Addressing “Metabolic Syndrome”: Key to tackling type-2 diabetes in India

India is a “global leader” in the prevalence of Type-2 diabetes, a disease that can be and has to be managed for a healthy lifestyle. From controlling your insulin levels, to exercise, and weight loss there are several ways to manage the condition effectively. Yet, according to the doctors, the most effective of the strategies is addressing the Metabolic Syndrome. What is Metabolic Syndrome and how do we address it? It is a cluster of metabolic abnormalities, including insulin resistance, abdominal obesity, hypertension, elevated triglycerides, and low HDL cholesterol.

These factors collectively contribute to chronic low-grade inflammation, influenced by intricate interactions between genetic predispositions and behavioural factors.^1,2

India is fast turning out to be a “leader” in this domain as well. The prevalence of metabolic syndrome in India has alarmingly escalated over the past few decades, ranging from 10% to as high as 84%.

A recent systematic review and meta-analysis revealed that the prevalence of metabolic syndrome in India is 30% and is more commonly seen among older adults (aged more than 60 years), women, and the urban population.^1,3

As urbanisation has accelerated, dietary habits have changed and lifestyle has become more sedentary; resulting in a surge in the prevalence of metabolic syndrome, exacerbating the already alarming diabetes epidemic.

The increase in the prevalence of metabolic syndrome in India is a pressing public health issue, underscoring metabolic syndrome as a prognostic predictor for future adverse health outcomes.

Metabolic Syndrome, Obesity, Type-2 Diabetes,and cardiovascular diseases: A link
The link between Metabolic syndrome and type-2 diabetes is directly proportional. The former amplifies the risk of developing the latter.

Each component of metabolic syndrome— including abdominal obesity, elevated triglycerides, low levels of HDL cholesterol, high blood pressure, and elevated fasting glucose—contributes to insulin resistance, which tends to be a hallmark of type-2 diabetes mellitus.

And it does not end there, given the co-existence of both factors becomes all the more lethal. When metabolic syndrome coexists with type-2 diabetes, it significantly increases the likelihood of severe health complications such as cardiovascular diseases, stroke, and kidney disorders.^1,2

Excess weight and obesity promote both hypertrophy and hyperplasia of adipocytes, leading to increased production of biologically active compounds known as adipocytokines. These include free fatty acids, tumour necrosis factor-α, interleukin-6, and plasminogen activator inhibitor-1.

What do these substances do to the human body? They initiate localized and systemic inflammation, triggering processes such as insulin resistance, oxidative stress, coagulation abnormalities, and inflammatory reactions, accelerating the progression of atherosclerosis.^2,6

According to a recent study, individuals with metabolic syndrome are at a five-fold increased risk of developing type 2 diabetes, and they face a two-fold heightened risk of cardiovascular disease compared to those without metabolic syndrome. That is scary, isn’t it? But there is a way to address this ‘syndrome’ effectively.

Addressing the challenge
Being an ideal predictor of type-2 diabetes mellitus, substantial consideration has to be given to ameliorating metabolic syndrome as an interventional approach for the prevention of type-2 diabetes mellitus.

Assessing metabolic syndrome will help to identify individuals at elevated risk of cardiovascular disease (CVD) and Type-2 diabetes. Besides, studying the interactions between these risk factors can enhance treatment adherence if the condition manifests.⁴

Numerous studies indicate that metabolic syndrome can be influenced by modifiable lifestyle and behavioural factors such as alcohol consumption, smoking, physical activity levels, and dietary habits. The good part is these risk factors are modifiable!

This essentially translates into the fact that addressing these modifiable risk factors can significantly reduce the risk of developing metabolic syndrome. Early adoption of a holistic lifestyle has been shown to have a significant and cumulative impact on cardiovascular health and in producing long-lasting changes.^7,8

And then there is something called “Metabolic memory” or the “legacy effect”. This refers to the phenomenon of continued beneficial effects on diabetes complications after a period of improved glycemic control, even when this is followed by a relapse into the earlier lesser disciplined lifestyle triggering a poorer glycemic control. This results in an improved prognosis subsequently.⁹

By prioritizing lifestyle modifications and targeted preventive measures, healthcare professionals can mitigate the impact of metabolic syndrome on public health. It therefore is quite important to talk to your doctor and explore new possibilities in blood glucose management and lifestyle modifications.

