Exactly how is your study different?
The ICMR-India Diabetes study is the first study on diabetes to include 14 states and a UT, sampling both rural and urban populations. It is the largest epidemiological study of diabetes in the country so far, and has produced, for the first time, diabetes data on the Northeast. Earlier studies were regional, with small sample sizes, had low response rates, and used varied diagnostic criteria. The 15 states-UT data reported represent an adult population of 363.7 million, which is 51% of India’s adult population. The data show large variations in region-specific prevalence of both diabetes — ranging from 4.3% in Bihar to 13.6% in Chandigarh — and pre-diabetes, ranging from 6.0% in Mizoram to 14.7% in Tripura. However, these estimates are based on data from just 15 states-UT out of a total 31 to be studied and, therefore, cannot be considered to be final. States yet to be sampled include the NCT of Delhi, Kerala (state with the highest reported prevalence of diabetes so far), UP (most populous), and Goa (highest per capita income).
So, almost half those surveyed did not even know they had diabetes?
In a developing country like India, awareness of the condition is low, and is frequently not diagnosed until complications appear. Low literacy is a problem. Community based mass awareness programmes are extremely important. Our study emphasises the need for comprehensive diabetes education for all individuals above the age of 30. Education about diabetes and the need for regular checkups, as well as screening, will go a long way in reducing the burden of the disease.
Why is it twice as common in urban areas (11.2%) compared to rural (5.2%)?
India’s economic development has drastically modified lifestyles over a single generation, particularly with respect to decrease in physical activity levels and adoption of western-style fast foods and sweetened beverages, especially by the younger generation in the urban areas. Dietary patterns that include high intake of refined grains, processed meats, added sugars, and low-fibre diets, have been associated with increased diabetes risk. Other factors in urban areas could be increased sedentary behaviour such as watching TV, the rise in obesity, exposure to environmental pollutants, depression, and reduced sleep patterns.
And people of low SES are now affected?
The findings show the prevalence of diabetes is higher among individuals of low SES than among high SES in urban areas of certain high income states, whereas, in rural areas, diabetes is more prevalent among individuals in the higher SES. Prevalence also seems to be higher in states with higher per capita income. Most of the treatment cost of diabetes is out-of-pocket expense, which puts a huge burden on patients and their families. Given the lifelong expenditure associated with diabetes and related co-morbidities, many individuals and families are unable to cope. The burden can be reduced by ensuring universal healthcare coverage, access to affordable medicines, early detection and treatment, and increased awareness.
How serious is the finding that the prevalence of pre-diabetes is 10.3%?
The high prevalence of pre-diabetes — one in every 10 individuals — means there are a huge number of people who will eventually develop diabetes in the near future. Compared to other groups, Asian Indians progress faster through the pre-diabetes stage to frank diabetes; this could add greater burden to already strained health resources.