India continues to be the Diabetes capital globally since it has the highest number of diabetes cases. According to Indian Council of Medical Research (ICMR), it is estimated that India has 6.3 crore cases of diabetes and the numbers are expected to rise to 10.1 crore by 2030 while the International Diabetes Federation claims that the increase is likely to be 123.5 million (12.35 crore) by 2040.
Since the disease is life threatening, many lives are at stake. Every year, it is believed that nearly ninety lakh people die due to diabetes. According to the World Health Organisation, about 125,000 deaths occur between the age of 30 and 69 years.
There are also cases of prediabetes, which occurs prior to the onset of diabetes. This condition can lead to heart disease and strokes and if interventions are not done at the right time then it becomes type-2 diabetes, which is even more serious since it causes kidney and nerve diseases as well as increases the risk of developing cardiovascular disease.
Since there is limited data on the prevalence of diabetes across all states in the country in both urban and rural areas, Indian Council of Medical Research (ICMR) conducted a study in three states — Tamil Nadu, Jharkhand, and Maharashtra, and Chandigarh.
It was found that the prevalence of obesity is higher in the urban areas as compared to rural areas. Among those who were tested, more than 60% had developed diabetes before 20 years of age. Except in Chandigarh, the prevalence of prediabetes was found to be higher in urban areas in all age groups in all three states. Other such as Gestational diabetes, a third form of diabetes, was also identified.
There are multiple elements, which are linked with diabetes. For instance, if anyone in the family has diabetes, the chances of getting diabetes increases. Besides, genetic susceptibility is also associated with diabetes. Besides, obesity, poor food habits and lifestyle choices also plays a major role in causing diabetes.
The other growing challenge is also smoking, poor physical activity and alcohol intake, which are critical risk factors of diabetes in India. Surveys have shown that close to 40% of Indian men are daily smokers and approximately 18% of the study respondents had poor physical activity levels. Environmental factors, specifically indoor air pollution contributes to the increasing prevalence of diabetes as well.
However, there are other gaps as well. In rural settings, especially in villages where underprivileged families reside, communities are both unaware of diseases like diabetes. In these areas, food quality is poor since their farming includes fertilizers and chemicals, which impacts their food products, which also contributes to a high prevalence of diabetes. However there is no data related to the disease prevalence in these areas.
Moreover, since these areas are unreachable, they cannot access any health services. Three adolescent adivasi girls in Jharkhand who were able to travel to the district hospital were found to have diabetes. But a majority of families in these areas do not have the facilities or support to reach health centers. Apart from poor awareness about the disease, there is also no access to health care and treatment because of the distance where they stay along with state indifference towards the tribals groups. As a result, prevalence of diabetes in these unreached areas is not available. It is critical that special steps are taken to identify the disease burden, like NCD and diabetes in these unreached areas to save lives.
Steps to Prevent and Control Diabetes
To prevent diabetes across the country, it is imperative to take steps to prevent the onset of diabetes. To begin with, there is an urgent need for lifestyle changes. It has been found that increased consumption of fat, sugar and high calories causes obesity. Besides, lack of physical activities also drives diabetes. However, there is very low knowledge and awareness in the public about what causes diabetes such as dietary practices. Dr Anup Misra, chairman of Fortis Center for Diabetes, Obesity, Metabolic Diseases, and Endocrinology in Delhi, says that Indians have more fat in their liver and pancreas, which is bad for metabolism. The disease occurs 10 years earlier among Indians and it has been found that it afflicts even non-obese people, he said.
To prevent diabetes, lifestyle changes such as regular physical exercises and changes in dietary intake is important. Physical exercise helps reduces weight and proper diet such as taking small meals on time helps control the blood sugar level.
To ensure better dietary regimen, instead of eating fatty and fried food products if the diet includes vegetables and brown rice instead of cereals and consumption of sugar and salt is reduced, it helps contain diabetes. Fruits like acai berries, apple, cranberry, citrus fruits, banana, grapefruit, grapes, oranges, plums, pomegranate, strawberry, watermelon, pineapple, raspberries, cheeries help fight diabetes as well.
Jitendra Singh, minister in the Union cabinet stated the increasing prevalence of diabetes among the younger population is a matter of grave concern.
Since a significant number of youth and adolescents are struggling with diabetes but often they do not get treatment on time because they are not diagnosed on time so there is a need to focus on the youth and adolescents of the country in order to prevent and combat lifestyles diseases such as diabetes before the early onset.
Union Health minister JP Nadda also supports the need to take special steps on diabetes so that prevention and awareness about non-communicable diseases which are largely linked with our way of living, dietary habits, lack of exercise will go a long way in ensuring that the country remains healthy. India can reap the benefits of its demographic dividend only when the youth of the country grow up to be healthy citizens, he stated.
The Health Ministry along with World Health Organisation has also developed a Multisectoral Action Plan for 40 ministries and departments to address Non-communicable diseases.
Similarly, to design more effective and state-specific intervention strategies, ICMR initiated an exercise to study 1,24,000 people from 28 states, Delhi and two Union Territories to create state-wise profile of diabetes.
In order to plan preventive and curative health services in the country among all categories, from adolescents, young and the elderly, population-based data on the burden of NCDs such as diabetes is necessary. Based on the data, preventive interventions to reduce the progression from pre-diabetes to diabetes can be implemented.
Once a proper strategy is created and overall information about the increasing prevalence of diabetes is identified, only then can diabetes be controlled and prevented across the country.
(Mohuya Chaudhuri is a journalist and researcher)