Number of people living with Type 1 diabetes set to almost double by 2040 in India: Lancet study

If India can ensure that everyone with Type 1 diabetes can access stable human insulin as well as test strips to self- monitor blood glucose, 21 of those healthy life years could be restored. “If India can do this by 2023, more than half a million more people will be alive with Type 1 diabetes in 2040,” says Priyanka Rai, Director, Global Policy, Juvenile Diabetes Research Foundation and co-author of the study. The model estimates also suggest that 21 per cent of individuals with Type 1 diabetes live in lower income countries and lower middle income countries.

“Non-diagnosis remains a big problem, especially in rural India, where symptoms of Type 1 diabetes may not be recognised or diagnosed. Type 1 diabetes is frequently misdiagnosed as different conditions, particularly infectious diseases, and without proper education on the signs, health practitioners tend to miss them. After the onset of Type 1 diabetes, people need insulin to survive. The biggest difference to care management then would be enabling access to a stable supply of insulin and test strips, as well as education that enables self-management for people living with Type 1 diabetes. Right now, the prevailing clinical management regime in India tends to be pre-mixed insulin injections (taken once or twice a day), with little or no focus on self-monitoring of blood glucose,” adds Rai. The result is poor glycaemic control and early onset of complications, leading to the average person with Type 1 diabetes in India losing nearly 45 years of his healthy life span to the condition.

Type 1 diabetes is an autoimmune disease targetting pancreatic β-cells that results in life-long absolute insulin deficiency. It is frequently associated with reduced quality of life, serious long-term complications, shortened life expectancy, and substantial costs for individuals and health-care systems, even in high-income countries with access to recent advances in diabetes management.

Dr V Mohan, noted diabetologist and Chairman of Dr Mohan’s Diabetes Specialities Centre, Chennai, says this study is one of the first to look at the global prevalence of Type 1 diabetes. “It is worrying that the numbers of children and adults with Type 1 diabetes is so high in India. The top priority of the government and society is to ensure that every child and adult with Type 1 diabetes has accessibility to insulin and that it is made freely available to all those who need it. For those with Type 1 diabetes, insulin is the elixir of life and the only known treatment. In one of our published studies, we have shown that even children with Type 1 diabetes can live for 70 or more years with good health. There are some who have crossed 85 years and hence there should be an equitable distribution of insulin,” he says.

The management of type 1 diabetes relies heavily on insulin and frequent glucose testing. For low-income families, this is practically unaffordable due to the heavy financial burden. “The society, government, schools and individuals will have to prepare to manage this epidemic more effectively. Philanthropic organisations, including those like the Hinduja foundation, Mukul Madhav foundation and others have helped in several ways over the years. Much more needs to be done in helping overcome the stigma attached to the disease, especially for young girls,” says Dr C S Yajnik, Director, KEM hospital’s diabetes unit and Professor at Danish Diabetes Academy.

Model estimates also place global deaths due to Type 1 diabetes at 1,75,000 in 2021. Of these, 35,000 or 20 per cent were attributed to non-diagnosis, of which 14,500 were in sub-Saharan Africa and 8,700 were in South Asia. The researchers estimate that an extra 3.1 million people would have been alive in 2021 if they hadn’t died prematurely due to sub-optimal care and a further 700,000 people would still be alive if they hadn’t died prematurely due to non-diagnosis.

In 2021, the model estimated that 8.4 million individuals worldwide were living with Type 1 diabetes. Of these individuals, 18 per cent were under 20 years old, 64 per cent were between 20 and 59 years while 19 per cent were over 60 years. Although historically Type 1 diabetes has been a disease associated with onset in childhood, these results reveal that numerically more adults than children are diagnosed every year (316,000 vs 194,000 incident cases worldwide in 2021), with a mean diagnosis age of 32 years. Type 1 diabetes associated mortality in 2021 in South Asia was 42,272.

Researchers modelled data on childhood, adolescent and adult Type 1 diabetes prevalence in 97 countries, along with incidence over time data from 65 countries and mortality data from 37 countries. The estimates were tested for accuracy against real world prevalence data from 15 countries. Authors have said in the report that their findings indicate that the overall footprint of Type 1 diabetes is much larger than previous estimates have indicated, when missing prevalence due to excess mortality is accounted for. “Given that prevalence of people with Type 1 diabetes is projected to increase in all countries to up to 17.5 million cases in 2040, our results provide a warning for substantial negative implications for societies and healthcare systems. There is an opportunity to save millions of lives in the coming decades by raising the standard of care for Type 1 diabetes (including ensuring universal access to insulin and other essential supplies) and increasing awareness of the signs and symptoms of Type 1 diabetes to enable a 100 per cent rate of diagnosis in all countries,” says Prof Graham Ogle, one of the authors of the study, Sydney Medical School, University of Sydney, Australia.