Indians get diabetes on average 10 years earlier than their Western counterparts
Being an Indian is a risk factor for diabetes; despite having lower overweight and obesity rates, India has a higher prevalence of diabetes compared to western countries and the risk for coronary artery disease is two to four times higher in diabetic subjects, and in Indians, and it occurs prematurely are a few of the facts compiled by Heart Care Foundation of India to create awareness about how to control the diabetic menace in India.
All the public, private and government sector should fight the diabetic menace epidemic menace together, said Padma Shri, National Science Communication and Dr B C Roy National Awardee, Dr KK Aggarwal President Heart Care Foundation of India and Senior National Vice President Indian Medical Association.
Diabetes challenges for India and Indians as compiled by the foundation
1. Diabetes is a huge problem in India. The prevalence of diabetes increased tenfold, from 1.2% to 12.1%, between 1971 and 2000. It is estimated that 61.3 million people aged 20-79 years live with diabetes in India (2011 estimates). This number is expected to increase to 101.2 million by 2030. And, 77.2 million people in India are said to have pre-diabetes.
2. Rough estimates show that the prevalence of diabetes in rural populations is one-quarter that of urban population for India and other Indian sub-continent countries such as Bangladesh, Nepal, Bhutan, and Sri Lanka. An ICMR study has shown that a lower proportion of the population is affected in states of Northern India (Chandigarh 0.12 million, Jharkhand 0.96 million) as compared to Maharashtra (9.2 million) and Tamil Nadu (4.8 million). The National Urban Survey conducted across the metropolitan cities of India reported similar trend: 11.7 per cent in Kolkata (Eastern India), 6.1 per cent in Kashmir Valley (Northern India), 11.6 per cent in New Delhi (Northern India), and 9.3 per cent in West India (Mumbai) compared with (13.5 per cent in Chennai (South India), 16.6 per cent in Hyderabad (south India), and 12.4 per cent Bangalore (South India).
3. Obesity is one of the major risk factors for diabetes, yet there has been little research focusing on this risk factor across India. Despite having lower overweight and obesity rates, India has a higher prevalence of diabetes compared to western countries suggesting that diabetes may occur at a much lower body mass index (BMI) in Indians compared with Europeans.
4. A most disturbing trend is the shift in age of onset of diabetes to a younger age. Indians get diabetes on average 10 years earlier than their Western counterparts. An upsurge in number of early-onset diabetes cases is also responsible for the development of various diabetic complications due to longer disease duration. Diabetes control in individuals worsened with longer duration of the disease (9.9±5.5 years), with neuropathy the most common complication (24.6 per cent) followed by cardiovascular complications (23.6 per cent), renal issues (21.1 per cent), retinopathy (16.6 per cent) and foot ulcers (5.5 per cent).
5. The risk for coronary artery disease is two to four times higher in diabetic subjects, and in Indians, and it occurs prematurely. Indians are genetically predisposed to the development of coronary artery disease due to dyslipidaemia and low levels of high density lipoproteins; these determinants make Indians more prone to development of the complications of diabetes at an early age (20-40 years) compared with Caucasians (>50 years) and indicate that diabetes must be carefully screened and monitored regardless of patient age within India. The rate of cardiovascular disease mortality in India in the 30-59-year age group is double that in the U.S.
6. Lifestyle changes have lead to decreased physical activity, increased consumption of fat, sugar and calories, and higher stress levels, affecting insulin sensitivity and obesity. 86% of adults consume less than five servings of fruits and vegetables a day. 18. Many Indians have insufficient physically activity (26.4% among males and 25.6% among females).
7. Costs of diabetes care are alarmingly high. The annual cost for India due to diabetes was about $38 billion in 2011. According to the WHO, if one adult in a low-income family has diabetes, “as much as 25% of family income may be devoted to diabetes care.” According to the World Economic Forum, cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions will cost India 126 trillion rupees between 2012 and 2030.
8. While HbA1c is the gold standard test around the world for insulin initiation and intensification, it is not easily available to a large section of Indian population.
9. There is a lack of “clinical inertia” for the commencement of insulin therapy in both the clinical and patient communities. The most common apprehensions are related to the complexities of the insulin regimen and concerns about weight gain, hypoglycaemic events, and fear of insulin prick.
10. An inadequacy in Indian guidelines is also responsible for wide variation in treatment preferences across the country. The creation of simple and practical insulin guidelines that can be incorporated into routine clinical practice by primary health care physicians are desperately required to facilitate treatment and the initiation of insulin therapy throughout the country. Poor glycaemic control, a factor that has been observed in the Indian diabetic population, is responsible for micro- and macrovascular changes that present with diabetes
Being an Indian is a risk factor for diabetes; despite having lower overweight and obesity rates, India has a higher prevalence of diabetes compared to western countries and the risk for coronary artery disease is two to four times higher in diabetic subjects, and in Indians, and it occurs prematurely are a few of the facts compiled by Heart Care Foundation of India to create awareness about how to control the diabetic menace in India.
