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Journalism of Courage
Are Indians becoming a sicker nation? One of the biggest and representative studies on lifestyle markers, which determine the burden of non-communicable diseases, has shown that we have a prevalence of metabolic disorders such as diabetes, hypertension, central obesity or abdominal fat and high cholesterol. Not only that. The country’s diabetes burden is likely to shoot up over the next five years, especially in rural areas and states where the prevalence of diabetes is currently low. The study, which was spearheaded by Dr Mohan’s Diabetes Specialities Centre with support from the Indian Council of Medical Research (ICMR), was based on 113,000 people from 31 states.
Published on Thursday in The Lancet Diabetes & Endocrinology, it shows that 11.4 per cent or 101 million people in India have diabetes. What is more concerning, however, is the finding that 15.3 per cent or 136 million people have prediabetes. “There is almost no rural and urban divide when it comes to the prevalence of prediabetes. Also, prediabetes levels were found to be higher in states where the current prevalence of diabetes was low. 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. She further explained: “If you have prediabetes, conversion to diabetes is very, very fast in our population; more than 60 per cent of people with prediabetes end up converting to diabetes in the next five years. Moreover, almost 70 per cent of India’s population lives in villages. So if the prevalence of diabetes increases by even 0.5 to 1 per cent, the absolute numbers will be huge.”
The second area of concern was the high prevalence of central obesity at 39.5 per cent. The generalised obesity, measured using the body mass index, was lower, at 28.6 per cent. Considering that belly fat is a major risk factor for diabetes and heart disease, there is an urgent need for Indians to prioritise sustainable weitght loss routines.
The study also found that the prevalence of hypertension to be very high at 35.5 per cent and high cholesterol levels at 24 per cent. “In our country, the abdominal or central obesity is a more important marker because in Asian Indian phenotype, we have seen that the BMI could be under control but people have high abdominal fat precipitating diabetes. Almost 40 per cent have a high abdominal obesity in urban areas and 23 per cent in rural India,” said Dr Anjana.
Indiab is a decade long study with over 1.13 lakh participants over the age of 20 years across 31 states and Union Territories studied between October 2008 and December 2020. Of the 1.13 lakh participants, 79,506 are from rural areas representing the 70 per cent demography living in rural areas.
This is the best and biggest representative estimate of the prevalence of metabolic disorders in the country. “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. “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,” he added.
While the earliest data for the study was collected in 2008 and has been conducted in phases, the data has been extrapolated for 2021 using NFHS-5 demographics. The data from across the states are now comparable.
Compared with their rural counterparts, urban residents were significantly younger and had higher BMI, waist circumference, diastolic blood pressure, according to the study.
Prevalence of diabetes was found to be 16.4 per cent in the urban areas as compared to 8.9 per cent in rural areas. The prevalence is high is almost all urban centres with more heterogenicity seen in rural areas, with prevalence being higher in South India and some parts of North India such as Delhi and Punjab and lower prevalence in the East. There was almost no divide in prevalence of prediabetes in rural and urban centres.
When it came to prevalence of obesity, it was almost 40 per cent in urban India and 23 per cent in rural parts of the country. Hypertension ranged between 40.7 per cent in urban India and 33 per cent in rural India.
