LAST SEPTEMBER, 40-year-old city resident Bhupinder Singh suddenly began to feel extraordinarily thirsty. His local doctor advised him to go to Postgraduate Institute of Medical Education and Research (PGIMER). There, doctors advised him to go for a blood sugar test. It was positive for Type 1 Diabetes. Since then, Singh has been on insulin treatment three times daily. He spends Rs 592 on one cartridge of the anti-diabetes medicine which lasts 10 days.
For Singh, who runs a cloth store at Zirakpur, the diagnosis was a shock. “There is no family history of diabetes,” he said, as he spoke about the extra financial burden of the treatment.
Two weeks ago when the reputed Lancet Diabetes & Endocrinology journal published a study about the prevalence of diabetes in the country, the report only corroborated what the city doctors had been saying for years. Chandigarh has the highest prevalence of the disease among 15 states/UTs of the country that were surveyed for the study. And with a per capita income of $ 3,433, it was the most affluent city.
But here’s the twist in the tale: it’s no longer just a rich man’s lifestyle disease. The disease is moving from the affluent to the urban poor. The Lancet study, which is still ongoing, found the national prevalence of diabetes to be 7.3 per cent. Chandigarh has 13.6 per cent, not just the highest among the surveyed states, but almost double the national prevalence.
Chandigarh was part of the study’s Phase 1 along with four other states (the study was conducted in three phases until 2015) from November 2008 to April 2010. In UT, it covered 3,356 individuals. The city was among the places with the highest waist circumferences both for men (82.9 cms) and women (78.7 cms). Punjab was the highest with 87.8 for men and 76.6 for women.
The study found that the prevalence of diabetes among Chandigarh’s urban poor is about 26.9 per cent. Among those surveyed, 370 were from a low SES (socio-economic status); 1,059 from middle SES; and 1,920 from high SES. For the purposes of the study, the prevalence in the middle and high SES was taken together.
“The spread of the epidemic to economically disadvantaged sections of society is a matter of great concern in India, where most diabetes treatment expenses are borne out of pocket by patients,” the report red flagged.
Dr Vijay Viswanathan, head and chief diabetologist at M V Hospital for Diabetes, Chennai, maintains that the lack of physical activity and faulty food are the main causes behind the rise of diabetes among the urban poor. Health administrators must be prepared for dealing with increasing numbers of diabetes patients from the lower soci-economic groups, and the cascading effect it has on patients’ health as it affects other systems in the body.
He asserts that people with less money to spend on food typically overload themselves with carbohydrates and transfats, as they tend to use the same oil repeatedly. Expensive items such as fruits and vegetables are the first to be sacrificed.
“The diet gets faulty and instead of fruits and vegetables they take rich carbohydrates like rice. They also consume a lot of food, which contains transfats. Since the urban poor gets diabetes, the health system has to look after these people as they would be developing certain complications related to heart, kidney and all, which is more expensive than treating the diabetes itself,” Dr Vishwanathan told Chandigarh Newsline.
In 2009, a similar study conducted by PGIMER doctors had concluded that the city’s diabetic prevalence was 11.1 per cent. PGI then studied 2,227 people from urban Chandigarh during April 2008-June 2009.
These studies were conducted some years ago, but the situation has not improved. The increase is now showing in the city hospitals, where doctors assert that the number of patients has gone up in the last few years. Other than the PGIMER, which records patients from neighbouring states, the city’s GMSH in Sector 16 and GMCH in Sector 32 are also recording a rise, according to doctors.
“Over the years the number of diabetes population coming to us has doubled,” said Dr Gopal Bhardwaj, head, department of medicine and endocrinology, GMSH, Sector 16. “Our hospital records patients mostly from the city itself and also the Tricity areas. The number has tremendously increased. Now the patients are younger, and also from varied groups such as labourers and workers. This could be due to a change in genetic make-up, possible environmental factors and food adulteration and other changes in the food habits.”
Dr Sanjay Bhadada, from the department of endocrinology, PGIMER, believes the change in lifestyle post-migration from villages to cities adds to the risk factors of diabetes.
“We are witnessing a large number of people of low socio-economic status migrating to cities like Chandigarh. In their villages, they are accustomed to a particular type of food. When they come to the city, their body doesn’t adjust to the change of food habits which could lead to diabetes,” he said.
The city also has recorded prevalence of pre-diabetes at 14.6 per cent — a similar prevalence was noted in both urban and rural areas (14.5 per cent versus 14.7 per cent respectively). Doctors caution that the alarming figures of pre-diabetes should be seen as serious and in the next few years, they should make some lifestyle changes.
What adds to the diabetes problem is that the people in the city are becoming more obese. While the city’s waist circumference was high, the Lancet study also pointed out that Chandigarh’s average body mass index (BMI) was also high at 23.2.
The normal values of BMI are between 18-22 in the country. According to the authors of the study, the prevalence of diabetes was higher in the urban areas compared with rural areas (14.2 per cent vs 8.3 per cent respectively).
Fitness experts underline the importance of fitness and changing food habits.
“It’s the combination of cardio, weight training and diet which could support the cause,” said Vikram Kapoor, a city-based fitness trainer.
“The morning and evening walks along with jogging must be supported by maintenance of muscles which serves a great deal in burning calories.”
Kapoor insists that the shift of the diabetes in the lower age groups keeps the future generation also in the high risk. “The shift of diabetes which was earlier in the 45-50 age group is now in the 30-35 age group. The lifestyle variations among this group are thereby promoting instances of hereditary diabetic symptoms in further younger generations.”
Bhupinder, the shop owner at Zirakpur, said he had little time to exercise, but occasionally he went for a walk. Recently, his doctor at PGI told him to get his kidney test, which has alarmed him. “I hope everything is fine, and there are no complications,” he said.
(Inputs by Radhika Pasrija)