Lifestyle correction is urgent; treatment cost has to go down
By Dr. Gyan Pathak
The new update on prevalence of diabetes in India, already referred to as the Diabetes Capital of the World for several years now, has revealed the alarming conditions heading towards a diabetes explosion in the country. About 11.4 per cent of the population is already diabetic while 15.3 per cent are just pre-diabetic, revealed the latest ICMR-INDAB study. Lifestyle correction has obviously become urgent, and also reduction in high cost of treatment and diabetes management which was estimated at Rs1265 per patient per month in 2021, and has been rising since.
The new update has even greater implication than that meets the eye in the first instance. Earlier estimate was quoted just six months before when India was observing Diabetes Day on November 14, 2022, that India had close to 80 million people with diabetes. Now the new estimate finds it to be 101.3 million in 2021, while 136 million were in just pre-diabetic stage. It was said that 17 per cent of all diabetic patients of the world were living in India, and the number was expected to increase to 135 million by 2045. The new estimates are much more frightening than the estimates of 70 million people living with diabetes in 2019.
Consequently, the real burden of non-communicable diseases (NCDs) is much higher than it was earlier estimated, and could be rising sharply necessitating new planning and investments to deal with the emerging emergency situation in the country. Since, the present estimation is based on an analysis of the prevalence of obesity, hypertensions and hypercholesterolemia that is the presence of bad cholesterol, India may need a relook on the entire planning on the control and prevention of NCDs.
The new ICMR-INDAB study published in the UK medical journal ‘Lancet' has covered the period between 2008 and 2020 across the country in 31 states and Union Territories. The study finds more prevalence of diabetes in urban area than the rural areas which were 16.4 per cent and 8.9 per cent respectively. However, it should not mislead the planners of diabetes management to put greater emphasis on the urban areas at the cost of rural areas, since it conceals another fact that in terms of total urban population and the prevalence of pre-diabetes patients among them was 15.4 per cent, only a little more than 15.2 per cent in rural India. All these means that both urban and rural areas are heading towards explosion of new cases of diabetes in near future if people do not make a course correction in their lifestyles, necessitating significant increase in the medical facilities in the country.
Ten worst affected states of the country in terms of percentage of diabetic patients are Goa (26.4), Puducherry (26.3), Kerala (25.5), Chandigarh (20.4), Delhi (17.8), Tamil Nadu (14.4), West Bengal (13.7), Sikkim (12.8), Punjab (12.7) and Haryana (12.2). Pre-diabetic stage people in Goa are 20.3 per cent, Puducherry 25.8 per cent, Kerala 18.3 per cent, Chandigarh 15.6 per cent, Delhi 18 per cent, Tamil Nadu 10.2 per cent, West Bengal 23.5 per cent, Sikkim 31.3 per cent, Punjab 8.7 per cent and Haryana 18.2 per cent. This only shows the greater task of preparation ahead the diabetes pandemic further worsens in the country. In these worst states, the burden of diabetes and pre-diabetes patients are ranging between 21.4 per cent in Punjab to 52.1 per cent in Puducherry.
If the diabetes and pre-diabetes patients are nearly equal in a geographical area, the situation is considered to be stabilizing, as we have been witnessing in Puducherry and Delhi, but it should not be taken lightly, since which the rapid change of lifestyles more vulnerable to diabetes could change the scenario. More so, it is still at high level which needs greater medical facilities including affordability of drugs.
In several states of the country, the number of diabetes patients are not at alarming level, such as in Uttar Pradesh, Madhya Pradesh, Bihar and Arunachal Pradesh. Nevertheless, the country cannot afford to take complaisant view in term of preparedness for the impending diabetes pandemic. For example, Uttar Pradesh have presently only 4.8 per cent diabetic patients. However, pre-diabetes stage people are as high as 18 per cent. It indicates that such states with lower prevalence of diabetes are rapidly moving towards explosion of diabetes cases over the next few years, the study has warned.
There are other serious factors too, that the study has revealed. Increasing levels of hypertension, cholesterol, and obesity which are already high at present, has tremendously amplified the risks of cardiac arrests, strokes, kidney disease, and many others. Hypertension was found among 35.5 per cent of people and cholesterol in 81.2 per cent. About 28.6 per cent of people are suffering from generalised obesity while 39.5 per cent from abnormal obesity. All these must be taken note of, in addition to over 7 lakh deaths in 2020 in diabetes and related medical conditions.