is a relatively new minimally model, proposed by Dr. Chan Gunn
invasive treatment approach used by (Gunn, 1997), and the myofascial trigger
physicians and physical therapists to point model (Simons et al., 1999).
manage myofascial pain. This review
 Scientific Research Journal of India (ScReJI)

The radiculopathy or intramuscular and syncopal events (Ga et al., 2007;

stimulation (IMS) technique is based on Huguenin et al., 2005). Incidence of
the premise that peripheral neuropathy significant effects is very low at 0.03%
or radiculopathy leads to muscle (Witt et al., 2009). The risk profile is
shortening and TrP formation (Gunn, similar to that seen with acupuncture
1997). Hence needling aims to treat the provided by trained professionals
underlying neuropathy. The myofascial (White et al., 2001; Witt et al., 2009).
trigger point approach involves
needling directly into the trigger point TRAINING REQUIREMENTS
in the muscle (Simons et al., 1999). Introductory dry needling workshops
Local twitch responses elicited on range from 24-32 hours followed by
needling indicates rapid depolarization supervised clinical training (KinetaCore,
of muscle fibers, decline in spontaneous 2010; Yun-Tao, 2010). Certain
electrical activity, and subsequent pain techniques like the radiculopathy model
relief (Chen et al., 2001). may warrant longer initial workshops.
Dr. Baldry (2005) introduced superficial Regulatory requirements for eligibility
dry needling where the needle is varies across countries and states. But
inserted into tissues overlying TrPs to a basic competency requires a licensed
depth of 5-10mm unlike deep medical or physical therapy degree
intramuscular needling. Superficial along with dry needling specific
needling is painless, has less risk of training.
tissue injury and post-treatment
soreness. Paraspinal needling is used in CONCLUSIONS
the radiculopathy model where muscles In summary, dry needling provides an
innervated by affected spinal segment effective and safe adjunct in the
are needled along with site of pain management of myofascial pain for
(Gunn (1997). trained healthcare providers. While
questions regarding precise
EFFECTIVENESS mechanisms and superiority over
The effectiveness of dry needling has placebo exist, more rigorous research is
been demonstrated through RCTs and required to further define the role of dry
systematic reviews (Cummings & White, needling for specific pain conditions.
2001; Furlan et al., 2005). While an
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