Rohit Shishodia
Even as India is currently grappling with the Covid pandemic and it is not certain when this deadly infectious disease will go away, an imminent diabetes epidemic could be a major public health problem that the country may face in the majority of the population in coming years.

A study published in Diabetologia (the journal of the European Association for the Study of Diabetes), co-authored by Delhi-AIIMS Professor Nikhil Tandon from Department of Endocrinology and Metabolism, has revealed that 55% men and 65% women currently aged 20 years in India will likely develop diabetes in their lifetime, with most of those cases (around 95%) likely to be type 2 diabetes.

The authors have pointed out that urbanization, decreasing diet quality and decreased levels of physical activity are all majorly contributing to this hidden epidemic.

They have stated that the figures are alarming as India already has a significant health burden caused by diabetes. They informed that estimates suggest 77 million adults currently have diabetes and this number is expected to almost double to 134 million by 2045.

Since urban centres are continuing to grow rapidly across the country, the authors aimed to estimate the probability of a metropolitan (urban-based) Indian of any age or body mass index (BMI) developing diabetes in their lifetime.

The data for the study came from using age, sex-and BMI specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010–2018), age, sex and urban specific rates of mortality from period life tables reported by Indian government (2014) and prevalence of diabetes from the Indian Council for Medical Research India Diabetes study (2008–2015).

The authors have explained that women generally had a higher lifetime risk across the lifespan. Lifetime risk of developing diabetes declined with age. They estimated that for those currently aged 60 years and currently free of diabetes, around 38% of women and 28% of men would go on to develop diabetes.

Obesity had a substantial impact on these projections. Lifetime risk was highest among obese metropolitan Indians: 86% among 20-year-old women and 87% among men.

People with lower BMI had considerably higher diabetes-free life expectancy. Those with normal or underweight BMI were projected to live out most of their remaining years (80-85%) diabetes-free.

The authors say: “The remarkably high lifetime risk of developing diabetes and the low diabetes-free life expectancy in India’s metropolitan cities, especially for individuals with high BMI, implies that interventions targeting the incidence of diabetes may be of paramount importance moving forward.”

They note that metropolitan Indians at every age and BMI have an alarmingly high probability of developing diabetes compared with results from high income countries, and that proactive efforts to prevent diabetes in metropolitan cities are urgently needed, given the rapid increase in urban obesogenic environments across the country.

Dr Shammi Luhar, Department of Public Health and Primary Care, University of Cambridge, UK, said “Such high probabilities of developing diabetes will have severely negative implications for India’s already strained health system and also out-of-pocket expenditure on diabetes treatment by patients, unless diabetes is immediately acknowledged for what it is: one of the most important threats to public health in India.”

Professor Viswanathan Mohan of the Madras Diabetes Research Foundation in Chennai and co-author of the paper said: “Despite these very high predicted lifetime risks of diabetes, it is possible to prevent or postpone diabetes by effective lifestyle modification, such as following a healthy diet, by increasing physical activity and reducing body weight in those who are obese or overweight.”

Professor Nikhil Tandon added: “We need policy and investment with clearly spelt out targets and commitments to meet by 2030. Perhaps, an aspirational target of ‘90-90-90’(90% of people with diabetes detected, 90% of those detected treated, and 90% of those treated controlled), is imminently needed. Such a target could operate in the same way as the 90-90-90 targets introduced some years ago for HIV, and since replaced by even more ambitious 95-95-95 targets.”