Diabetes – a growing health concern in India

A chronic metabolic disease, diabetes now affects more than 77 mn Indians, a number which is expected to grow to 134 mn by 2045.

Diabetes and its types
Diabetes occurs either when the pancreas doesn’t produce enough insulin to regulate blood glucose or when the body cannot effectively use the insulin it produces. The main types of diabetes are:

Type 1: Previously known as Insulin Dependent Diabetes or Juvenile Diabetes, it is caused due to body’s malfunction to produce insulin.

Type 2: This is caused due to insulin resistance, a condition in which cells fail to use insulin properly. This form was previously known as non-insulin dependent diabetes or adult onset diabetes.

Besides this there is a third type, the Gestational diabetes that occurs in pregnant women, who develop a high blood glucose level without previous history of diabetes.

Global prevalence of diabetes

According to the International Diabetes Federation (IDF), there are 537 mn adults now living with diabetes and its global prevalence has reached 10.5% with almost half the adults undiagnosed. What is more alarming is that there is a rise of 16% since the last estimates in 2019. By 2045, one in eight adults would be living with diabetes. Over the last 15 years, diabetes has led to a 316% increase in health expenditure. It is estimated that around 10% of global health expenditure is being spent on diabetes. With a majority of the people living in low and middle income countries, diabetes is no more a disease of the high income groups.

Where does India stand?

India is home to the second largest number of people with diabetes, second only to China. More than 95% of Indians have type 2 diabetes. Why is the propensity to be a diabetic higher in Indians? Research has proved that Indians have a low threshold for the risk factors, due to the presence of susceptible genes. While most diagnosed cases of diabetics are in the urban areas, it is also true that 50% cases are undiagnosed. And a large percentage of patients, who don’t know they have the disease, will be found in the rural areas, where 70% Indians do not have access to even primary healthcare facilities.

Diabetes is also appearing much earlier in life, afflicting more young Indians, which means that the chronic long-term complications are becoming more common. This obviously has an enormous implication on the Indian healthcare system.

Socio-economic impact of diabetes in India

Experts believe that India needs to pause and re-evaluate its strategy to combat diabetes. The assessment of the socio-economic impact of diabetes in India is important for several reasons. First, India is considered the diabetes capital of the world, yet not enough is done for the diagnosis and treatment of the disease. Second, by 2025, most people with diabetes in developing countries like India will be in the 45 to 64 year age group, thus threatening the economic productivity of the country and the income-earning ability of individuals. Third, the management of diabetes and its complications can be expensive, which poses serious obstacles to the Government’s plan to achieve universal health coverage by 2022.

Within the diabetes population, low income individuals bear the highest burden of the disease. This is due to the high expenditure on medical consultations, lab tests and drugs. As the epidemiological burden of diabetes increases, the burden of diabetes on total healthcare spending is likely to increase and, potentially, will have important consequences on the sustainability of healthcare financing.

Multi-dimensional strategies for prevention and disease management are the need of the hour

The IDF has stressed on the urgency to develop and implement strategies for creating awareness and increasing access to testing for early diagnosis. When it is undetected or inadequately treated, almost all diabetic patients would also suffer from other disorders like deranged lipid profile, hypertension, risk of cardiovascular and renal disorders. It is thus imperative for a diabetic patient to adopt a 360 degree approach for diabetes management. Besides testing for blood glucose levels, it is necessary to undergo blood tests for lipid profile, renal profile among others. Early diagnosis and access to appropriate care can avoid or delay complications.

Experts believe that in India the focus should be on preventive diagnostics for diabetes. In addition to diabetics the country also has a huge burden of pre-diabetics. This group needs to be targeted with information on right lifestyle options and undergoing regular check-ups to keep blood glucose, lipids and the other parameters under control.

Diagnosis of diabetes - estimation of blood glucose

Blood glucose can be directly tested in several ways:

· Random blood test - Regardless of when a person last ate, blood sugar is tested at random time.

· Fasting blood test - Blood is tested after an overnight fast.

· Postprandial test - Conducted two hours after a meal.

· Oral glucose tolerance test - Blood glucose level is tested every 30 minutes, over a two hour period. Although it gives better results than the fasting blood test, it is more expensive and hence not prescribed often.

· HbA1c blood test – Measures the amount of HbA1c in the body. The good news is factors such as time of day, meal intake, exercise, stress, etc. do not interfere with the diagnosis.

HbA1c - holds the key!
The free glucose in the blood attaches to the hemoglobin in our red blood cell (RBC) to form glycated hemoglobin (HbA1c). HbA1c stands for Hb= Hemoglobin, A= Adult, 1c= glycosylated. Higher the blood glucose, higher will be the HbA1c value. The lifespan of RBCs is 90-120 days, and so monitoring of HbA1c gives the average blood glucose levels over a period of 3-4 months. In fact, the American Diabetes Association has recommended it as a possible substitute to fasting blood glucose for diagnosis of diabetes, and for people with diabetes it is an important indicator for predicting the risk of diabetes-related complications. An HbA1c test may also be used to check for pre-diabetes in adults; this means the blood sugar levels indicate whether a person is at risk of getting diabetes.

Source:

https://www.idf.org/news/240:diabetes-now-affects-one-in-10-adults-worldwide.html

https://www.thehindu.com/sci-tech/health/india-has-second-largest-number-of-people-with-diabetes/article29975027.ece

https://indianexpress.com/article/lifestyle/health/world-diabetes-day-2020-what-diabetics-need-to-know-about-keeping-their-heart-healthy-7048026/