Diabetes has emerged as a major healthcare problem in India. According to Diabetes Atlas published by the International Diabetes Federation (IDF), there were an estimated 40 million persons with diabetes in India in 2007 and this number is predicted to rise to almost 70 million people by 2025. The countries with the largest number of diabetic people will be India, China and USA by 2030. It is estimated that every fifth person with diabetes will be an Indian. Due to these sheer numbers, the economic burden due to diabetes in India is amongst the highest in the world. The real burden of the disease is however due to its associated complications which lead to increased morbidity and mortality. WHO estimates that mortality from diabetes, heart disease and stroke costs about $210 billion in India in the year 2005. Much of the heart disease and stroke in these estimates was linked to diabetes. WHO estimates that diabetes, heart disease and stroke together will cost about $ 333.6 billion over the next 10 years in India alone.
Rapid urbanisation and
industrialisation have produced advancement on the social and economic front in
developing countries such as India which have resulted in dramatic lifestyle
changes leading to lifestyle related diseases. The transition from a
traditional to modern lifestyle, consumption of diets rich in fat and calories
combined with a high level of mental stress has compounded the problem further.
There are several studies from various parts of India which reveal a rising
trend in the prevalence of type II diabetes in the urban areas. A National
Urban Survey in 2000 observed that the prevalence of diabetes in urban India in
adults was 12.1 per cent per cent. Recent data has illustrated the impact of
socio-economic transition occurring in rural India. The transition has occurred
in the last 15 years and the prevalence has risen from 2.4 per cent to 6.4 per
cent.
The Risk Factors for Diabetes in
Indians Are:
- Age—Indians develop diabetes at a very young age, at least 10 to 15 years earlier than the western population. An early occurrence of diabetes gives ample time for development of the chronic complications of diabetes. The incidence of diabetes increases with age. In India, the life span has increased, hence more number of people with diabetes are being detected.
- Family History—The prevalence of diabetes increases with a family history of diabetes. The risk of a child developing diabetes with a parental history increases above 50 per cent. A high incidence of diabetes is seen among the first degree relatives. Indians have a high genetic risk for diabetes as observed in Asian Indians who have migrated to other countries. They have been found to have a higher rate of diabetes as compared to the local population .
- Central Obesity—The association of obesity with Type II Diabetes is well known. Even with an acceptable body weight range, weight gain could increase the risk of diabetes . An excess of body fat specially concentrated within the abdomen has an increased risk of diabetes. The cut-off limit for waist circumference for Indians have been recommended to be 90 cm for males and 80 cm for females. Abdominal obesity is defined by waist circumference above these limits.
- Physical Inactivity and Sedentary Living—There is enough evidence to demonstrate that physical inactivity as a independent factor for the development of type II diabetes. The availability of motorised transport and a shift in occupations combined with the plethora of television programmes has reduced the physical activity in all groups of populations.
- Insulin Resistance—Asian Indians have been found to be more insulin resistant as compared to the white population. They have a higher level of insulin to achieve the same the blood glucose control. A cluster of factors consisting of abnormal fats (Dyslipidemia), high blood pressure, obesity, and abnormal glucose levels known as metabolic syndrome is highly prevalent in Asian Indians.
- Stress—The impact of stress both physical and mental along with lifestyle changes has a strong effect of increasing incidence of type II Diabetes amongst persons is a strong genetic background.
In India, the lack of proper healthcare
infrastructure, rampant ignorance and absence of clear cut guidelines mean that
approach to the management of diabetes is ad hoc. The lack of awareness among
patients and General Practitioners (GPs) is a key factor in the poor care.
There are practically no nurse educators or diabetic counselors, no podiatrists
(foot experts) and very few dieticians which means that the treating doctor has
no support and has to take the entire burden of caring for these patients. The
patients' inability/unwillingness to pay for this additional support also
hinders the treatment.
Even after the diagnosis, monitoring of
diabetes is very poor. Most of the patients initially visit a doctor and then
discontinue their therapy once their symptoms and controlled. A majority of the
patients abandon modern allopathic treatment in favour of indigenous
treatments. Further, more patients with poor control avoid insulin for fear of
injection and belief of addiction of insulin. Hence they keep changing doctors
and hop from one system of treatment to another leading to further
complications and early death. Lack of resources, medical reimbursement and
poor state funding for diabetes is a barrier to quality care often because the
patient is unable to afford the high cost of treatment.
There is ample evidence to suggest that
preventive measures to reduce the burden of diabetes are needed. The US
Diabetes Prevention Programme and the Finnish Diabetes Prevention Programme and
the Chinese Study have conclusively proved that lifestyle modification
including weight loss, increased physical activity and dietary changes can
prevent or delay the onset of diabetes. The need of the hour is direct public
education and mass media campaigns, awareness about diabetes and its
complications. There is a need to spread the message that diabetes is
preventable and we need to have a behavioral change to adopt a healthy
lifestyle.