India has 101 million people living with diabetes: What a recent ICMR study said

The findings can be utilised by the states to develop health policies to target these non-communicable disease.

What were the findings of the study?

Using a large representative sample of over 113,000 people across 31 states and union territories in the country, the researchers were able to determine the prevalence of various metabolic disorders such as diabetes across Indian population.

The study found:

• More than a quarter of the population was either diabetic or in pre-diabetic stage. 11.4% of India’s population or 101 million people are living with diabetes. Whereas 15.3% of the population or an additional 136 million people are pre-diabetic. This is concerning as the researchers say that almost half of the pre-diabetics may convert to diabetes within five years or so.
• The prevalence of hypertension or high blood pressure was found to be higher still in the country. Around 35.5% of the population or 315 million people are living with the condition as per the study.

Prevalence of non-communicable diseases in India. (Source: ICMR)

• In addition to BMI (body mass index) that is generally used as a measure for obesity, the Indiab researchers looked at abdominal or central obesity. This is because Indians tend to gather fat in the abdominal region and despite the BMI being normal people might be at a higher risk of diseases of obesity.
• The study found that 28.6% of the population would be considered to be obese as per the BMI measure, 39.5% of the population or 351 million people had abdominal obesity.
• The study also found that 24% of the population or 213 million people were living with hypercholesterolemia — a condition where the bad cholesterol or LDL levels are high.

What is Indiab? And, why is the study so important?

India Diabetes or Indiab study is a 12 year-long project with over 113,000 participants. Data collected by the study over the years in phases across the different states have helped researchers in India accurately determine the prevalence of metabolic disorders. In addition, it has also generated important evidence such as a study by the group last year that showed that only 7% of the known diabetics have their sugar, BP, and cholesterol in check.

The study is also highly representative of the Indian population, meaning it has kept ratio of say men and women or people living in the rural or urban centres similar to the country’s population. Of the 1.13 lakh participants, 79,506 are from rural areas representing the country 70% demography living in rural areas. “If you look at the Indiab demographic graph it matches exactly with the census graph, meaning it is a highly representative study,” said Dr V Mohan, one of the authors of the study.

It is also one of the largest studies ever attempted. “No country has ever done such a big study representative of all their states. Even the biggest study from China had 40,000 participants from five or six places in the country. We have conducted door-to-door screening of 113,000 people representing all states and the 1.4 billion people living in it,” said Dr Mohan.

With the data from different state being collected in different years 2008 through 2020, it was normalised for the year 2021 using demographic data from the most recent National Family Health Survey.

Is there a geographical variation in the data?

The study found a definite rural-urban divide in the prevalence of the diseases. The prevalence of diabetes stood at 16.4% in urban India as compared to 8.9% in rural India. The prevalence of diabetes was higher in the Southern states and a few north Indian states such as Delhi and Punjab. The prevalence of diabetes was lowest in Uttar Pradesh at 4.8% of the population.

But, the prevalence of pre-diabetes was found to be almost same for both rural and urban India.

“There is almost no rural and urban divide when it comes to the prevalence of pre-diabetes. In fact, pre-diabetes levels were found to be higher in states where the current prevalence of diabetes was lower. This means there is a huge proportion of people who are waiting to convert to diabetes, especially in the rural India. Even if there is a 0.5% or 1% increase in the number of diabetes cases in rural India, the numbers would still be huge seeing that 70% of the country’s population lives in the villages. It is a ticking time bomb,” said Dr RM Anjana, lead author of the study and managing director at Dr Mohan’s Diabetes Specialities Centre during the release of the study.

More than half the people living in urban centres were found to have abdominal obesity as compared to 33.5% of people in rural India. The highest prevalence was found to be in Puducherry with 61.8%.

When it came to hypertension, the prevalence was found to be 40.7% in urban India as compared to 33% in rural India. The highest prevalence of hypertension was seen in Punjab with 51.8%. Hypercholesterolemia was reported in 27.4% of the urban population and 22.3% of the rural population. The highest prevalence was seen in Kerala with 50.3%.

Would the study look at these numbers change over the years?

Prior to this study, the estimate number of people living with diabetes in India by the World Health Organisation stood at 77 million. “Even then we thought the number was low. And, the under-estimation could have been because it was based on earlier data generated by our team that had a lower prevalence of diabetes because it included many east Indian states where the prevalence is generally lower than say Southern states,” said Dr Mohan.

The current study with data from across 31 states paints a more accurate picture.

However, he added, that it might not always be possible to re-do the study on over 100,000 people. So, to study the trends over time the research team will collect samples again later from states like Arunachal Pradesh and Tamil Nadu that were found to have the lowest and the highest prevalence of these non-communicable diseases in 2008 when the study first began. The changes can then be applied to existing data from across the country.

How do the study findings help in developing policies?

With granular data available from each of the states, it can be used by the state governments to device their health policies. For example, the high prevalence of pre-diabetes shown in rural India by the study would mean that governments would need to focus their prevention and screening programmes and future health infrastructure there.

Screening for the NCDs and medicines for those who get them have already been included in 1.5 lakh government health and wellness centres.

Most of the interventions would include urging people to adopt lifestyle changes like better diet, exercise, regular sleep, no smoking or alcohol consumption. It would also include providing medicines like statins or metformin to control the cholesterol or blood glucose levels.