Explained | How can India cope with its diabetes burden?

What are the key findings?

It was estimated that around 11% of the population is diabetic, and 15.3% of the country is in the pre-diabetic stage. Given that the study was conducted in the world’s most populous nation, the actual numbers are naturally staggering. According to these estimates, 101.3 million people in the country are diabetic, and there are another 136 million people in the prediabetes stage. Questions are being raised as to whether this constitutes an emerging crisis in India and what urgent methods need to be employed to manage this situation and control the possible increase in these numbers in the future. According to the World Health Organization (WHO), around 422 million people worldwide have diabetes and 1.5 million deaths are directly attributed to the disease each year. Both the number of cases and the prevalence of diabetes have been increasing, and there is a globally agreed target to halt the rise in diabetes and obesity by 2025, according to the WHO.

What are the implications of these statistics?

The thing about metabolic lifestyle disorders is that, with a little attention, serious complications and a morbid state of life can be avoided; it is also possible to ensure that the 136 million in the pre-diabetic stage do not progress to diabetes. “Prevention is key, and here is the window of opportunity,” says V. Mohan, Madras Diabetes Research Foundation, which conducted the study funded by the Indian Council of Medical Research. “There is a window of possibility open in a couple of areas and we need to take advantage of it,” he explains. He believes that the anchor of any intervention program must be “prevention”: in the case of diabetics, the goal must be to prevent the occurrence of life-threatening complications; and in the case of prediabetics, every effort should be made to prevent progression to diabetes, and in rural areas, where the prevalence is still low, the goal should be to keep it that way.

There are multiple studies showing that poor blood sugar control leads to complications (cardiovascular disease, kidney disease, neuropathy, blindness, and lower extremity amputation) that then become a major cause of increased morbidity and mortality. The question is whether any nation will be equipped to provide comprehensive care for all diabetics who develop complications in their lifetime with diabetes. While it is sensible to ensure there are enough facilities to treat complications, the smart approach would be to launch public awareness campaigns on the use of lifestyle modifications to keep blood sugar within acceptable limits and complications at bay. says Dr. Mohan. Mass education should be promoted throughout the country for control and periodic checkups, adhere to the recommended medication regimen and reinforce health-seeking behaviors, he stresses.

Dr. Mohan explains that while conducting the study, the researchers found a strange phenomenon: that the conversion from prediabetes to diabetes was faster in India, in some cases even within six months. Therefore, immediate attention should be given to promoting a healthy lifestyle that leads to slowing down the rate of progression to diabetes, or even preventing the progression to diabetes. Urban India accounts for 16.4% of the prevalence, while in the rural population the prevalence is 8.9%. Although the prevalence is lower now, this is an area where the chance of prevention is greater. As traditional lifestyles change and more modern practices take over, it is essential to once again emphasize maintaining a healthy diet, getting enough moderate to vigorous exercise, and regular testing for those with risk factors and after a certain age group, experts say.

Periodic epidemiological detection programs are very important, they say, to detect new diabetics and bring them into the protective network.

Were there any surprises during the study?

The impression, even among researchers, was that the prevalence was high only in metropolitan cities, says Dr. Mohan, adding that they were very surprised to find that it was similar or growing in 2- or 3-tier cities.

In Kerala, which is said to be one of the states with the best indicators of social development, prevalence in rural areas has risen to surpass that in urban areas.

This is a side effect of progress, one that states must be careful to keep an eye on, experts add.

All northeastern states were covered in one phase and surprises included high prevalence in Tripura and Sikkim. While in Tripura, the ethnic composition of the state was claimed to be different from the other states in the region, being populated by Bengalis, leading to a high prevalence rate of 13%; in Sikkim, where the prevalence of diabetes and prediabetes (31%) was high, this was attributed to its smaller size and relatively better socioeconomic indicators there.

Wich is the way to go?

Dr. Mohan says there is a plan to do a cross-sectional study to measure the actual incidence in the community. “What we did was an estimate. For example, in Tamil Nadu, we had the numbers from a decade ago and that was extrapolated as projections for 2020. Now we will do a current study to find out how many are actually diabetic. Now we also intend to go back to the same people, people who were then tested for diabetes to see how they have progressed, to assess their quality of life and to see if they have developed complications. Prediabetics will also be targeted in that study to see how many of them have converted to the next stage, and among people who were not diabetics a decade ago, to track their status now.”

Some of the islands and union territories that could not be covered during the study will now be included in the study.

Experts have also indicated links as part of the public-private partnership mode to engage the broader community in supporting diabetes screening and treatment.