Diabetes in India

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Prevalence of diabetes in Indian states in 2016 India Diabetes Prevalence in 2016.png
Prevalence of diabetes in Indian states in 2016

India has an estimated 100 million [2] people (1 in 10 Indians) formally diagnosed with diabetes, which makes it the second most affected in the world, after China. [3] Furthermore, 700,000 Indians died of diabetes, hyperglycemia, kidney disease or other complications of diabetes in 2020. One in six people (17%) in the world with diabetes is from India. [3] (India’s population as calculated in October 2018 was about 17.5% of the global total. [4] ) The number is projected to grow by 2045 to become 134 million per the International Diabetes Federation. [3]

Contents

In India, type 1 diabetes is rarer than in western countries, and about 90 to 95% of Indians who were diagnosed had type 2 diabetes. Only about one-third of type 2 diabetics in India have a body mass index above 25. [5] A 2004 study suggests that the prevalence of type 2 diabetes in Indians may be due to environmental and lifestyle changes resulting from industrialization and migration to urban environment from rural. [6] This lifestyle change has led to the increased consumption of energy intake from animal foods in Asian populations. [7] This change has been seen in India where urban residents consumed 32% of energy from animal fats compared to 17% of rural residents. [8] These changes also occur earlier in life, which means chronic long-term complications are more common.

Epidemiology

Rates of diabetes worldwide in 2014. The worldwide prevalence was 9.2%. In India it is 8.9% as of 2020. Prevalence of Diabetes by Percent of Country Population (2014) Gradient Map.png
Rates of diabetes worldwide in 2014. The worldwide prevalence was 9.2%. In India it is 8.9% as of 2020.

In 2020, according to the International Diabetes Federation (IDF), 463 million people have diabetes in the world and 88 million people in the Southeast Asia region. Of this 88 million people, 77 million belong to India. [9] The prevalence of diabetes in the population is 8.9%, according to the IDF. According to the IDF estimates, India has the second highest number of children with type 1 diabetes after the United States. It also contributes to the largest proportion of incident cases of type 1 diabetes in children in the SEA region. [10] Per the World Health Organization, 2% of all deaths in India are due to diabetes. [11]

The number of people with diabetes in India has increased from 26 million in 1990 to 65 million in 2016. [1] According to the 2019 National Diabetes and Diabetic Retinopathy Survey report released by the Ministry of Health and Family Welfare, the prevalence was found to be 11.8% in people over the age of 50. [12] The prevalence of diabetes is 6.5% and prediabetes 5.7% among the adults below the age of 50 years, according to the DHS survey. [13] The prevalence was similar in both male (12%) and female (11.7%) populations. It was higher in urban areas. [14] When surveyed for diabetic retinopathy, which threatens eyesight, 16.9% of the diabetic population aged up to 50 years were found to be affected. Per the report, diabetic retinopathy in the 60-69-years age group was 18.6%, in the 70-79-years age group it was 18.3%, and in those over 80 years of age it was 18.4%. A lower prevalence of 14.3% was observed in the 50-59-years age group. [12] High prevalence of diabetes is reported in economically and epidemiologically advanced states such as Tamil Nadu and Kerala, where many research institutes which conduct prevalence studies are also present. [15]

There are four sub-groups or clusters of people with type 2 diabetes in India, two of which are unique to the country. These sub-groups have different risk levels of complications and might need different treatments. [16] [17]

Over the past three decades, the burden of diabetes in terms of deaths and Disability-adjusted life year (DALYs) has more than doubled in India. As per the Global Burden of Disease (GBD) Data Visualizations, the recorded death rate and DALY rate of diabetes in 2019 were 19.64 per 100,000 and 919.02 per 100,000 population, respectively, including males and females. [18] The GBD explore risk assessment framework estimated that diabetes-related DALYs attributable to high risk for Stroke, Coronary artery disease, Chronic obstructive pulmonary disease, Chronic kidney disease, Diarrhoeal diseases, Lower respiratory tract infection, Dietary iron deficiency, and Neonatal disorders. [19]

According to a survey conducted in 2016, the High body mass index (BMI) appeared to be the major risk factor contributing to 36% of diabetes DALYs. Besides, other risk factors, such as dietary risk, tobacco consumption, occupational exposure to passive smoke, low physical activity, and alcohol consumption, played a significant role as contributing risk factors. [1]

