Damian Sendler: Diabetes is on the rise, especially in developing countries like India, where the prevalence of obesity and unhealthy habits is on the rise. In 2019, 77 million people in India were estimated to have diabetes, which is expected to rise to 134 million by 2045, according to the estimates. A whopping 57% of those affected by this disease are still unaccounted for. Microvascular and macrovascular complications can occur as a result of type 2 diabetes, which accounts for the vast majority of cases. An increase in premature morbidity and mortality among diabetics is a major contributor to decreased life expectancy as well as a significant financial and other burden on the Indian health care system. Diet and lifestyle habits, as well as genetics and a family history of the disease, all play a role in the development of diabetes. Diabetes complications can be avoided or delayed with proper blood sugar, blood pressure, and lipid levels management. An array of factors, including a lack of a multisectoral approach, surveillance data, awareness of diabetes’ risk factors and complications, as well as access to health care settings and affordable medicines, make the prevention and management of diabetes a huge challenge in India. Consequently, effective health promotion and primary prevention at both the individual and population levels are needed to reduce the diabetes epidemic in India.
Damian Jacob Sendler: Diabetes is one of the top 10 leading causes of death in the world today, along with cardiovascular disease (CVD), respiratory disease, and cancer, according to the World Health Organization.
Dr. Sendler: Noncommunicable diseases (NCDs) accounted for 74% of global deaths in 2019, with diabetes accounting for 1.6 million of those deaths, making it the ninth leading cause of death worldwide, according to the WHO. [2] Nearly 592 million people will die of diabetes by that year. [3] Before, type 2 diabetes was thought to be limited to the more affluent “Western” countries, but it has now spread throughout the world and is now a leading cause of disability and death among people in their 20s and 30s. [1] Over the past few decades, countries like China and India have seen a dramatic rise in the prevalence of diabetes. Diabetic patients’ numbers are rising fastest in countries with low and middle incomes, according to the World Health Organization. [4] Rapid socioeconomic change in conjunction with urbanization and industrialization, as well as population growth, unhealthy eating habits, and a sedentary lifestyle, play a major role in the global increase in the diabetes epidemic. [5]
Chronic diseases such as diabetes can have a devastating impact on a person’s health and well-being as well as their family, community and healthcare system. Diabetic retinopathy, nephritis, and neuropathy are all complications of uncontrolled diabetes, which increases the risk of vascular disease and contributes significantly to the burden of type 2 diabetes. [5,6]
Pacific Islanders, Asian Indians, and Native Americans all have a significantly higher risk of developing type 2 diabetes than people in other parts of the world. There has been a dramatic increase in the number of people worldwide with type 2 diabetes since 2000, which began in the 1990s. [7] Men (9.6 percent) have slightly higher rates of diabetes than women (8.8 percent), according to the International Diabetes Federation (IDF) (9.0 percent ). [1] Around 463 million people have diabetes and 374 million people have impaired glucose tolerance (IGT), a pre-diabetic state. According to current projections, the number of people living with diabetes and IGT will rise by 51% by 2045, reaching 700 million people with diabetes and 548 million people with IGT. [1]
It is estimated that there are 163 million people with diabetes in the Western Pacific region, which is the most populous of the International Diabetes Federation’s six regions, followed by 88 million people in Southeast Asia and Europe, 59 million people in the Middle East and North Africa, and 55 million people in North America and the Caribbean (47.6 million). South and Central America (36.1 million people) and Africa are currently home to the lowest population densities worldwide (19.4 million). [1] Thus, it is clear that the affluent regions of Europe and North America are not the only ones experiencing the diabetes epidemic.
For the year 2019, the International Diabetes Federation (IDF) estimates that China has 116.4 million diabetics, India has 77.0 million, and the United States has 77.0 million (31.0 million). China (with 140,5 and 147.2 million people) and India (with 101.0 and 134.2 million people) will continue to have the highest diabetes burdens in 2030 and 2045. [1] A report from the Global Burden of Disease Study found that China and India, two of the world’s most populous countries, have the highest rates of diabetes in the world. [8]
In low- and middle-income countries, diabetes prevalence is increasing faster than in high-income countries (367.8 million) (95.2 million).
Damian Sendler
[1] More than 170 countries and territories participated in the Global Burden of Disease (GBD) study, which provided a comprehensive look at trends in diabetes prevalence between 1990 and 2025. [9] The study also found that the burden of diabetes was higher in low and middle-income areas than in high-income areas. Between 1990 and 2017, the number of people diagnosed with diabetes increased from 11.3 million to 22.9 million (a 102.9 percent increase), and the number of people diagnosed with diabetes increased from 211.2 million to 476.0 million (a 129.7 percent increase). Diabetes burden was found to be largely caused by modifiable metabolic, environmental, and behavioral risk factors.
