Equal prevalence of diabetes among women exposes gender inequality in Maharashtra

A recent ICMR study reveals that India’s diabetes population has surged to over 101 million, up from 70 million in 2019. Nevertheless, a significant portion of the population remains undiagnosed, with women often overlooking these metabolic disorder symptoms, much like Ashabai.

To address the issue, the state health department has started the screening of women above the age of 30 years. Data gathered by The Indian Express contradicts the commonly held belief that men are at higher risk of diabetes. In Maharashtra, 5.18% of screened men (521,149 out of 10,056,009) had diabetes, while 5.22% of screened women (531,347 out of 10,164,193) were diagnosed with diabetes. Mumbai data is not included.

A thorough analysis of the data revealed that in many districts, diabetes prevalence is higher among women. Thane stands out as a prominent example, with 7.8% of screened men (9,236 out of 117,334) found to have diabetes, while 9.3% of screened women (10,971 out of 117,805) were diagnosed with the condition. Other districts, such as Jalgaon (5.6%-6.4%), Kolhapur (5.3%-6.3%), and Yavatmal (7.4%-8.04%), show a similar trend.

In the case of hypertension, its prevalence among women is even higher. Among 10,078,399 men screened, 10.2% (1,028,159) had hypertension. Meanwhile, out of 10,188,001 women screened, 12.1% (1,235,160) were diagnosed with hypertension.

Despite this, awareness about the disease, particularly among women, still remains low. Women mostly receive a diabetes diagnosis during hospital visits for non-diabetic concerns like blurred vision, fatigue, or weight loss, which are linked to uncontrolled diabetes. “Nearly 90% of the women who come to us experience severe side-effects due to delayed diabetes diagnosis. Juggling domestic responsibilities, fieldwork, and a lack of awareness, they ignore these symptoms until it’s too late,” said Dr Suresh Sable, Beed’s former civil surgeon.

The delay in diagnosis is not only limited among adults but also children who suffer from type-1 diabetes. Subhashini from Nityaasha Foundation that works for type-1 diabetic patients in Maharashtra outlined the median monthly expenditure of treatment cost is Rs 2,000 per patient. Families from poor economic backgrounds often neglect treatment for their daughters over their son. “They tend to choose tablets over life-saving insulin, leading to worsening health. Some families avoid spending on medicines and administer them on alternate days to save money, whereas they ensure daily medication for their diabetic sons,” she said. In such cases, the volunteers have to counsel the parents.

A report published by Lancet in 2017 stated, “Indeed, women with type 1 diabetes have a 40% higher excess risk of premature death than men with the disease, and those individuals with type 2 diabetes have up to 27% higher excess risk of stroke and 44% higher excess risk of coronary heart disease.”

Despite this, socioeconomic obstacles disproportionately affect women, limiting their access to proper nutrition, healthcare, and opportunities for physical activity compared to men.

Social stigma in rural India also deters women from adhering to diabetic treatment by subjecting them to shame, guilt, and fear of judgment. Dr Lalit Kumar from NGO United World Against Diabetes explained, “Due to lack of awareness, especially in villages, women fearing stigmatisation hide their condition impacting their willingness to attend medical appointments, adhere to prescribed treatments, and make necessary lifestyle changes. Often, they are labelled as ‘unhealthy’.”

Nearly one-third of the women develop diabetes during the child-bearing age which leads to complications during pregnancy, including gestational diabetes. This can increase the risk of high blood pressure, preeclampsia, and the need for a caesarean section.

Dr Tushar Bandgar, head of endocrinology at KEM hospital who gets around 4-5 such women with gestational diabetes every week shared how these patients especially from rural regions are rushed to the hospital after repeated delays in diagnosis due to unavailability of specialists in those remote areas and references. “These pregnant women develop elevated blood sugar levels which impact the developing foetus, increasing the risk of birth defects, large birth weight, and neonatal hypoglycaemia (low blood sugar levels),” he said.

Low adherence to medication is another big problem in dealing with diabetes treatment among women. In households with limited economic resources, costly, nutritious foods like eggs, milk, fruits, and meat are often prioritised for fathers and sons. The latest National Family Health Survey identified a protein deficit in women’s diets, leading to a higher consumption of simple carbohydrates, which can be harmful for diabetic patients.

For instance, Gayatri Sule, a resident of Palghar, reasoned how she thinks twice before buying a protein shake—low in carbs prescribed by the doctor. “That one bottle costs Rs 500 — it will be an additional expense on our family budget so we never bought it,” she said.

To address this gender gap in the treatment of diabetes, echoing the Lancet editorial, doctors outlined the need for more increased and equitable access to care and improved outcomes for all girls and women with diabetes.

The correspondent is a recipient of the 2023 REACH Media Fellowships for Reporting on Non-Communicable Diseases