Diabetes a pandemic, needs vaccines, efficacious medication for control

India is considered as the diabetes capital of the world. The numbers are growing alarmingly and indicate that we are sitting on a ticking time bomb!

According to a report in BBC news, which quotes a recent study published in The Lancet Diabetes and Endocrinology, the first such comprehensive study commissioned by our Ministry of Health, it is estimated that 101 million people in India – around 10 per cent of the country's population - are suffering from diabetes. This number is alarmingly higher as compared to the earlier WHO figure of 77 million. And, even this number is expected to almost double if people with undetected, border line or pre-diabetes are also included! In cases of pre-diabetes, conversion to diabetes is very, very fast. More than 60 per cent of people with pre-diabetes end up becoming diabetics in five years. According to the above ICMR survey, 136 million people (this number in the earlier WHO figure was 25 million) – or around 15 per cent of the people - could be living with pre-diabetes!

What is worse is that diabetes is the cause of several other serious diseases, like heart disease, stroke, renal disease, vision loss and nerve damage. In India, diabetes is the leading cause of kidney failure, in almost 30 per cent of all cases.

Diabetes is of two types - Type-1 and Type-2. Type-1 diabetes is a disease of the immune system, generally affecting young people. It supposedly attacks the body's insulin factories (beta-cells) leading to a deficiency of the hormone which controls blood sugar levels. Type 2 diabetes is the result of a poor and sedentary lifestyle, unhealthy food, lack of activity, genetic reasons and excess fat, which can all affect the way insulin works.

The comprehensive, decade-long study was conducted by the Madras Diabetes Research Foundation jointly with the Indian Council of Medical Research (ICMR) and involved 113,000 participants over the age of 20 from every state in India. Data collected in 2008 was extrapolated for 2021 using demographics in the latest National Family Health Survey.

The highest prevalence of diabetes was observed in Goa (26.4 per cent), Puducherry (26.3 per cent) and Kerala (25.5 per cent). The study warned of a sharp rise in diabetes cases in states like Uttar Pradesh, Madhya Pradesh and Bihar. The problem is more severe in urban areas as compared to rural areas for obvious reasons.

According to earlier research studies in BBC news, scientists felt diabetes can be grouped in five separate clusters, and treatment tailored to each form.

Cluster 1 - Severe autoimmune diabetes  - broadly Type-1 - affects young people, seemingly healthy but with an immune disease as a result of which their body is unable to produce insulin.

Cluster 2 - Severe insulin-deficient diabetes patients as in cluster 1 - young, with a healthy weight, but with bodies struggling to make insulin, with a deficient immune system.

Cluster 3 - Severe insulin-resistant diabetes patients, generally overweight, with their bodies making insulin, but bodies no longer responding.

Cluster 4 - Mild obesity-related diabetics, people who are overweight, but metabolically much closer to normal.

Cluster 5 - Mild age-related diabetics developed symptoms when they were significantly older than in other groups.

The problem is also raging globally. According to the above report, by 2050, 1.3 billion people (13.4 per cent of the global population) will have diabetes, double the 2021 figure of 529 million. The report noted that diabetes cases are growing exponentially, with the disease outpacing most other diseases.

In view of the pandemic-like global spread of the disease, the question arises as to why a globally co-ordinated research cannot be conducted to develop diabetes vaccines, like successfully done for Coronavirus. Researchers are working on developing vaccines for diabetes, especially for Type-1 diabetes, which is an autoimmune disorder and where the body’s immune system attacks and destroys insulin-producing cells in the pancreas. Here are some of the promising vaccine candidates under development:

1. Diamyd: Diamyd is a vaccine that contains a protein fragment found in insulin-producing cells. It is designed to teach the immune system to tolerate this protein, preventing it from attacking the cells that produce insulin. Clinical trials of Diamyd have shown promising results.

2. TOL-3021: TOL-3021 is a vaccine that targets a protein called Hsp60, found on the surface of insulin-producing cells. The vaccine is designed to suppress the immune response to Hsp60, preventing the destruction of insulin-producing cells. Clinical trials are currently underway.

3. BCG vaccine: The Bacillus Calmette-Guérin (BCG) vaccine, which is commonly used to prevent tuberculosis, has also shown promise in preventing and reversing type 1 diabetes. The vaccine appears to boost the activity of a type of immune cells called regulatory T-cells.

4. Peptide vaccine: Researchers are also developing peptide vaccines that can target specific immune cells that attack insulin-producing cells. These vaccines contain short chains of amino acids that can stimulate production of regulatory T-cells.

While work is in progress, though mainly for Type-1 diabetes, there is no vaccine yet which can prevent and cure diabetes; especially Type-2 diabetes, which is more prevalent and in need of evolving, efficacious and affordable medication. Some time ago, at the instance of US president, Eli Lilly, one of the three major vaccine companies in the world, reduced prices by 70 per cent. However the other two, Sanofi and Novo Nordisk, are yet to follow suit. According to National Study Reports, healthcare bill is over 10 per cent of total spend for 90 million Indians, of whom 30 million spend over 25 per cent. There is a need to reduce prices and make medication affordable for common people, aprt from constant research into new and effective medication. Of course, education is also needed on lifestyle corrective measures like regular exercise, healthy diet (low in carbs and high in fibre), weight management, meditation and if needed, surgery. Fortunately, in India, there are excellent hospitals and globally reputed doctors across the country. Yet there is a need for a nationwide war-like campaign, which was seen during the Coronavirus pandemic, to control and remedy the raging problem.

Dhanendra Kumar is the former Executive Director for India at World Bank and First Chairman, Competition Commission of India. He is the Founder Chairman of Competition Advisory Services LLP. Views are personal.