There is also a high percentage of people with undiagnosed diabetes, which currently stands at more than 50 percent. Health care systems in developing countries tend to be underdeveloped, which explains why this is more common. There are an estimated 231.9 million (one in two) adults in the world with diabetes who have not been diagnosed, according to estimates. [1] According to Fig. 1, undiagnosed diabetes is prevalent in various regions of the Israeli Defense Forces (IDF). [1] Nearly 59.7 percent of Africans with diabetes are unaware of their disease, while only 37.8 percent of North Americans and Caribbean residents with diabetes are aware of their disease, according to reports (the lowest proportion among all the regions). There are fewer people with diabetes who have not yet been diagnosed in Africa and South and Central America than in other IDF regions (11.6 and 13.3 million, respectively). [1] These figures suggest that a greater emphasis should be placed on diabetes screening in the near future. Undiagnosed diabetes can have negative consequences, including an increased risk of diabetes-related complications and increased healthcare use and associated costs, if it is not diagnosed and treated in a timely manner. [10]
Over the last three decades, the global burden of diabetes has risen steadily, with India bearing a disproportionately large share of it. While mortality from communicable and maternal, neonatal, and nutritional diseases (CMNNDs) has decreased, NCDs and injuries have markedly increased their contribution to overall disease burden and mortality in India as a result of an epidemiological shift. [11] Overall DALYs from CMNNDs accounted for 61% of India’s 1990 DALY total, followed by NCDs (30%), and injuries (9%). Due to major epidemiological changes in India, total DALYs from CMMNDs have decreased by 33 percent, while those from NCDs and injuries have increased by 55 and 12 percent, respectively, in 2016 [Fig. 2]. DALY rates for diabetes in India increased fourfold in 2016, and when looking at the leading causes of DALYs in India, most NCDs have seen an increase in rank since 1990, with diabetes showing a dramatic increase, from 35th place in 1990 to 13th position in 2016. [11]
Diabetes’ toll in India has been steadily rising since 1990, and it has accelerated dramatically since the year 2000. According to the International Diabetes Federation (IDF), diabetes prevalence in India has steadily increased over the past decade. [1,12,13,14,15,16] As of 2019, 8.9 percent of Indians had diabetes, up from 7.9 percent in 2009. Table 1 shows the diabetes burden in India in a single table. There are currently 25.2 million adults with IGT, and that number is expected to rise to 35.7 million by 2045. India is the second-largest country in the world with 77 million people suffering from diabetes. There are currently 12.1 million people over the age of 65, and this number is expected to rise to 27.5 million by 2045. An additional 43.9 million adults in India, or about 57 percent of the country’s total number of diabetics, remain undiagnosed. Diabetes is directly responsible for 1 million deaths each year and costs the average American family $92 per person per year in medical expenses.
A study on the disease burden in India’s states found a 64.3% increase in diabetes prevalence across the country’s entire population, with an age-standardized prevalence of 29.3%, between 1990 and 2016.
[11] Study collaborators on the India State-Level Disease Burden Initiative Diabetes found that in India, the prevalence and number of diabetics rose from 5.5 percent and 26.0 million in 1990 to 7.7 percent and 65.0 million in 2016. Tamil Nadu had the highest prevalence in 2016, followed by Kerala, Delhi, Punjab and Goa. Karnataka had the lowest prevalence.
According to cross-sectional surveys conducted in various parts of India, diabetes is becoming more prevalent.
[18] In a study of 18,243 people conducted in Mumbai in 1963, it was discovered that 1,5% of those tested had diabetes after testing their urine. [19] Some national studies have been done on the prevalence of diabetes, but they are few and far between. The multicenter ICMR survey, conducted between 1972 and 1975 in Ahmedabad, Calcutta, Cuttack, Delhi, Poona, and Trivandrum as well as neighboring rural areas, found a national prevalence of diabetes of 2.1%. [20] An age-standardized prevalence of 12.1% was found in the National Urban Diabetes Survey conducted in India’s six major cities in 2001,[21] while the Prevalence of Diabetes in India Study, conducted in India’s 40 urban and 37 small and rural areas in 2004, found a prevalence of 5.9% and 2.7% to be respectively. [22] Between 2003 and 2005, researchers from the WHO-ICMR NCD Risk Factor Surveillance Study monitored people in urban and rural areas across six states and found that 4.5% of those studied had self-reported diabetes. [23]
India DIABetes, the largest nationally representative epidemiological survey conducted in India on diabetes and pre-diabetes, found that the prevalence of diabetes ranged from 3.5 to 8.7 percent in rural to 5.8 to 15.5 percent urban, and the prevalence varied from 4.3 percent in Bihar to 13.6 percent in Chandigarh [Table 2].”
