India has the highest number of diabetes patients in the world

Viswanath Pilla

Moneycontrol News

Contrary to popular belief that diabetes is a sign of prosperity, a national study by the Indian Council of Medical Research (ICMR) shows the epidemic now to be affecting people from low socioeconomic status (SES) living in cities.

The report has warned of an increasing trend of diabetes prevalence among people of low SES in urban and rural areas.

"The spread of the diabetes epidemic to these economically disadvantaged and vulnerable sections of society has serious implications for the country’s health and socioeconomic development, and warrants the urgent implementation of effective preventive measures," the report said.

The results of the study called ICMR - India Diabetes (INDIAB) published in Lancet - measured the prevalence of diabetes and pre-diabetes in 15 states of India with sample of size of 57117 individuals aged 20 years or older.

The study conducted over a period of seven years across states including Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra in phase-1, Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab (phase-2), and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya.

The cumulative data from 15 states represent a total adult population of 363·7 million people or 51 percent of India’s adult population.

The capillary oral glucose tolerance tests were used to diagnose diabetes and pre-diabetes in accordance with WHO criteria.

The method didn’t allow to differentiate between type 1 and type 2 diabetes.

Findings

The report assessed prevalence of diabetes in different states in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state.

The overall prevalence of diabetes in all 15 states of India was 7·3 percent.

The prevalence of diabetes varied from 4·3 percent in Bihar to 10 percent in Punjab and was higher in urban areas (11·2 percent) than in rural areas (5·2 percent) and higher in mainland states (8·3 percent) than in the northeast (5·9 percent). Overall, 1862 (47·3 percent) of 3938 individuals identified as having diabetes had not been diagnosed previously.

States with higher per-capita gross domestic product (GDP) seemed to have a higher prevalence of diabetes. For example Chandigarh, which had the highest GDP of USD 3433, had the highest prevalence of 13·6 percent.

In rural areas of all states, diabetes was more prevalent in individuals of higher SES.

However, in urban areas of some of the more affluent states such as Chandigarh, Gujarat, and Tamil Nadu, diabetes prevalence was higher in people with lower SES.

“Notably, high SES seemed to be a risk factor for diabetes in rural areas, but not urban areas,” the report said.

“This difference could be related to improved awareness about diabetes in urban areas, and because individuals of higher SES can afford to adopt health-promoting behavioural changes. This finding is a classic example of the economic transition in India and its relation with the diabetes epidemic,” the report added.

The main factors driving the diabetes epidemic in both urban and rural areas of India are obesity, age, and family history of diabetes.

The report identified male sex as an independent risk factor for diabetes. Unlike in earlier studies from wealthier nations, smoking and alcohol consumption did not seem to independently increase the risk of diabetes in India.

The overall prevalence of pre-diabetes in all 15 states was 10·3 percent. The prevalence of pre-diabetes varied from 6·0 percent in Mizoram to 14·7 percent in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance.

The prevalence estimates of prediabetes were high across the country, exceeding those of diabetes in most states and implying the existence of a huge number of individuals who could conceivably develop type 2 diabetes in the near future. This finding is all the more important because Asian Indians have been shown to progress faster through the prediabetes stage than do people of other ethnic group

The pool of people with prediabetes seems to be shrinking in many of the more economically advanced states, raising the possibility of stabilisation of the epidemic in the near future.

Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.

Diabetes is treated with a combination of diet, physical activity and medication.