Percentage contribution of major risk factors to diabetes DALYs in India by gender Risk factors Diabetes.png
Percentage contribution of major risk factors to diabetes DALYs in India by gender

Prevention

The majority of diabetes cases are of type 2 diabetes. [20] In order to control diabetes in India, the Government of India initiated the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in 2010. [15] It aims to set up outreach camps for opportunistic screening at all levels in the health care delivery system for early detection of diabetes, among other illnesses. [21]

Preventing diabetes in the developing nations is valued highly because of the high cost of treating it. In India, it is estimated that a diabetic person spends a median of ₹10,000 (US$120) for medical treatment. Pragmatic, cost-effective strategies for primary prevention of diabetes is necessary. Studies using information technology were tested. In one such program, SMS was used to motivate people with impaired glucose tolerance (IGT) to follow lifestyle modification (LSM). This was found to be effective with a relative risk reduction of 36% compared to the participants who had only standard care. [22]

Indian Diabetes Prevention Program

The Indian Diabetes Prevention Program is a three-year randomized control trial that employed LSM and metformin (Met) to prevent type 2 diabetes in subjects with IGT. It concluded that LSM and Met were cost-effective interventions for preventing diabetes among high-risk individuals in India and other developing countries. [23]

National Diabetes Control Program

The National Diabetes Control Program was initiated in 1987 in some districts of Tamil Nadu, Jammu and Kashmir, and Karnataka. Its objectives included: [24]


However, the program was not expanded to other states due to shortage of funds. [24]

See also

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<span class="mw-page-title-main">Retinopathy</span> Medical condition

Retinopathy is any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to retinal vascular disease, or damage to the retina caused by abnormal blood flow. Age-related macular degeneration is technically included under the umbrella term retinopathy but is often discussed as a separate entity. Retinopathy, or retinal vascular disease, can be broadly categorized into proliferative and non-proliferative types. Frequently, retinopathy is an ocular manifestation of systemic disease as seen in diabetes or hypertension. Diabetes is the most common cause of retinopathy in the U.S. as of 2008. Diabetic retinopathy is the leading cause of blindness in working-aged people. It accounts for about 5% of blindness worldwide and is designated a priority eye disease by the World Health Organization.

<span class="mw-page-title-main">Diabetic retinopathy</span> Medical condition

Diabetic retinopathy, is a medical condition in which damage occurs to the retina due to diabetes. It is a leading cause of blindness in developed countries.

<span class="mw-page-title-main">Type 2 diabetes</span> Form of diabetes mellitus

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

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<span class="mw-page-title-main">Diabetic nephropathy</span> Chronic loss of kidney function

Diabetic nephropathy, also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus. Diabetic nephropathy is the leading causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) globally. The triad of protein leaking into the urine, rising blood pressure with hypertension and then falling renal function is common to many forms of CKD. Protein loss in the urine due to damage of the glomeruli may become massive, and cause a low serum albumin with resulting generalized body swelling (edema) so called nephrotic syndrome. Likewise, the estimated glomerular filtration rate (eGFR) may progressively fall from a normal of over 90 ml/min/1.73m2 to less than 15, at which point the patient is said to have end-stage renal disease. It usually is slowly progressive over years.

<span class="mw-page-title-main">Type 1 diabetes</span> Form of diabetes mellitus

Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar for energy and it helps regulate glucose levels in the bloodstream. Before treatment this results in high blood sugar levels in the body. The common symptoms of this elevated blood sugar are frequent urination, increased thirst, increased hunger, weight loss, and other serious complications. Additional symptoms may include blurry vision, tiredness, and slow wound healing. Symptoms typically develop over a short period of time, often a matter of weeks if not months.

The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentrations of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity-onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

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<span class="mw-page-title-main">Prediabetes</span> Predisease state of hyperglycemia with high risk for diabetes

Prediabetes is a component of metabolic syndrome and is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It usually does not cause symptoms but people with prediabetes often have obesity, dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension. It is also associated with increased risk for cardiovascular disease (CVD). Prediabetes is more accurately considered an early stage of diabetes as health complications associated with type 2 diabetes often occur before the diagnosis of diabetes.

