Diabetes in India: becoming a killer disease of the poor

As India becomes more prosperous, the prevalence of diabetes is undergoing a demographic transformation, shifting from largely afflicting the affluent to increasingly burdening the poor and middle income population.according to a new study.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 groups. 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.

An ongoing government funded research project to understand the prevalence pattern of diabetes across states indicates that the disease is disproportionately catching up with the urban poor in the country s developed states.

The findings of the Indian Council of Medical Research-INdia DIABetes 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, published in the international medical journal Lancet recently, suggests that the urban areas of more affluent states have transitioned further along the diabetes epidemic. Less affluent individuals have a higher prevalence of diabetes than their more affluent counterparts in rich states.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.

The overall prevalence of prediabetes in all 15 states was 10.3 per cent. The prevalence of prediabetes varied from 6 per cent in Mizoram to 14.7 per cent in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history were independent risk factors for diabetes in both urban and rural areas, the study said.

The researchers pointed out that the rural prevalence estimates are much higher than identified in earlier studies. “Given that about 70 per cent of India s population resides in rural areas, even a small increase in the rural prevalence of diabetes will translate into several millions of individuals requiring chronic care. Factoring in the additional burden that arises because of the overall younger age of onset type 2 diabetes in south Asian people compared with other populations, the strain on the country s health-care system is likely to be immense”, they cautioned.

Why the rise in the diabetes? Blame genes and changing lifestyles

Indians are especially predisposed to diabetes due to social and genetic reasons. Peculiar genetic composition of Indians known as ‘Asian Indian Phenotype’ makes them appear thin but with fat depositions around their internal organs.

It makes them prone to greater abdominal fat, insulin resistance, higher levels of bad fat and increased chances of suffering from diabetes and coronary artery disease.

Lifestyle changes with reduced physical activity and carbohydrate-rich diets, along with environmental factors, are increasing India’s diabetes burden, IndiaSpend reported in June 2015.

Cost of diabetes: Urban poor spend 34% of income on treatment

It is estimated that diabetes patients in urban areas spend Rs 10,000 and patients in rural areas spend Rs 6,260 every year on treatment, according to a 2013 study published by The Association of Physicians of India.

Following are some of the measures India can take to reduce the risk of diabetes:

a)  Current nutrition labels should be made more comprehensive by including RDA value and per serve information, among others.

b)  FoP labels should be introduced across all products irrespective of size and packaging to help consumers make informed dietary decisions.

c)  Warning labels should be introduced to highlight the high nutrient content of foods on the label.

d)  Aggressive marketing and promotion of unhealthy foods should be regulated. Celebrity endorsement should be banned.

Studies have also linked increase in air pollution to diabetes. For every 10 µg/m3 (microgram/cubic metre) increase in PM2.5 exposure, there can be increase in diabetes prevalence. A study published in Diabetes Care 2011 has found that counties with higher levels of PM2.5 had more than 20 per cent increase in diabetes. This remained even after controlling for other diabetes risk factors.

The non-profit recommends an integrated approach combining good food strategy with control of environmental risk factors to reduce the disease burden and health costs associated with diabetes.

Suggestions by non-profit Centre for Science and Environment(CSE):

Regulating advertisements that promote junk foods would go a long way in preventing and limiting obesity, diabetes etc.

Restricting availability of sugary beverages and other ultra-processed foods that are high in salt, sugar and fats in schools and near-by areas would limit consumption among children.

Appropriate labelling on packaged foods is critical to help the consumer choose healthy foods.

Regular consumer awareness initiatives through public communication targeted at consumption of salt, sugar and fat and its relation with diet-related NCDs is the need of the hour.

CSE review has also shown that along with food habits, other environmental risk factors like air pollution will also have to be addressed to control the risk of diabetes. Scientific evidences have indicated how particulate pollution can enhance diabetes risk.

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