Between 1980 and 2014 the number of adults with diabetes in the world increased four-fold from 108 million to 422 million.  The increase was particularly sharp in low- and middle-income countries.  In 2014, 50 per cent of adults with diabetes lived in five countries — China, India, the U.S. Brazil and Indonesia, notes a paper published today (April 6) in The Lancet. The paper is based on data from 751 studies totalling 4.4 million adults from 146 countries.

The prevalence of diabetes in adults (after adjusting for age) more than doubled in men in India and China (3.7 to 9.1 per cent in India; 3.5 to 9.9 per cent in China) between 1980 and 2014 and increased by 80 per cent among women in India (4.6 to 8.3 per cent) but only 50 per cent in women in China (5 to 7.6 per cent).

The absolute number of adults with diabetes in India increased from 11.9 million in 1980 to 64.5 million in 2014. In the case of China, the increase was from 20.4 million in 1980 to 102.9 million in 2014. While India contributed 15.3 per cent of global share of adults with diabetes in 2014, it was 24.4 per cent in the case of China.

In the case of the U.S., the absolute increase in the number of diabetics was from 8.1 million in 1980 to 22.4 million in 2014. However, global share of adults with diabetes in the case of the U.S. reduced from 7.5 per cent in 1980 to 5.3 per cent in 2014.  China, India and the U.S. have maintained their number one, two and three positions in 1980 and 2014.

Indonesia and Pakistan moved up in the world ranking from 12th and 13th position in 1980 (with 2.1 million and 1.7 million diabetics respectively) to fifth and sixth position in 2014 (with 11.7 and 11 million diabetics respectively).

In the case of Western Europe, though there has been an increase in overall rates of diabetes in many countries between 1980 and 2014, the increase has largely been due to ageing population.

There is a very slim chance of meeting the UN global target of halting the rise in diabetes and obesity (against the 2010 baseline) by 2025 if current trends in the rates of diabetes, which are rising quickly in China, India, and many other low- and middle-income countries, continues.

According to the World Health Organisation’s first Global report on diabetes, 1.5 million deaths in 2012 were caused by diabetes. An  in 2012. An additional 2.2 million deaths, by increasing the risks of cardiovascular and other diseases, were caused by higher-than-optimal blood glucose.  WHO says that 43 per cent of these 3.7 million deaths take place before the age of 70 years.

The good news is that diabetes, particularly Type II diabetes and gestational diabetes, can be easily prevented. Interventions are required to prevent people from becoming overweight and obese, beginning before birth and in early childhood, encouraging breast feeding, and the consumption of healthy foods.  All steps need to be taken to discourage the  consumption of unhealthy foods, such as sugary sodas. Besides focusing on healthy diet, attempts to increase physical activity have to be taken.

According to the WHO, the Indian Diabetes Risk Score, which uses a simplified risk score for identifying undiagnosed diabetic subjects using four simple parameters – age, waist circumference, family history of diabetes and physical activity, is a simple tool that can be used for screening.

Obese Indians

India faces a double whammy with increasing prevalence of obesity and underweight population. According to an April 2, 2016 paper in The Lancet, ranked 19th in the world in 1975, India had only 0.4 million obese men and 0.8 million obese women. But in 2014, the number shot up to 9.8 million obese men and 20 million obese women; Indian men and women occupied the 5th and 3rd rank respectively in the world in 2014.

With 0.1 million, Indian women were ranked 35th in the severely obese category in 1975 but shot up to 8th position in 2014 with 3.7 million severely obese women.

Underweight adults

If the number of obese men and women is increasing in India, it ranks number one in the case of underweight adults. According to The Lancet, the number of underweight men in India increased from 61.4 million in 1975 to 101.8 million in 2014.  The number of underweight women in India increased from 58.3 million in 1975 to 100.5 million in 2014.

As a result of the huge number of underweight men and women in the country, India’s percentage contribution to global underweight was also very high. India contributed to nearly 38 per cent of global underweight men in 1975 and 46.2 per cent in 2014.  In the case of women, India contributed to nearly 33.4 per cent of global underweight women in 1975 and 41.6 per cent in 2014.

Published in The Hindu on April 6, 2016