From the Guidelines
The recommended management approach for type 2 diabetes in the Indian population involves a comprehensive strategy combining lifestyle modifications and pharmacological interventions, with metformin as the first-line medication, as supported by the most recent evidence from the 2024 study 1.
Key Components of Management
- Lifestyle changes: a low-calorie, balanced diet rich in complex carbohydrates, proteins, and healthy fats, with reduced intake of refined carbohydrates and saturated fats.
- Regular physical activity: at least 150 minutes per week of moderate-intensity exercise.
- Pharmacotherapy: metformin as the first-line medication, starting at 500 mg once or twice daily and gradually increasing to 2000 mg daily as tolerated.
Second-Line Agents
- Sulfonylureas (glimepiride 1-8 mg daily)
- DPP-4 inhibitors (sitagliptin 100 mg daily)
- SGLT-2 inhibitors (empagliflozin 10-25 mg daily)
- GLP-1 receptor agonists
Special Considerations
- For patients with established cardiovascular disease, SGLT-2 inhibitors or GLP-1 receptor agonists are preferred, as they have been shown to have cardiovascular benefits 1.
- Regular monitoring of blood glucose levels, HbA1c every 3-6 months, and screening for complications are crucial.
- The target HbA1c is generally <7%, but should be individualized based on age, comorbidities, and hypoglycemia risk.
Rationale
The Indian population has a unique set of challenges, including genetic predisposition to insulin resistance, earlier disease onset, and higher carbohydrate consumption in traditional diets. The recommended approach is based on the most recent evidence from the 2024 study 1, which supports the use of metformin as the first-line medication, and is consistent with other recent guidelines 1.
From the Research
Recommended Management Approach for Type 2 Diabetes in the Indian Population
The management of type 2 diabetes in the Indian population is a complex issue due to various factors such as lifestyle, genetics, and socioeconomic conditions.
- The increasing prevalence of type 2 diabetes in India can be attributed to factors such as obesity, physical inactivity, and unhealthy diets 2, 3.
- A multisectoral approach is recommended to promote healthier diets and increase physical activity, which can help in slowing down the diabetic epidemic 4.
- Management of type 2 diabetes in India faces multiple challenges, such as low levels of awareness, paucity of trained medical and paramedical staff, and unaffordability of medications and services 5.
- Novel interventions using readily available resources and technology promise to revolutionize the care of patients with diabetes mellitus in India 5.
Lifestyle Factors and Diabetes Management
- Lifestyle factors, including physical inactivity and unhealthy diet, play a significant role in the epidemic of diabetes in India 4.
- Increasing physical activity and improving diet can help reduce the risk of type 2 diabetes 3, 4.
- A traditional diet rich in fiber and low in refined grains, fat, and sugar can help prevent and manage type 2 diabetes 3.
Future Projections and Prevalence of Diabetes
- The prevalence of diabetes in India is expected to rise from 9.6% in 2021 to 10.9% by 2045 6.
- The global prevalence of diabetes is expected to rise from 10.5% in 2021 to 12.5% by 2045 6.
- Effective health promotion and primary prevention at both individual and population levels are necessary to curb the diabetes epidemic and reduce diabetes-related complications in India 2.