The Prevention of Diabetes in India

Long considered a disease endemic to rich, developed countries, diabetes – particularly type 2 diabetes – is now gaining ground in countries once considered “developing” or “poor”. Today, China and India have become the two countries with the most diabetics in the world. While this is partly explained by population size – both countries are home to over one billion people – it is also due to changes in consumption patterns and lifestyles brought about by globalization. Between them, China and India now account for 20% of diagnosed diabetes cases worldwide… and many scientists believe that a huge number of patients (almost 50% of diabetics) are still undiagnosed. Worse: this is an ongoing trend, and forecasts suggest a surge of cases within 20 years. Diabetes has thus become a major public health problem in India in the span of just a few decades. But how is the diabetes epidemic progressing in India? What about diabetes management? And what are the solutions to prevent the onset of diabetes in India? Let’s take a closer look.

Diabetes and pre-diabetes in India: some key figures.

With nearly 74 million people suffering from diabetes, India is now the second country with the most diabetic patients in the world, just behind China. Yet the country has not always had such a high prevalence rate. In fact, such a high prevalence of the disease is much more recent than it seems.

In fact, before the 1970s, the rate of diabetes in India was almost zero. Some studies tell us that the prevalence rate of diabetes among urban Indians aged 20-70 years was 2.1% in the early 1970s. However, this prevalence rate increased to 12% in the early 2000s and will reach 21% by 2021.

There has been an exponential growth in the number of diagnoses of diabetes in India, particularly in the urban population. At the national level, urban and rural dwellers combined have a prevalence of about 10% to 11%.

And that is not counting the undiagnosed patients, who would reach 40 million inhabitants according to the International Diabetes Federation (IDF).

Likewise, the incidence of pre-diabetes is also high. This transitional situation between normal blood sugar levels and type II diabetes affects 1 in 6 Indians, which suggests that the number of people suffering from diabetes will increase in the coming years.

The International Diabetes Federation estimates that India will have 92 million diabetics by 2030 and 124 million by 2045.

In view of the magnitude of the phenomenon, and the explosion of cases of diabetes and pre-diabetes, India has taken several measures to limit the increase in cases and reduce patient morbidity. India’s approach to diabetes includes prevention, risk awareness, treatment, and monitoring of complications.

The main causes of the increase in diabetes in India

It is now known that the onset of diabetes mellitus in an individual can be the result of causes both endogenous and exogenous to the individual.

The vast majority of scientists agree that the increase in type 2 diabetes is linked to the profound change in Indian consumption patterns.

Indeed, the last two decades have seen an increase in the rate of urbanization in India. While only 10% of Indians lived in cities 30 years ago, today nearly 30% do. However, urban life has profoundly changed the lifestyle of Indians. Many risk factors for diabetes have appeared in the daily life of Indians living in cities: sedentary life, lack of physical exercise, obesity, stress, etc.

Changing dietary habits are also responsible for the rapid surge of diabetes cases. While the Indian diet was mainly based on whole grains and vegetables, life in the city has encouraged the consumption of refined grains, which are more calorific. This was compounded by smoking, alcohol, and other highly processed foods, all of which are risk factors for diabetes.

The prevalence of diabetes in India is also caused by a certain genetic predisposition of Indians of Asian origin. This population group would then be more likely to develop insulin resistance, another risk factor for diabetes.

Diabetes prevention: the Indian government’s flagship issue

Faced with the scourge that diabetes has become in India, the government has taken a series of measures since the 1980s to curb the disease’s progression and raise awareness among Indian citizens.

And for good reason: with nearly 74 million diabetic patients, one Indian in six suffering from pre-diabetes and nearly one million deaths per year due to this pathology, diabetes is a very real public health problem. However, tackling a “new” disease in a country with a population of one billion people is a challenge.

In addition, there are financial problems: not all Indians have access to healthcare and cannot afford the costs of diabetes treatment. Prevention remains one of the main methods of action for the health authorities.

The National Diabetes Control Program

Launched in 1987, the National Diabetes Control Program was the first pilot scheme devised and established by the Indian federal government to control and reduce the prevalence of diabetes.

Introduced in the districts of Kashmir, Tamil Nadu and Tarnataka, the program aimed to raise awareness of the disease (health education), identify high-risk individuals, reduce mortality in high-risk individuals, and rehabilitate people disabled by diabetes.

However, despite the merits of the plan, it was not extended to other Indian states due to lack of funding. The program received new funding in 1995 and 1997.

The National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke

Despite an increase in the number of diabetes cases at the end of the 1990s, it was not until 2008 that the federal government launched a program for the prevention of diabetes under the aegis of the Ministry of Health. This health plan is called the “National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke” (NPCDCS).

The objectives of this broad program include the prevention and control of non-communicable diseases, health education, detection of people at risk and monitoring of people with various conditions, such as diabetes.

To date, the program is still in operation in India and is the only one that has been implemented in all Indian states.

Limitations of the prevention programs implemented by the Indian state

However, despite the desire to achieve effective diabetes prevention in India, the federal programs have faced several limitations.

The first is financial. While India now accounts for nearly 15% of the world’s diabetes population, its health expenditure on diabetes is barely 6% of its health budget. Today, the World Health Organization recommends that India allocate more resources to prevention and health education. Likewise, it needs to bridge inequalities in access to health care between regions and social classes.

The Indian state’s status as a federation is yet another obstacle to the success of its health programs – as it poses challenges to creating a consistent national health policy.

Added to this is the fact that the Indian government has not yet changed its dietary recommendations (decrease in the consumption of glucose and ghee – clarified butter – increase in the consumption of fruits and vegetables, etc.) unlike other countries facing an increase in the incidence of diabetes, such as Mexico or Brazil. However, some efforts have been made to broadcast video clips aimed at young Indians to teach them good eating habits.

NGOs: an important player in diabetes prevention in India

In India, non-governmental organizations (NGOs) play a particularly important role in both prevention and treatment. Some organizations are involved in prevention and education on a provincial or state level.

They are sometimes the only resource that Indian diabetic patients have. These actions take the form of awareness campaigns, enabling Indians to become aware of the importance of diet in the prevention of diabetes and pre-diabetes.

For example, in 2016, an NGO launched a text message campaign to encourage Indians to eat more fruit and vegetables. By the end of the campaign, 40% of the people targeted by the operation had improved their lifestyle and adopted a healthier behavior.