In India, diabetes is fast becoming a disease of the poor
India Stepped down the staircase of diabetes, China is now a World Capital of Diabetes
Blame Prosperity and Non Awareness, as the prevalence of diabetes is becoming more common among the middle-class and the poor in affluent cities, finds a new study says Dr Anil Bhansali, PGIMER, Chandigarh.
Two years ago, 49-year-old Ramanjit Singh, a resident of Chandigarh, underwent a regular medical check-up and was told that he was pre-diabetic. Even though he changed his diet to control his blood sugar levels, after a year he found that he was losing weight unusually and that his vision was blurring.
In September last year, Ramanjit Singh was diagnosed with type 2 diabetes. Raman is an engineer from a middle-income background. It is among people like Raman that diabetes is on the rise.
Diabetes has long been a disease of affluence but small regional studies in recent years have indicated that, in India, it has been slowly spreading among lower income starta groups especially in Youngsters. However, an ongoing national survey of diabetes called the Indian Council of Medical Research – India Diabetes or simply ICMR-INDIAB study finds that many more people from middle-income and poor communities are becoming diabetic.
The ICMR-INDIAB study is the largest national representative of diabetes and includes data from more than 57,000 people across 15 states, both in rural and urban areas. The study represents 363·7 million people or 51% of India’s adult population. Similar previous studies have been only regional with small sample sizes, low response rates and with varied diagnostic criteria. For this study, the researchers considered each person’s bodyweight, height, waist circumference and blood pressure and used glucose tolerance tests to diagnose diabetes and pre-diabetes.
“We have also provided the first-ever data on the status of the diabetes epidemic in the North-Eastern states of India,” said Dr Anil Bhansali, HOD Endocrinology talked about the study published on Wednesday in the journal The Lancet Diabetes & Endocrinology.
The overall prevalence of diabetes across the 15 states studied was 7.3%. The rates varied between states, from 4.3% in Bihar to 13.6% in Chandigarh.
The overall prevalence of pre-diabetes was 10.3% as per the criteria set by the World Health Organisation. Men were more likely to be diabetic than women. Almost half of the people enrolled in the study were previously undiagnosed and were thus not aware of their diabetes until they were tested.
On an average, the researchers found diabetes to be twice as common in urban areas at 11.2% compared to the rural areas at 5.2%. However, in the urban areas of more economically advanced states, diabetes was higher among people even from low socio-economic backgrounds – a transition that is already common in high-income countries.
“This trend is a matter of great concern because it suggests that the diabetes epidemic is spreading to individuals who can least afford to pay for its management,” said Dr Bhansali. “The peculiarity about this epidemic in India is the relatively young age of onset compared to the Western world.”
The study suggests that the age of onset is in the age group of 25-34 years, which is at least two decades earlier than in developed countries.
Point to be Noted: People living in urban areas have access to diabetes care services and can afford the associated out-of-pocket expenditure. However, people living in semi-urban and rural areas do not have access to diabetes centres or clinics that provide comprehensive care. Given that people in rural areas and poorer communities in cities are unable to access care earlier, they would be more prone to advanced complications such as renal failure and blindness due to retinopathy.
According to Dr Bhansali, the changing lifestyle of people even among the middle-class and the poor in Smart city like Chandigarh might be the reason for this demographic shift in the diabetes epidemic.
“Those who were walking to work can now afford to take a bus or buy a motorbike and they are discouraged from being physically active,” he said. “Also, as affordable fast-food and sweetened beverages become more and easily available, people are encouraged to consume these in large quantities putting their health at risk.”
Public health solutions
Kerala, the state with the highest reported prevalence of diabetes in India so far, has recently imposed a fat-tax. Countries like the United Kingdom are imposing sugar taxes on sweetened food and beverages. Can such taxes help reverse the diabetes epidemic in India?
Dr Bhansali said it might help but only to a some extent. “It would be the steps taken by individuals for their own health and the government’s for their citizens that will help,” he said. “People should adopt a healthier lifestyle such as, consuming a healthy diet and increasing physical activity.”
Minimising television and screen time, giving breaks to sedentary behaviour, using the stairs instead of an elevator, eating more fruits and vegetables, and cutting down junk-food all go a long way in preventing diabetes.
Dr Bhansali also recommends that central and state governments make policy changes and investments to control the burden of non-communicable diseases like diabetes. These measures include ensuring the supply of nutritious food and creating public spaces for people to exercise. The National Program for Control of Diabetes, Cardiovascular Disease and Stroke, which has been rolled out across the country, could also help improve diabetes awareness levels at a national level.
The ICMR-NDIAB study will continue to gather diabetes information from remaining states and overall data for India might be available within a few years, said Dr Bhansali.