Friday, June 09, 2017

India’s Diabetes Epidemic Is Making A Worrying Demographic Shift

More than 10% of urban Indians have diabetes, at least half of Indians who have it don't know it, and the prevalence of the disease is increasingly shifting to poorer people, the largest nationally study of the disease in India has found.

The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study is the largest nationally representative study of diabetes in India and includes data from 57,000 people across 15 states; glucose tolerance tests were performed on participants to diagnose diabetes and pre-diabetes. The study was published in the medical journal Lancet Diabetes & Endocrinology late on Wednesday night.

Across the 15 states, 7.3% of people had diabetes (the study did not differentiate between Type 1 and Type 2 diabetes) and half of them had not previously been diagnosed with the condition. The prevalence of diabetes varied from a low of 4.3% in Bihar to a high of 10% in Punjab and was higher in urban areas (11.2%) than in rural areas (5.2%). It was higher in mainland states than in the northeast.

The researchers found that richer states seemed to have a higher prevalence of diabetes. In rural areas of all states, the rates of diabetes were much higher than those identified in previous studies, and diabetes was more prevalent in better-off individuals. However, in the urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in poorer people. For example, in urban areas of Chandigarh, the rate of diabetes was 26.9% for among people from low socio-economic background, compared to 12.9% for people from high socio-economic backgrounds. In urban areas of Punjab, the rates were 16.1% and 11.9%, respectively.

This, the researchers call "evidence of an epidemiological transition"; "Our study suggests that cities in the country's more affluent states have transitioned further along the diabetes epidemic. As the overall prosperity of individual states and the country as a whole increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of society, a transition that has already been seen in high income countries," senior author Dr Viswanathan Mohan, President, Madras Diabetes Research Foundation, Chennai, India, the national coordinating centre for the study, said.

"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," added Dr R. M. Anjana, lead author of the study, Vice-President, Madras Diabetes Research Foundation.

Additionally prevalence of pre-diabetes (being borderline diabetic) was 10.3% across all 15 states, varying from 6.0% in Mizoram to 14.7% in Tripura. "Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas," the study found. "The high rates of pre-diabetes across the country imply the existence of a huge number of individuals who could conceivably develop diabetes in the near future. Our findings have serious implications for the country's health and socioeconomic development and highlight the urgent need for implementing effective preventative measures," Dr Mohan said.

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