Ampayaparambath Vijayan, Koyikkal Karthikeya Varma and Radha Malattiri
Background : Diabetes is being recognized as number one disease of mankind especially in India with a heavy toll on individuals, family and country. Diagnosing Diabetes Mellitus Type 2 by hyperglycemia may be too late for interventions aimed at reducing the burden of diabetes and its complications. Methods: A total of 857 subjects from three groups, students between ages 10 and 17, Non diabetic and diabetic individuals with stroke and angiography proven Coronary Artery Disease and individuals from Master Health Check were recruited. Insulin resistance was calculated in all the above groups from fasting insulin and fasting blood sugar. A follow up was conducted on available students from the first group after intervention with folic acid and exercise. Results: Of 507 children tested, four already exhibited hyperglycemia. Insulin Resistance was high in a third and fasting plasma insulin in 42.6%. Acanthosis Nigricans, Body Mass Index and waist circumference were associated with high fasting plasma insulin and insulin resistance. The percentage of high insulin resistance and fasting plasma insulin among hyperglycemic Coronary Artery Disease is 92.9 (p=0.001). The percentage of abnormal values is higher in non hyperglycemics also. In Master health check, we found over 50% prevalence of high insulin resistance and plasma insulin even if they were not hyperglycemic. Conclusion.: High Insulin Resistance and high Fasting Plasma Levels are found at early age and it is possible to identify these in children from external characteristics. Intervention can be started at that age hopefully to abort or delay onset of hyperglycemia and/or the vascular complications of Diabetes. There is indirect evidence that individuals with high insulin resistance become hyperglycemic eventually. High insulin resistance and plasma insulin are seen in patients even before hyperglycemia is evident. Hence we suggest inclusion of insulin estimation in Master Health check and in investigation of diabetes type 2.