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Complications of diabetes are secondary diseases that are a result of elevated blood glucose levels that occur in diabetic patients. These complications can be divided into two types: acute and chronic. Acute complications are complications that develop rapidly and can be exemplified as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), lactic acidosis (LA), and hypoglycemia. Chronic complications develop over time and are generally classified in two categories: microvascular and macrovascular. Microvascular complications include neuropathy, nephropathy, and retinopathy; while cardiovascular disease, stroke, and peripheral vascular disease are included in the macrovascular complications.

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<span class="mw-page-title-main">Epidemiology of diabetes</span>

Globally, an estimated 537 million adults are living with diabetes, according to 2019 data from the International Diabetes Federation. Diabetes was the 9th-leading cause of mortality globally in 2020, attributing to over 2 million deaths annually due to diabetes directly, and to kidney disease due to diabetes. The primary causes of type 2 diabetes is diet and physical activity, which can contribute to increased BMI, poor nutrition, hypertension, alcohol use and smoking, while genetics is also a factor. Diabetes prevalence is increasing rapidly; previous 2019 estimates put the number at 463 million people living with diabetes, with the distributions being equal between both sexes icidence peaking around age 55 years old. The number is projected to 643 million by 2030, or 7079 individuals per 100,000, with all regions around the world continue to rise. Type 2 diabetes makes up about 85-90% of all cases. Increases in the overall diabetes prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight or obese. The prevalence of African Americans with diabetes is estimated to triple by 2050, while the prevalence of whites is estimated to double. The overall prevalence increases with age, with the largest increase in people over 65 years of age. The prevalence of diabetes in America is estimated to increase to 48.3 million by 2050.

<span class="mw-page-title-main">Diabetes</span> Group of endocrine diseases characterized by high blood sugar levels

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Diabetes accounts for approximately 4.2 million deaths every year, with an estimated 1.5 million caused by either untreated or poorly treated diabetes.

Diabetes, in particular, non-insulin-dependent diabetes, is prevalent in the Aboriginal and Torres Strait Islander populations of Australia. As many as 1 in 20 Australians are said to suffer from diabetes. Aboriginal people are three times as likely to become diabetic in comparison to non-Aboriginal people. In contrast with type 1 diabetes, which is a predisposed autoimmune condition, type 2 diabetes or insulin-resistant diabetes, is a preventable disease, heavily influenced by a multitude of socioeconomic factors. Sufferers of the disease are consequently more susceptible to chronic health issues, including heart disease and kidney failure. Conclusively, this has contributed to the 17 year life expectancy gap between Aboriginal people and non-Aboriginal people and has led to health inequities between Aboriginal people and non-Aboriginal people.

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Vijay Viswanathan is a diabetologist from India who is the chief diabetologist at M.V. Hospital for Diabetes based in Chennai. He is also the President of Prof. M. Viswanathan Diabetes Research Centre and the first Asian President of D-Foot International, a non-profit organization based in Belgium. Viswanathan has published over 543 research papers, in publications including the National Library of Medicine, on topics such as primary prevention and management of diabetes, diabetic foot and prevention of amputation, diabetic nephropathy, socio-economics of diabetes care and Pulmonary TB and diabetes.