Conclusion

• Addressing the escalating prevalence of metabolic syndrome and associated conditions necessitates comprehensive strategies focused on early detection and effective intervention.

• By prioritizing lifestyle modifications and targeted preventive measures, healthcare professionals can mitigate the impact of metabolic syndrome on public health.

• This approach not only reduces the burden of type 2 diabetes mellitus and related complications but also promotes overall health and well-being in affected populations.

References:

1. Shrivastava S, Singh K, Chakma T, Kavishwar A; Metabolic syndrome in Indian tribes: challenges to reveal its true status; Frontiers in Clinical Diabetes and Healthcare; VOL 4; 2023; Link
2. Alawdi S H., Al-Dholae Mohd, Alshawky S; Metabolic Syndrome in Patients with Type 2 Diabetes Mellitus and its Impact on Pharmacotherapy Outcomes; Frontiers in Clinical Diabetes and Healthcare; VOL 5; 2024; Link
3. Krishnamoorthy Y, Rajaa S, Murali S, Sahoo J, Kar SS. Association Between Anthropometric Risk Factors and Metabolic Syndrome Among Adults in India: A Systematic Review and Meta-Analysis of Observational Studies. Prev Chronic Dis 2022;19:210231. DOI: Link
4. Rus M, Crisan S, Andronie-Cioara FL, Indries M, Marian P, Pobirci OL, Ardelean AI. Prevalence and Risk Factors of Metabolic Syndrome: A Prospective Study on Cardiovascular Health. Medicina (Kaunas). 2023 Sep 25;59(10):1711. doi: 10.3390/medicina59101711. PMID: 37893429; PMCID: PMC10608643.
5. Gemeda, D., Abebe, E., &Duguma, A. (2021). Metabolic Syndrome and Its Associated Factors among Type 2 Diabetic Patients in Southwest Ethiopia, 2021/2022. Journal of Diabetes Research, 2022(1), 8162342. Link
6. Ramachandran, Ambady &Chamukuttan, Snehalatha & Viswanathan, Vijay. (2001). The burden of type 2 diabetes and its complications Indian scenario. Diab Research. 83.
7. Montesi, L., Moscatiello, S., Malavolti, M. et al. Physical activity for the prevention and treatment of metabolic disorders. Intern Emerg Med 8, 655–666 (2013). Link
8. Ghodeshwar GK, Dube A, Khobragade D. Impact of Lifestyle Modifications on Cardiovascular Health: A Narrative Review. Cureus. 2023 Jul 28;15(7):e42616. doi: 10.7759/cureus.42616. PMID: 37641769; PMCID: PMC10460604.
9. Ranjit Unnikrishnan I, Anjana RM, Mohan V. Importance of controlling diabetes early–the concept of metabolic memory, legacy effect and the case for early insulinisation. J Assoc Physicians India. 2011 Apr;59 Suppl:8-12. PMID: 21818992.
   
   

Other Sources:

1. Oza, C., Khadilkar, V., Karguppikar, M. et al. Prevalence of metabolic syndrome and predictors of metabolic risk in Indian children, adolescents and youth with type 1 diabetes mellitus. Endocrine 75, 794–803 (2022). Link
2. Nouri Z, Hajialyani M, Izadi Z, Bahramsoltani R, Farzaei M. H, Abdollahi M.; Nanophytomedicines for the Prevention of Metabolic Syndrome: A Pharmacological and Biopharmaceutical Review; Frontiers in Bioengineering and Biotechnology; VOL 8;2020; Link
3. Saquib, Nazmus & Khanam, Masuma & Saquib, Juliann & Anand, Shuchi & Chertow, Glenn & Barry, Michele & Ahmed, Tahmeed & Cullen, Mark. (2013). High prevalence of type 2 diabetes among the urban middle class in Bangladesh. BMC Public Health. 13. 1032. 10.1186/1471-2458-13-1032.

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