‘Prevalence Of Diabetes Double In Urban Areas Compared To Rural Areas’
A report released by Lancet, titled “Prevalence of diabetes and pre-diabetes in 15 states of India: Results from the ICMR–INDIAB population-based cross-sectional study”, was undertaken among over 55,000 people in 15 states across the country.
Madras Diabetes Research Foundation (MDRF), a part of Dr Mohan’s Diabetes Specialty Center, was the national co-ordination agency for the study. In an exclusive interview with BW Businessworld, Dr RM Anjana, lead author of the report and Vice President of MDRF discusses the report. Edited Excerpts:
1. What were the main findings of the report?
The cumulative data from 15 states/UT reported represent a total adult population of 363·7 million people (51 percent of India’s adult population). Among the 15 states/UT studied, there was large variation in state-specific diabetes and pre-diabetes prevalence ranging from 4.3 percent in Bihar to 13.6 percent in Chandigarh and 6.0 percent in Mizoram to 14.7 percent in Tripura respectively.
We estimated the overall prevalence of diabetes in India to be 7·3 percent and the prevalence of pre-diabetes to be 10·3 percent (WHO criteria) or 24·7 percent (ADA criteria), depending on which definition was used.
However, these estimates are based on data from 15 states/UT out of a total of 31 to be studied, and cannot be considered as final, especially since the states yet to be sampled include the National Capital Territory of Delhi, Kerala (the state with the highest reported prevalence of diabetes in India so far), Uttar Pradesh (the most populous state) and Goa (the state with the highest per capita income).
2. How did the findings vary from urban to rural and between different economic sections of society?
Overall in the 15 states/UT studied, the prevalence of diabetes was almost double in urban areas (11.2 percent) compared to rural areas (5.2 percent). The prevalence of diabetes ranged from 5.8 percent in Arunachal Pradesh to 15.5 percent in Tripura in urban areas and from 3.5 percent in Bihar and Meghalaya to 8.7 percent in Punjab in rural areas.
With regards to socio economic status (SES), the prevalence of DM was higher in the higher GDP states and in individuals in the higher SES group. However, in the urban areas of Chandigarh, Punjab, Tamil Nadu, Andhra Pradesh and Maharashtra, which are also ranked among the more economically advanced states of India, the prevalence of diabetes was higher in individuals of low SES.
3. What is the impact of the disease in the already burgeoning health infrastructure of the country?
The finding from the ICMR-INDIAB study which suggests that the urban areas of more affluent states have transitioned further along the diabetes epidemic and that less affluent individuals have a higher prevalence of diabetes than their more affluent counterparts is worrisome.
This is because, 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 suggests that the diabetes epidemic is spreading to those individuals who least can afford to pay for its management. Moreover, this could lead to large increases in the number people with diabetes and thereby add more burden to the already strained health resources of the country.
4. What changes are required in the screening and education to highlight the prevalence of the disease?
The overall awareness levels regarding diabetes in many parts of the country are still low. Community based mass screening and awareness programmes are extremely important to tackle the epidemic. This study emphasizes the need for comprehensive diabetes education through awareness programs for all individuals above the age of 30 years.
Education about diabetes, the various risk factors, and complications, importance of a healthy diet, increasing physical activity levels, regular checkups and the need for screening will go a long way in reducing the burden of diabetes and associated complications.
5. What healthcare policy is required to arrest this epidemic?
* National food policies must target and improve the availability and accessibility of healthy and nutritious foods.
* Nutrition and agricultural policies that support production and distribution of healthy foods are critical, such as introducing agricultural subsidies that increase the accessibility and affordability of whole grains, fruit, vegetables, legumes and nuts.
* Collaboration between health, education, information and agriculture ministries is essential to create awareness and to facilitate a healthy lifestyle among the population.
* Creating awareness of the impact of unhealthy diets and educating people that prevention is the best cure for NCDs like type 2 diabetes, through newspapers, national TV channels and radio channels, may help to promote healthy eating behaviours and thus promote good health.
Some suggested changes by governments to improve physical activity levels in general are as follows:
* Construct parks and provide provisions for sports, fitness and recreational facilities.
* Improve lighting and security in public exercise areas such as walking paths and cycling lanes.
* Maintaining facilities that promote activity, usable public transport systems, cycling and walking infrastructure, especially in cities.
* Ensure that the public health benefits of both leisure-time and transportation-related physical activity are conveyed to state transportation agencies and urban planners.
* Put in place legislation to promote the provision of safe open spaces and widespread dedicated walking and cycling facilities throughout built and external environments.
* Invest in systems to monitor physical activity patterns in the population.
