The bitterness of sugar – Economic Times

In 2022, India will emerge as the world’s largest sugar consumer, but this distinction is highly questionable¹.Indians collectively consumed a whopping 29.5 million tonnes of sugar in one year²!!! It is no surprise that more than 100 million Indians are living with diabetes, according to ICMR-INDIAB data.³.

“Sweet as sugar” may sound melodious, but it’s best to limit it to English idioms or songs. In reality, abnormally high blood sugar levels (diabetes) are associated with several painful facts. High blood sugar (diabetes) damages several important organs in the body and increases the risk of developing several serious health complications. People with diabetes are at a much higher risk of developing heart disease, kidney disease, eye disease, nerve damage, and several other complications.^Four,^Five. The most worrying risk is heart disease. Did you know that the most common cause of death for people with diabetes is a heart attack? However, most of these complications can be prevented by controlling blood sugar, blood pressure, and cholesterol levels.^Four.

One of the most important risk factors for heart disease in people with diabetes is obesity.Abdominal obesity is a particularly high risk factor for heart disease in people with diabetes⁶. Abdominal obesity is defined as waist circumference of 90 cm or more for men and 80 cm or more for women.⁷. More than 80% of people with type 2 diabetes are overweight or obese⁸. Unfortunately, Indians are more prone to diabetes as well as abdominal obesity.⁹. Compounding the problem is that many drugs used to manage diabetes have led to weight gain.⁶. Many diabetics require insulin injections, which are also known to cause weight gain.^Ten. Therefore, the overall risk of heart disease in diabetics in India is very high. Additionally, obese diabetics are more likely to die after a heart attack.¹¹.

The good news is that weight loss can lower a diabetic’s risk of heart disease and reduce the number and dosage of medications needed to control diabetes.⁶. Therefore, as much as it is important to focus on maintaining normal blood sugar levels, it is equally important to focus on weight. Even a 5-10% weight loss can significantly improve blood sugar levels. In fact, some patients find that a 10-15% weight loss can control their blood sugar to the point where they no longer need diabetes medication for up to three months or more.¹². It is important to discuss weight loss strategies with your doctor. The most common measures likely to be suggested for weight loss are dietary modification and exercise. Effective dietary modifications include eating healthy foods that are high in fiber and protein and low in refined carbohydrates, and reducing total calorie intake. Still, meal planning must be individualized and there is no standard plan that can be recommended for everyone.¹². Exercises should include a combination of aerobics and strength training. Like your diet, your exercise plan should be customized for each person in consultation with your diabetes specialist. Increasing even 500 steps per day reduces the risk of heart disease by 2-9%¹². The American Diabetes Association recommends that people with prediabetes lose at least 7 percent of their body weight and plan at least 150 minutes of moderate-intensity physical activity per week.¹³.

It may sound simple, but weight is a sensitive issue for many people, and achieving an ideal, healthy weight is easier said than done. Almost one-third of diabetics fail to achieve even a 5% weight loss even if they follow the recommended diet and exercise for a year.⁶. Even people who are successful in losing weight in the first few months reach a plateau after 4 to 6 months and begin to gain back the weight they lost.⁶. Some people may need weight loss medication along with a diet plan and exercise.¹². This means that every person with diabetes has a different journey, and there is no single approach that is right for everyone. Regular discussions and follow-ups with your diabetes specialist can help you manage your diabetes, modify risk factors, and prevent diabetes-related complications. These are essential to reduce the bitterness of sugar.

References
1. India has emerged as the world’s largest sugar producer and consumer and the world’s second largest sugar exporter. Ministry of Consumer Affairs, Food and Public Distribution. October 2022. Link
2. Available on CNBC TV 18. Link
3. Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, et al. Health report on metabolic non-communicable diseases in India: ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinology. 2023 Jul 1;11(7):474–89.
Four. Raghavan S, Vassy JL, Ho YL, Song RJ, Gagnon DR, Cho K, et al. Diabetes-related all-cause and cardiovascular mortality in a national adult cohort. J Am Heart Association 2019;8(4).
Five. Available at What are the causes of complications associated with diabetes? Link
6. Van Gaal L, Scheen A. Weight management in type 2 diabetes: current and emerging treatments. diabetes care. 2015 Jun 1;38(6):1161–72.
7. Dhawan D, Sharma S. Abdominal obesity, adipokines, and noncommunicable diseases. Vol. 203, Journal of Steroid Biochemistry and Molecular Biology. Elsevier Ltd; 2020.
8. Bramante CT, Lee CJ, Guzne KA. Treatment of obesity in diabetic patients. diabetes spectrum. 2017 Nov 1;30(4):237–43.
9. Bolgarkar SS, Das SS. Real-world evidence of glycemic control in his type 2 diabetic patients in India: the TIGHT study. BMJ Open Diabetes Rescare. July 1, 2019;7(1).
Ten. Edens MA, Van Dijk PR, Haku E, Biro HJG. Determinants of excessive weight gain after initiation of insulin therapy in type 2 diabetes: A retrospective initiation cohort study (ZODIAC 60). Diabetes treatment clinical practice. 2023 6 1;200.
11. Henning RJ. Obesity and obesity-induced inflammatory diseases contribute to atherosclerosis: an overview of the pathophysiology and treatment of obesity. [Internet]. Vol. 11, Am J Cardiovasc Dis. 2021. Link
12. Davis MJ, Aroda VR, Collins BS, Gabay RA, Green J, Marser NM, et al. Managing hyperglycemia in type 2 diabetes, 2022. Consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). diabetes care. 2022 Nov 1;45(11):2753–86.
13. Franz MJ Weight management: from obesity to diabetes. diabetes spectrum. 2017 Aug 1;30(3):149–53.

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