An ongoing government funded research project to understand the prevalence pattern of diabetes across states indicates that the disease is disproportionately catching up with the urban poor in the country's developed states. The project is the biggest ever of its kind conducted in India.
The findings of the Indian Council of Medical Research-INdia DIABetes study, published in the international medical journal Lancet recently, suggests that the urban areas of more affluent states have transitioned further along the diabetes epidemic. Less affluent individuals have a higher prevalence of diabetes than their more affluent counterparts in rich states.
Chandigarh, the region which had the highest per capita GDP of US$ 3433 among Indian states and union terriroties, has the highest prevalence (13.6 per cent) of diabetes among urban poor. The trend remained the same in Maharashtra and Tamil Nadu too. However, in rural areas of all states, diabetes was more prevalent among the rich than the economically and socially weaker sections of the society.
The report suggests that as the overall prosperity of states and India as a whole increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of the society, a transition that has already been noted in high-income countries. "This trend is worrying because it suggests that the diabetes epidemic is spreading to those individuals who can least afford to pay for its management," the research points out. The researchers claim that while the previous studies did not adequately capture the heterogeneous nature of the diabetes epidemic in India, the ongoing study aims to estimate the national prevalence of diabetes and pre-diabetes in India by estimating the prevalence by state.
The overall prevalence of diabetes in all 15 states of India was 7.3 per cent. The prevalence of diabetes varied from 4.3 per cent in Bihar to 10 per cent in Punjab and was higher in urban areas (11.2 per cent) than in rural areas (5.2 per cent) and higher in mainland states (8.3 percent) than in the northeast (5.9 per cent). Overall, 1862 (47.3 per cent) of 3938 individuals identified as having diabetes had not been diagnosed previously.
The overall prevalence of prediabetes in all 15 states was 10.3 per cent. The prevalence of prediabetes varied from 6 per cent in Mizoram to 14.7 per cent in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history were independent risk factors for diabetes in both urban and rural areas, the study said.
The researchers pointed out that the rural prevalence estimates are much higher than identified in earlier studies. "Given that about 70 per cent of India's population resides in rural areas, even a small increase in the rural prevalence of diabetes will translate into several millions of individuals requiring chronic care. Factoring in the additional burden that arises because of the overall younger age of onset type 2 diabetes in south Asian people compared with other populations, the strain on the country's health-care system is likely to be immense", they cautioned.
The study is being funded by Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare.