How should India address its diabetes burden?

Story so far: above international diabetes day (November 14th), Paper published in lancetbased on worldwide research, has been recorded More than 800 million adults live with diabetesmore than half do not receive treatment. According to the study, the total number of adults living with type 1 or type 2 diabetes worldwide is more than 800 million, which is more than four times the total number in 1990. More than a quarter of these people (212 million people) live in India. There are an additional 148 million people in China. The estimate came as a bit of a shock, as the last scientific national estimate from a study by the Indian Council of Medical Research and INDIAB last year pegged the number at just over 100 million.

Why are the numbers different?

Experts say the crux of the problem lies in the methods used to measure blood sugar levels. lancet The study, conducted jointly by the NCD Risk Factor Collaboration (NCD-RisC) and the World Health Organization (WHO), used data from more than 140 million people (aged 18 and older) selected from more than 1,000 studies in different countries. It was done. They estimated diabetes prevalence and treatment trends from 1990 to 2022 in 200 countries and territories. So they had to use what was available as data in these countries, choosing between fasting blood glucose, HbA1C, or 3-month average glycated hemoglobin. However, the ICMR study used fasting measurements and 2-hour postprandial measurements to determine how many people had elevated blood sugar levels.

The use of different scales to estimate diabetes is a source of variability. V. Mohan, chairman of the Madras Diabetes Research Foundation (Chennai), who participated in the ICMR-INDIAB study, said that while many countries have moved to measuring HbA1C, India is still sticking to fasting and two-hour postprandial measurements. It says that there is. Oral glucose tolerance test (OGTT) is measured as the gold standard. “If you just took the OGTT value, that number would be half the recorded value,” he says. “When using HbA1c, they preferred a single cut-off point for diabetes, 6.5%. A small percentage of HbA1c values ​​of 6.5%, depending on whether the Glycation is affected by various factors such as anemia and aging. Older people who don't have diabetes may have higher A1C levels. In some previous studies, we found that when we used HbA1C, the numbers doubled,” he added, explaining why the OGTT number is considered the gold standard.

However, a global study of the scale attempted as part of this exercise would need to use information already available in each country, and not all countries would have fasting and postprandial values ​​for OGTT. He added that it was not.

Anup Mishra, Chairman, Fortis CDOC Diabetes and Allied Sciences Hospital, adds that there are multiple sources of data here, leading to a clear discrepancy in the total numbers. He also added that Type 1 diabetes constitutes a small proportion of the total diabetes population in India, and Type 2 diabetes will be the problem in the future.

What are the areas of concern?

Be it 100 million or 200 million, India already has a large number of people who require treatment for diabetes, resulting in several life-threatening complications involving the heart, eyes, kidneys and peripheral nerves. The fact remains that they are more likely to get sick. system. If you argue about the difference in numbers, lancet This study is a further reminder that diabetes is increasing and continues to increase across the population in India, and that efforts need to be on the alert to both prevent diabetes and treat people with diabetes. It should be seen as something that allows

Another aspect highlighted by the study was the lack of access to treatment for people with diabetes. Lead author of the paper, Majid Ezzati from Imperial College, London, said: “Our research highlights growing global inequalities in diabetes, with treatment rates stagnant in many low- and middle-income countries where the number of adults with diabetes is increasing significantly. 'is increasing'. This is because people with diabetes tend to be younger in low-income countries and, without effective treatment, are at risk of lifelong complications such as amputation, heart disease, kidney damage and vision loss. This is particularly worrying. cases, early death. ”

No country in the world can afford to treat patients when diabetes complications begin, Dr. Mohan explains. “If we assume that there are 100 million people with diabetes and 20% of them progress to kidney failure, that's 20 million people who will need kidney transplants. How are you going to help all those people?” Dr. Mishra draws on the metaphors of war to emphasize the urgency of the battle ahead, with challenges that, like the efforts of Hercules, seem unattainable but require only superhuman effort. “Unless there is a war-like effort to use the mass media to raise awareness about nutrition and physical activity, and further legal provisions to reduce carbohydrate and sugar-sweetened drinks, the numbers will continue to rise.” “That would be a very difficult task,” he says. Ahead of World Diabetes Day, Peter Schwartz of the International Diabetes Federation spoke about prevention as a key and important aspect of the game: And the next step is prevention, and then prevention again. ”

Dr Mishra added that a nation like India has a duty to focus on the vulnerable lower middle class, semi-urban and rural population. “We need to focus on educating women because they are more likely to become obese after pregnancy and are at increased risk during menopause. We need to break the trend of obesity. [Abdominal obesity has been identified as one of the key causes of diabetes among Indians] With all these efforts. We need a long-term vision of about 10 years,” he explains.

What can individuals do?

lancet The paper identifies obesity and poor diet as important factors in the rising rates of type 2 diabetes. In some regions where obesity was prevalent or began to become prevalent between 1990 and 2022, diabetes rates were already high or were increasing. This is compared to many high-income countries, particularly those in the Pacific region and Western Europe, where obesity and diabetes are common. Interest rates either did not rise, or the rise was relatively small. A message on the wall says that careful eating and exercise have been proven to help prevent diabetes and control blood sugar levels.

But the challenge for governments is to enable people to exercise these healthy choices and to demand them from their rulers. Anjana Ranjith, co-investigator of the ICMR-INDIAB study, said: “We need more ambitious policies that limit unhealthy food and make healthy food affordable. Access to public parks and fitness centres, healthy food and free healthy school meals. Opportunities to exercise must be ensured, as well as promoting safe places to walk and exercise, including through the provision of subsidies.