India’s diabetes demographic is changing. The ‘rich man’s disease’ is becoming increasingly common among people of “low socioeconomic status (SES)” living in urban areas of the more affluent states, shows an ongoing study, the results of which were published online in The Lancet Diabetes & Endocrinology Wednesday. The Indian Council of Medical Research-INdia DIABetes study, funded by ICMR and the Department of Health Research of the union Health Ministry, seeks to estimate the national prevalence of diabetes and pre-diabetes in India, broken down by states.
The published results include data from 11 states surveyed during the second and third phases of the study carried out between September 2012 and July 2015, along with some unpublished data from the first phase of sampling (November 2008-April 2010) which covered three states — Tamil Nadu, Jharkhand, Maharashtra — and the Union Territory of Chandigarh. While overall, diabetes is twice as common in urban areas (11.2 per cent) as in rural areas (5.2 per cent), in as many as seven of the 15 regions surveyed, its prevalence in the villages was higher than in the towns and cities. Almost all of these seven regions are considered economically advanced: the states of Punjab, Tamil Nadu, Andhra Pradesh, Maharashtra, Tripura and Manipur, and the UT of Chandigarh.
The study results also showed that the richer states — those with higher per capita GDP — generally have a higher prevalence of diabetes overall. As a whole, the prevalence of diabetes across the 14 states and Chandigarh is 7.3 per cent, the study showed. Chandigarh has the highest prevalence — 13.6 per cent — and Bihar the lowest (4.3 per cent). The study has also revealed that half of those surveyed were unaware of their diabetic condition until they were tested. Rural prevalence is highest in Punjab (8.7 per cent), followed by Chandigarh (8.3 per cent) and Tamil Nadu (7.8 per cent). Urban prevalence is highest in Tripura (15.5 per cent), followed by Chandigarh (14.2 per cent) and Tamil Nadu (13.7 per cent).
In the urban areas of Chandigarh, the prevalence of diabetes among those in the ‘Low SES’ group is a massive 26.9 per cent, double the incidence (12.9 per cent) among the ‘High SES’. In Bihar, on the other hand, the trend is reversed — Low SES incidence in urban areas is only 4.7 per cent, compared to a High SES incidence of 15.4 per cent.
“We noted that the prevalence of diabetes was higher in individuals of low SES in the urban areas of Chandigarh, Tamil Nadu and Maharashtra. Most of these states are also ranked among the more economically advanced states. This finding suggests that urban areas of more affluent states have transitioned further along the diabetes epidemic, such that less affluent individuals have a higher prevalence of diabetes than their more affluent counterparts,” Dr R M Anjana, lead author of the study and Vice-President, Madras Diabetes Research Foundation, told The Indian Express.
“The results suggest that as the overall prosperity of states and India as a whole increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of society, a transition that has already been noted in high-income countries,” Dr Anjana added. The reasons, she said, could include the faster pace of urbanisation and an improvement of socioeconomic status. “What people have to do now (is that), as they become more prosperous, you need awareness about healthy eating habits,” Dr Anjana said.
ICMR director-general Dr Soumya Swaminathan, when contacted in the UK, said the data shows “a gradient of diabetes prevalence with higher prevalence in more ‘developed’ states”. Prediabetes, however, is quite high even in the less developed states. This, Dr Swaminathan said, is worrying because “it indicates that in the coming years, more and more people will develop diabetes in these states”. However, she said, “there is an opportunity to slow this down, as modification of diet and lifestyles can prevent the progression to diabetes”.