Asians have a 2–4-times higher risk of type 2 diabetes than white Europeans.
NEW DELHI – With a prediabetes prevalence of 10.3% among adults, people with diabetes in India are likely to more than double in the next decade from the current 70 million, a study by the country’s apex research organisation has estimated.
The prevalence of prediabetes — also known as “impaired glucose tolerance” and a precursor to diabetes — is 1.4 times higher than the diabetes prevalence of 7.3%, according to the Indian Council of Medical Research-IndiaB study of 57,117 adults over 20 years from 14 states and the Union Territory (UT) of Chandigarh.
Around 47.3% of India’s 70 million diabetics are undiagnosed and do not know they have high blood glucose levels that, if left untreated, lead to complications such as blindness, kidney failure, heart disease, stroke and foot amputation, the study found.
Diabetes emerged as India’s seventh biggest cause of early death in 2016, up from 11th in 2005, shows data from Institute of Health Metrics & Evaluation .
Diabetes prevalence is higher in affluent states and UTs like Chandigarh, Maharashtra and Tamil Nadu, but pre-diabetes prevalence, which ranged from 6% in Mizoram to 14.7% in Tripura, was high across states irrespective of income.
Even a state like Bihar with a low diabetes prevalence of 4.3% had 10% people with prediabetes, indicating that diabetes cases would shoot up in the state over the next decade.
“There is evidence of an epidemiological transition, with diabetes prevalence being higher in low socio-economic groups of urban areas in more economically developed states,” said Dr Tanvir Kaur, deputy director general, Indian Council of Medical Research, who was part of the research team doing India’s largest community-based diabetes study.
Training for the third leg of the study to track prevalence in Delhi, Uttar Pradesh, Madhya Pradesh and Rajasthan began in September 2017.
“Since diabetes is a chronic disease that needs lifelong management, its spread to the economically disadvantaged sections is a matter of great concern, and need urgent policy and lifestyle interventions,” said Dr Kaur.
Several studies have shown south Asians develop diabetes a decade earlier than Europeans at a lower weight, and those with prediabetes progress to overt diabetes at a faster rate.
The progression in south Asians happens at 12–18% per year (which can be reduced by 30% with healthy lifestyle changes) compared to 5–11% in white Europeans, reported a UK study in Lancet Diabetes Endocrinology abstract.
“Indians get diabetes at a lower body weight, with around 20–25% people (diabetics) not being overweight,” said Dr Anoop Misra, chairman, Fortis Centre of Diabetes, Metabolic Diseases and Endocrinology, New Delhi.
He pointed out that another distinctive feature among Indians is abdominal fat — excess fat under the skin and inside the abdomen — which hampers blood glucose control, as does a fatty liver and excess fat in the pancreas, which produces insulin.
Since Asians have a 2–4-times higher risk of type 2 diabetes than white Europeans — roughly four times higher in Bangladeshis and about two times higher in Indians — independent of weight, and develop diabetes on 5–10 years earlier than them, the WHO recommends diabetes screening at a lower body weight (BMI, which is a ratio of weight to height, ideal being 23 kg/m2) for people at risk.