References

  1. 1 2 3 Tandon, Nikhil; Anjana, Ranjit M.; Mohan, Viswanathan; Kaur, Tanvir; Afshin, Ashkan; Ong, Kanyin; Mukhopadhyay, Satinath; Thomas, Nihal; Bhatia, Eesh; Krishnan, Anand; Mathur, Prashant (2018-12-01). "The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990–2016". The Lancet Global Health. 6 (12): e1352–e1362. doi:10.1016/S2214-109X(18)30387-5. ISSN   2214-109X. PMC   6227383 . PMID   30219315.
  2. ↑ "Lancet study: More than 100 million people in India diabetic". BBC. 9 June 2023. Retrieved 9 June 2023.
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  4. ↑ Geoffrey Migiro (October 25, 2018). "Countries By Percentage Of World Population". WorldAtlas. Retrieved May 19, 2020.
  5. ↑ Editor (2019-01-15). "Over 30 million have now been diagnosed with diabetes in India. The CPR (Crude prevalence rate) in the urban areas of India is thought to be 9 per cent". Diabetes. Retrieved 2020-04-29.{{cite web}}: |last= has generic name (help)
  6. ↑ Mohan, V. (June 2004). "Why are Indians more prone to Diabetes?". The Journal of the Association of Physicians of India. 52: 468–474. ISSN   0004-5772. PMID   15645957.
  7. ↑ "Diabetes in Asia". American Medical Association. 301 (20). May 27, 2009 – via JAMA Network.
  8. ↑ Prakash, Shetty (2002). "Nutrition transition in India". Cambridge University Press. 5 (1A): 175–182 – via Public Health Nutrition.
  9. ↑ "Members". idf.org. Retrieved 2020-04-29.
  10. ↑ Ramachandran, Ambady; Snehalatha, Chamukuttan; Ma, Ronald Ching Wan (2014-02-01). "Diabetes in South-East Asia: An update". Diabetes Research and Clinical Practice. 103 (2): 231–237. doi:10.1016/j.diabres.2013.11.011. ISSN   0168-8227. PMID   24300015. S2CID   33810939.
  11. ↑ "Diabetes country profiles - World Health Organization" (PDF). who.int. Retrieved 30 April 2020.
  12. 1 2 Sharma, Neetu Chandra (2019-10-10). "Government survey found 11.8% prevalence of diabetes in India". Livemint. Retrieved 2020-04-29.
  13. ↑ Chandrupatla, Siddardha Gowtam; Khalid, Isma; Muthuluri, Tejdeep; Dantala, Satyanarayana; Tavares, Mary (2020-09-18). "Diabetes and prediabetes Prevalence Among Young and Middle Aged Adults, And Geographic Differences In India- National Family Health Survey". Epidemiology and Health. 42: e2020065. doi: 10.4178/epih.e2020065 . ISSN   2092-7193. PMC   7871157 . PMID   32972049.
  14. ↑ "Diabetes in India". Cadi Research. Retrieved 2020-04-29.
  15. 1 2 Atre, Sachin (2019-04-01). "The burden of diabetes in India". The Lancet Global Health. 7 (4): e418. doi: 10.1016/S2214-109X(18)30556-4 . ISSN   2214-109X. PMID   30879507.
  16. ↑ "New sub-groups of diabetes could lead to more targeted treatment for people in India". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2021-03-04. doi:10.3310/alert_45105. S2CID   241327246.
  17. ↑ Anjana, Ranjit Mohan; Baskar, Viswanathan; Nair, Anand Thakarakkattil Narayanan; Jebarani, Saravanan; Siddiqui, Moneeza Kalhan; Pradeepa, Rajendra; Unnikrishnan, Ranjit; Palmer, Colin; Pearson, Ewan; Mohan, Viswanathan (17 August 2020). "Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study". BMJ Open Diabetes Research & Care. 8 (1): e001506. doi:10.1136/bmjdrc-2020-001506. ISSN   2052-4897. PMC   7437708 . PMID   32816869.
  18. ↑ "Institute for Health Metrics and Evaluation GBD compare data visualization". Healthdata.org. Retrieved 2021-09-12.
  19. ↑ "Institute for Health Metrics and Evaluation GBD compare data visualization". Healthdata.org. Retrieved 2021-09-12.
  20. ↑ Atre, Sachin (September 2015). "Addressing policy needs for prevention and control of type 2 diabetes in India". Perspectives in Public Health. 135 (5): 257–263. doi:10.1177/1757913914565197. ISSN   1757-9147. PMID   25585513. S2CID   32092695.
  21. ↑ "National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke". Directorate General Of Health Services. Retrieved 2020-04-29.
  22. ↑ Ramachandran, Ambady; Snehalatha, Chamukuttan (2014-05-01). "Prevention of diabetes: How far have we gone?". Indian Journal of Endocrinology and Metabolism. 18 (3): 252–3. doi: 10.4103/2230-8210.131112 . ISSN   2230-8210. PMC   4056119 . PMID   24944915.
  23. ↑ "Cost effectiveness of prevention of diabetes" (PDF). Indian Diabetes Prevention Programme: 13. 1 August 2007.
  24. 1 2 Verma, Ramesh; Khanna, Pardeep; Mehta, Bharti (2012-06-30). "National programme on prevention and control of diabetes in India: Need to focus". The Australasian Medical Journal. 5 (6): 310–315. doi:10.4066/AMJ.2012.1340. ISSN   1836-1935. PMC   3395295 . PMID   22848329.

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