Damian Jacob Sendler
[24,25] In comparison to rural areas, diabetes was more common in urban areas (11,2 percent) (5.2 percent ). In rural areas, the prevalence of prediabetes ranged from 5.8 to 14.7%; in urban areas, the prevalence ranged from 7.2 to 16.2%. In most states, the prevalence of pre-diabetes was higher than the prevalence of diabetes. Many people are at risk of developing type 2 diabetes in the near future, based on this data. Compared to other ethnic groups, Asian Indians appear to progress more quickly through the pre-diabetes stage. [25,26] Diabetes was more common in states with higher GDP per capita and in people with higher socioeconomic status (SES). An epidemiological transition is clearly evident in this study, with a greater prevalence of diabetes in low socioeconomic status urban areas in more economically developed states.
Damian Jacob Markiewicz Sendler: Indian states/union territories were divided into 15 regions, with the Andaman and Nicobar Islands (26 and 14.5 percent, respectively, for males and females) having the highest prevalence of diabetes, followed by Haryana (8.2 percent) and Bihar (6.1%), respectively. Urban areas had a higher prevalence than rural areas. The prevalence of diabetes increased from 18.6 percent in 2006 to 21.9 percent in 2016 in urban areas, while it increased from 16.4 percent to 20.3 percent in small towns and from 9.2 percent to 13.4 percent in periurban villages in the recent Secular Trends in Diabetes in India study. [28]
Diabetes or pre-diabetes affects six out of every ten adults in South Asian cities, according to data from the Center for Cardio-metabolic Risk Reduction in South Asia (CARRS).
[29] 22.8 percent of the population in Chennai and 25.2 percent in Delhi were estimated to have diabetes. Karachi, Pakistan, has a diabetes prevalence of 16.3 percent, which is lower than the two Indian cities studied in this study. In the CARRS cohort, men had a 55.5% lifetime diabetes risk compared to women’s 64.6%, and both women (86.0%) and men (86.0%) were obese (86.9 percent ). In women, the risk of diabetes declines to 37.7%, while in men, the risk drops to 27.5% with increasing age (at age 60). [30] Migrant Indians have lower rates of type 2 diabetes than their Indian counterparts, according to new research. Type 2 diabetes was found to be more common in Asian Indians living in Chennai (38%) than in Asian Indians living in San Francisco and Chicago (both in the United States) (24 percent ). [31] According to these findings, the “diabetogenic” environment in India is now as bad as it is in the United States due to the country’s rapid economic and nutritional transitions.
There has been a steady increase in the number of people with diabetes in India, in addition to the rising prevalence of the disease itself. The prevalence of diabetes and prediabetes has received relatively little attention in Indian longitudinal studies. Diabetes and pre-diabetes incidence rates in the Chennai Urban Population Study cohort were reported to be 20.2 and 13.1 per 1000 person-years, respectively, in the follow-up study conducted in the Chennai Urban Rural Epidemiology Study (CURES) cohort. [33] People with normal glucose tolerance have a diabetes conversion rate of 19.4%, while those with prediabetes have a diabetes conversion rate of 58.9%. Diabetes incidence among those with pre-diabetes was reported to be 78.9 per 1000 person-years. [33]
Participants from two semiurban wards of Venmony Panchayat in Alappuzha district in Kerala were tracked for ten years as part of the Study of Life Style Diseases in Central Kerala. Type 2 diabetes and impaired fasting glucose (IFG) incidence rates were 24.5 per 1000 person-years and 45.01 per 1000 person-years, respectively, in this study. Nearly 60% of participants with baseline IFG developed type 2 diabetes during the follow-up period.
It’s no secret that diabetes has a systemic effect on a wide range of diabetes-related complications, including macro- and micro-vascular problems, as well as death. Non-traditional complications such as mental illness, cancer, physical impairment, and liver disease have also been linked to diabetes in recent years. [36] Diabetic retinopathy, the most specific complication of diabetes, has been used to set diagnostic thresholds for the disease. Adults with diabetes in urban South India are estimated to have diabetic retinopathy at a prevalence rate of 17.6 percent. [37] Diabetic retinopathy was found to be prevalent in one-third of people with type 2 diabetes who visited 14 eye-care facilities in India, and one-fifth of those patients had sight-threatening diabetic retinopathy. [38] Comparing Indian urban populations to Western populations, the CURES study found lower prevalences of eye and kidney diseases and peripheral vascular disease (CAD) but higher prevalences of heart disease (retinopathy, nephropathy, neuropathy, and atherosclerosis). [37,39,40,41,42] A comparison of rural and urban South Indian areas reveals that the burden of complications in rural areas is comparable, if not higher. [43] Complications, co-existing illnesses, inadequate health care, and high drug costs, particularly insulin, may be to blame for the high prevalence of diabetic complications in developing economies like India.
