Prevalence of Diabetes in India

Context:

According to recent study, air pollution contributes to diabetes

Diabetes and its Types

• Diabetes is a chronic disease caused when either pancreas does not produce enough insulin or the cells in the body do not respond properly to insulin.
• It is a non-communicable disease-non-infectious or non-transmissible.
• There are three types of diabetes –

1. Type 1 when pancreas does not produce enough insulin
2. Type 2 -cells in the body do not respond to insulin properly, and
3. Gestational Diabetes – formed during pregnancy.

• Diabetes is characterized by prolonged elevated blood sugar levels which further expose a person to risk of developing a range of health issues including cardiovascular diseases.

Diabetes in India- Fast Facts:

• The World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death by 2030.
• India currently represents 49% of the world’s diabetes burden. There are more than 60 million cases
• In India, an estimated 7.8% of the population above 18 years of age has raised blood glucose level or are on treatment for diabetes. However a large section of population remains unaware of the disease
• Tamil Nadu had the highest death rate (53/ 100,000) from diabetes among Indian states, followed by Punjab (44) and Karnataka (42)
• Diabetes, directly or indirectly accounts for 2% of deaths in India annually

• According to a report by Institute for Health Metrics and Evaluation, University of Washington while diabetes rate had increased by 45% globally, it has increased by 123% in India between 1990 and 2013

Causes of Increasing Prevalence of Diabetes:

1. Genetics:

• Genetic susceptibility is an important factor contributing to the onset of diabetes. According to studies, the South Asian population is four times more likely to develop the diabetes than Europeans. However, diet and environmental conditions contribute to more than 50% of the risk

2. Rapid urbanization and associated change in lifestyle:

• Obesity, a diet rich in fats and refined cereals, lack of exercise and increased levels of stress are important causes of diabetes.

Relationship between diabetes and economic development:

• Diabetes is often termed as a ‘lifestyle disease’ and becomes more prevalent as populations accumulate wealth. In general, inactivity and consumption of high calorie food is associated with economic development.
• Various studies have shown that with economic growth, diet has changed both in rural and urban areas- intake of excess calories mainly from refined carbohydrates.
• According to a 2017 study by Indian Council of Medical Research, states with higher per-capita gross domestic product (GDP) have a higher prevalence of diabetes. Among the 15 states/ UT surveyed, Chandigarh had the highest GDP ($3,444) and the highest prevalence of diabetes at 13.6 percent. On the other hand Bihar with the lowest GDP of $682 had 4.3% diabetes prevalence.

3. Rising levels of Pollution:

• According to a recent study by Washington University School of Medicine and VA St. Louis Health Care System, US, the risk of incident diabetes increased with rising concentrations of PM2.5
• As fine dust enters the bloodstream through the lungs, it reduces insulin production, causes inflammation and leads to increasing risk of developing diabetes.
• According to the researchers, the risk pollution related diabetes is more likely in lower-income countries such as India that lack the resources for environmental mitigation systems.

4. Tobacco and Alcohol:

• According to studies, smokers are 30–40% more likely to develop type 2 diabetes than non-smokers. Smoking can make body more resistant to insulin which can lead to high blood sugar levels
• Several studies have suggested that even alcohol consumption might lead to enhancement the risk of diabetes

Impact:

1. Health Impacts:

• Gestational diabetes can cause health problems during pregnancy for both the child and mother. Children whose mothers had gestational diabetes have an increased risk of developing obesity and type 2 diabetes.
• Adults with diabetes have an increased risk of cardiovascular diseases and strokes
• Diabetes may also lead to foot ulcers, infections and eventual need for limb amputation
• Diabetes also adversely affects health of eyes and may lead to blindness. According to WHO, 2.6% of global blindness is attributed to diabetes
• Diabetes also a major cause for kidney failures

2. Economic Burden:

• According to a World Economic Forum Report, in 2010, healthcare expenditures on diabetes accounted for 11.6% of the total healthcare expenditure in the world.
• Higher prevalence of diabetes will add to India’s financial burden incurred in healthcare. India is expected to lose $140 billion by 2030.
• Diabetes largely adds to the economic burden of an individual. Health care expenditure for people with diabetes is two to three times higher than people without diabetes.
• Diabetes and other non-communicable diseases can lead to:
• increased absenteeism
• reduced productivity while at work
• inability to work as a result of disease-related disability
• lost productive capacity due to early mortality

Government Initiatives:

• In line with WHO’s Global action plan for the prevention and control of NCDs 2013-2020, India aims to reduce number of premature deaths by 25% and control NCDs by 2025
• Target 3 of India’s National NCDs Targets: Halt the rise in obesity and diabetes prevalence

Key action points include:

• Implement promotion of breastfeeding policies
• Develop and conduct evidence based public health campaign for early detection and treatment of obesity and diabetes; and promotion of healthy food options
• Develop and promote nutrition policies to limit content of sugar in food and non-alcoholic beverages, limit excess calorie intake, reduce portion size and energy density of foods
• Develop and implement policy measures for food producers and processors for reducing saturated fatty acids in food and replacing them with unsaturated fatty acids, and replacing trans fats with unsaturated fats in food products
• Develop and implement policies and guidelines on marketing of foods and beverages to children
• Reduce tax and increase subsidies on food products containing unsaturated fats
• Create health and nutrition monitoring environments in educational institutions, work places, health facilities etc.
• Promote physical activity through public awareness campaigns, promotion of physical activity in schools, creation and maintenance of spaces meant for physical activity.

National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010

Objectives:

1. Health promotion, Awareness generation and promotion of healthy lifestyle
2. Management of chronic Non-Communicable diseases, especially Cancer, Diabetes, CVDs and Stroke through early diagnosis, treatment and follow up through setting up of NCD clinics
3. Provide support for diagnosis and cost effective treatment at various levels of health care
4. Capacity Building at various levels of health care for prevention, early diagnosis, treatment

Way Forward:

1. Measures should be taken to prevent overweight and obesity, promote healthy diet and physical activity. Policies to be initiated that increase the price of foods high in fat, sugar, salt to discourage their consumption

Best Practice: Mexico:

Mexico which has had a very high prevalence of diabetes implemented a tax on sugar-sweetened beverages (SSBs) in January 2014. It also initiated various nationwide campaigns against junk food and towards healthier lifestyle.

2. Early Childhood nutrition should be improved. Measures should be taken to improve maternal health and nutritional status and infant and young child-feeding practices
3. Trade policies to promote healthy diet- Trade measures have proven effective in reducing the availability of unhealthy foods and changing people’s diet.

Example: In 2000 Fiji banned the supply of high-fat mutton flaps under the Trading Standards Act.

4. Measures should be taken to promote physical activity in schools, work places. It important to develop and preserve environments that support physical activity.
5. Infrastructure and capacity development for early diagnosis and treatment of non-communicable diseases like diabetes
6. Citizen awareness about consequences of unhealthy diet, sedentary diet is utmost necessary to prevent increasing diabetes prevalence