All the public, private and government sector should fight the diabetic menace epidemic menace together, said Padma Shri, National Science Communication and Dr B C Roy National Awardee, Dr KK Aggarwal President Heart Care Foundation of India and Senior National Vice President Indian Medical Association.
Diabetes challenges for India and Indians as compiled by the foundation
1. Diabetes is a huge problem in India. The prevalence of diabetes increased tenfold, from 1.2% to 12.1%, between 1971 and 2000. It is estimated that 61.3 million people aged 20-79 years live with diabetes in India (2011 estimates). This number is expected to increase to 101.2 million by 2030. And, 77.2 million people in India are said to have pre-diabetes.
2. Rough estimates show that the prevalence of diabetes in rural populations is one-quarter that of urban population for India and other Indian sub-continent countries such as Bangladesh, Nepal, Bhutan, and Sri Lanka. An ICMR study has shown that a lower proportion of the population is affected in states of Northern India (Chandigarh 0.12 million, Jharkhand 0.96 million) as compared to Maharashtra (9.2 million) and Tamil Nadu (4.8 million). The National Urban Survey conducted across the metropolitan cities of India reported similar trend: 11.7 per cent in Kolkata (Eastern India), 6.1 per cent in Kashmir Valley (Northern India), 11.6 per cent in New Delhi (Northern India), and 9.3 per cent in West India (Mumbai) compared with (13.5 per cent in Chennai (South India), 16.6 per cent in Hyderabad (south India), and 12.4 per cent Bangalore (South India).
3. Obesity is one of the major risk factors for diabetes, yet there has been little research focusing on this risk factor across India. Despite having lower overweight and obesity rates, India has a higher prevalence of diabetes compared to western countries suggesting that diabetes may occur at a much lower body mass index (BMI) in Indians compared with Europeans.
4. A most disturbing trend is the shift in age of onset of diabetes to a younger age. Indians get diabetes on average 10 years earlier than their Western counterparts. An upsurge in number of early-onset diabetes cases is also responsible for the development of various diabetic complications due to longer disease duration. Diabetes control in individuals worsened with longer duration of the disease (9.9±5.5 years), with neuropathy the most common complication (24.6 per cent) followed by cardiovascular complications (23.6 per cent), renal issues (21.1 per cent), retinopathy (16.6 per cent) and foot ulcers (5.5 per cent).
5. The risk for coronary artery disease is two to four times higher in diabetic subjects, and in Indians, and it occurs prematurely. Indians are genetically predisposed to the development of coronary artery disease due to dyslipidaemia and low levels of high density lipoproteins; these determinants make Indians more prone to development of the complications of diabetes at an early age (20-40 years) compared with Caucasians (>50 years) and indicate that diabetes must be carefully screened and monitored regardless of patient age within India. The rate of cardiovascular disease mortality in India in the 30-59-year age group is double that in the U.S.
6. Lifestyle changes have lead to decreased physical activity, increased consumption of fat, sugar and calories, and higher stress levels, affecting insulin sensitivity and obesity. 86% of adults consume less than five servings of fruits and vegetables a day. 18. Many Indians have insufficient physically activity (26.4% among males and 25.6% among females).
7. Costs of diabetes care are alarmingly high. The annual cost for India due to diabetes was about $38 billion in 2011. According to the WHO, if one adult in a low-income family has diabetes, “as much as 25% of family income may be devoted to diabetes care.” According to the World Economic Forum, cardiovascular disease, cancer, chronic respiratory disease, diabetes and mental health conditions will cost India 126 trillion rupees between 2012 and 2030.
8. While HbA1c is the gold standard test around the world for insulin initiation and intensification, it is not easily available to a large section of Indian population.
9. There is a lack of “clinical inertia” for the commencement of insulin therapy in both the clinical and patient communities. The most common apprehensions are related to the complexities of the insulin regimen and concerns about weight gain, hypoglycaemic events, and fear of insulin prick.
10. An inadequacy in Indian guidelines is also responsible for wide variation in treatment preferences across the country. The creation of simple and practical insulin guidelines that can be incorporated into routine clinical practice by primary health care physicians are desperately required to facilitate treatment and the initiation of insulin therapy throughout the country. Poor glycaemic control, a factor that has been observed in the Indian diabetic population, is responsible for micro- and macrovascular changes that present with diabetes
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