Editorial: On detecting and delaying diabetes

Between 1980 and 2014, the age-adjusted prevalence of diabetes in India more than doubled among men (from 3.7 to 9.1 per cent) and increased by 80 per cent among women (4.6 to 8.3 per cent). In absolute terms, the number of diabetics in India galloped from 11.9 million to 64.5 million in the same period, according to a paper published a few days ago in The Lancet. India stands next only to China in the prevalence of diabetes, and contributes nearly one-sixth to the global disease burden of 422 million. It will be difficult to meet the UN global target of halting adult prevalence of diabetes at 2010 levels by 2025 if the current rates of increase continue in China, India and other low- and middle-income countries. In fact, if the post-2000 trend continues, the global prevalence of diabetes in 2025 will surpass 700 million. It is true that increase in longevity and population growth have been responsible for the spike in diabetes in India, but going forward it is rising levels of obesity that could well be the more significant contributing factor. Obesity is the most important risk factor for diabetes. According to a April 2, 2016 paper published in The Lancet, the number of obese men in India increased from 0.4 million in 1975 to 9.8 million in 2014; and from 0.8 million to 20 million women during the same period. Indeed, in 2014 there were 3.7 million severely obese women in the country. Besides obesity, there are other factors that put Indians at greater risk of developing diabetes. Increased consumption of sugar-rich and refined food products, central adiposity (commonly seen in Indian adults), sedentary lifestyles, and genetic susceptibility make more Indians vulnerable to the disease than Caucasians.

According to the Global Burden of Disease Study 2013 report, the number of years both men and women live with disease and disability has shot up since 1990. In India, diabetes is one of the major causes of disability in adults. With a direct annual cost of $73 billion, the economic burden of diabetes in India is considerable. And a substantial part of treatment costs is met by out-of-pocket expenditure. Concerted efforts must be directed at preventing and delaying the onset of the disease. A relatively easy and short-term intervention that can go a long way in keeping the disease burden under check is to diagnose and treat gestational diabetes — mostly through dietary changes and physical activity. The management of gestational diabetes — started in Chennai, it is now a national programme — which can prevent the disease in mother and child, has unfortunately not got the same attention as prevention of vertical transmission of HIV. Another missed opportunity is early detection of pre-diabetes when the blood sugar level is higher than normal but not elevated enough to be classified as diabetes. The progression to full-blown diabetes can be effectively delayed and even prevented through dietary changes and increased physical activity. This is why public awareness is crucial.

Published in The Hindu on April 11, 2016