Damien Sendler: Diabetes is a leading cause of death because of the complications it can cause. As of 2019, the South East Asian region ranked second in the IDF Regions with 1.2 million deaths attributable to diabetes in adults; India accounted for more than one million of these deaths. [1] All-cause mortality and CV mortality rates were significantly higher in low- and middle-income countries among 143,567 adults with and without diabetes, according to the Prospective Urban Rural Epidemiology study involving 143,567 adults with and without diabetes from 21 countries, including India. [44] There has been an increase in the number of deaths from diabetes in India since 1990 by more than 131 percent, according to the India State-Level Disease Burden Initiative Diabetes study. [17]
As of now, there are no large-scale Indian studies on the mortality of type 2 diabetics, and the few clinical studies available show a wide range of results. Among the 234,776 inpatient admissions studied retrospectively in Srinagar[45], 16,690 people died, with diabetes accounting for 4.4% of those deaths. Infections accounted for 41% of deaths, chronic renal failure 33.6 %, CAD 16.9 %, cerebrovascular disease 13.2 %, and chronic obstructive pulmonary disease 6.9 % of deaths in the top five causes of death. People with diabetes have a mortality rate nearly four times higher than those without diabetes, according to a follow-up of the CURES cohort (27.9 per 1000 person-years vs. 8.0 per 1000 person-years). Ischemia heart disease and diabetes were found to have the highest population-attributable risk for all-cause mortality in the study cohort. [46]
It is estimated that in 1990, a tenth of the total disease burden in India was caused by a cluster of risk factors that included an unhealthy diet, being overweight or obese, high blood pressure, blood sugar, and cholesterol, all of which contributed to ischemic heart disease, stroke, and diabetes, which in 2016 increased to a quarter of the total disease burden in India. According to the Indian Centers for Disease Control and Prevention (CDC), tobacco use is a significant contributor to cardiovascular disease and diabetes, as well as cancer and other diseases. [47] Obesity, low dietary intake of fruits, nuts and seeds, and whole grains, and tobacco use are the most significant risk factors for DALYs and deaths from diabetes, according to the Global Burden of Disease Study 2016. [48]
Many people in India are concerned about rising rates of pre-diabetes, diabetes and their associated complications in urban and rural areas and among the young. India, the second-largest country in the world, has a large and diverse population, making addressing diabetes-related health issues a challenge. Diabetes prevention and management faces numerous challenges, including I a lack of strong national partnerships for multisectoral actions, (ii) a lack of robust surveillance and research data on diabetes, (iii) abysmal public awareness, (iv) a lack of access to basic prevention/management of diabetes in the primary health care setting, which includes access to affordable medicines, (v) disproportionate fund allocation.
A shift from a biomedical to a public health approach is required to effectively combat diabetes. Instead of focusing on a single risk factor, the focus should be on a group of risk factors as a whole. As a result, a multifaceted approach is essential when planning prevention and control programs. I reducing exposure to lifestyle risk factors through health promotion and primary prevention; (2) early detection and prompt treatment; (ii) surveillance to track trends in diabetes and its associated risk factors are all methods of preventing or controlling the disease. Diabetes is a growing problem in India, and it requires a multisectoral approach to combat it. There are a number of policies that may help to slow down the diabetes epidemic in India: I national food policies aimed at ensuring the availability and accessibility of healthy and nutritious foods; (ii) health policies to reduce harmful behaviors such as smoking, alcohol abuse; and (iii) policies to promote healthy eating habits. Health, information, education, and agriculture ministries must work together effectively to raise awareness of the importance of leading a healthy lifestyle among Indians.
For countries like India, where the burden of diabetes has increased significantly in recent decades and will continue to rise in the future, the picture is even more bleak than it already is. This could have a significant impact on diabetes-related morbidity and mortality in India, as well as the country’s overall healthcare costs. Early diagnosis, screening for complications, optimal treatment at all levels of care for those who have already developed diabetes, and primary prevention of diabetes in those with pre-diabetes are all necessary components of a multi-pronged approach to halting the diabetes epidemic and its associated complications.
