Burden of diabetes in India - An Overview

The Burden of diabetes in India is an alarming topic. Diabetes is a chronic disease also called "a touch of sugar". India has an estimated about 77 million people with diabetes and second most affected country in the world. International Diabetes Federation (IDF) forecasted by 2045 India will become 134 million of people with Type 1 diabetes. Diabetes pyramid of prevention - Low risk, Moderate Risk, High Risk, Very High Risk, Undiagnosed and Diabetes are the stages of the pyramid.
International Diabetes Federation has reported that the prevalence of Diabetes in adults in India is around 7.1%. In Urban areas is around 9%.
The crude prevalence of diabetes and pre-diabetes among adults were 5.1 and 13.5%, respectively, while the prevalence of pre-diabetes in youth aged 10–17 years was 5.1%. Intervention reduced fasting blood glucose levels of pre-diabetic adults by 11%.
Primordial prevention was provided to the whole population in the form of mass- scale diabetes awareness programs. This part of the program used VHWs to increase awareness and to screen all subjects in the community.

1. Burden of diabetes in India Risk factors and method to reduce the disease Evangelin Ida Mary.J

2. Outline Diabetes – a chronic disease Diabetes in India Burden of the diabetes Prevalence of diabetes in India Risk factors Preventive methods References

3. Diabetes- a chronic disease Diabetes mellitus , commonly known as diabetes , is a chronic diseases that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” These terms suggest that someone doesn’t really have diabetes or has a less serious case, but every case of diabetes is serious.

4. Diabetes in India India has an estimated 77 million people with diabetes, the second most affected in the world, after China. India is considered as diabetes capital of the world. One in six people (17%) in the world with diabetes is from India. (India’s population as calculated in October 2018 was about 17.5% of the global total.) The number is projected to grow by 2045 to become 134 million per the  International Diabetes Federation( IDF). In India, type 1 diabetes is more rare than in western countries. Only about one-third of type 2 diabetics in India are overweight or obese.   Approximately 85–95% of all cases of diabetes are type 2 diabetes and the worldwide explosion of this disorder is a major health care burden. It is estimated that nearly 380 million adults worldwide will have diabetes by 2025.

5. Cont.... In 2020 , according to the  International Diabetes Federation (IDF), 463 million people have diabetes in the world and 88 million people in the Southeast Asia region. Of this 88 million people, 77 million belong to India. The prevalence of diabetes in the population is 8.9% , according to the IDF. According to the IDF estimates, India has the second highest number of children with type 1 diabetes after the United States. It also contributes to the largest proportion of incident cases of type 1 diabetes in children in the SEA region. As Per the World Health Organization, 2% of all deaths in India are due to diabetes.

6. Burden of the disease There are estimated 72.96 million cases of diabetes in adult population of India. The prevalence in urban areas ranges between 10.9% and 14.2% and prevalence in rural India was 3.0-7.8% among population aged 20 years and above with a much higher prevalence among individuals aged over 50 years (INDIAB Study). Diabetes is endemic in India. The International Diabetes Federation has estimated that India currently has more than 65 million people with type 2 diabetes and the numbers are poised to double in the next 20 years. Cardiovascular diseases (coronary heart disease, stroke, peripheral arterial disease) are the major causes of morbidity and mortality in type 2 diabetes. It has been reported that 60–80% of patients with diabetes die of cardiovascular events. It has been reported that 60–80% of patients with diabetes die of cardiovascular events. Control of cardiovascular risk factors in diabetes can prevent or delay cardiovascular events

7. Cont... The increased number of diabetics in India is likely to be due to a significant increase in the incidence of type 2 diabetes, caused by unprecedented rates of urbanization, which results in environmental and lifestyle changes.  Although India accounts for about 15% of the world's diabetes burden, its spending on healthcare related to diabetes is only 6.4% of worldwide spending; health resource allocations should reflect the burden of disease. The greatest numbers of people with diabetes are between 40 and 59 years of age. Diabetes is ubiquitous, its prevalence is rising globally, and the social and economic burden caused is very huge.

8. Prevalence of diabetes in India The International Diabetes Federation has reported that the prevalence of diabetes in adults in India is 7.1%. The prevalence in urban areas is 9%.This study shows a greater prevalence among the middle-class urban Indians. Recent studies have reported urban diabetes prevalence rates of 8–20% and rural diabetes prevalence rates of 5–15%.There are only a few multisite studies of diabetes prevalence in India. A 2004 study suggests that the prevalence of type 2 diabetes in Indians may be due to environmental and lifestyle changes resulting from industrialization and migration to urban environment from rural. In India, prevalence of foot ulcers in diabetic patients in clinic population is 3%. The crude prevalence of diabetes and pre-diabetes among adults were 5.1 and 13.5%, respectively, while the prevalence of pre-diabetes in youth aged 10–17 years was 5.1%. Intervention reduced fasting blood glucose levels of pre-diabetic adults by 11%, pre-diabetic youth by 17%, and type 2 diabetic adults by 25%. 

9. Cont.. The rising prevalence of diabetes in India and other developing countries is chiefly attributed to urbanization. India will continue to have the largest number of diabetic subjects as a result of the rapid urbanization and economic development . The crude prevalence of diabetes and pre-diabetes among adults were 5.1 and 13.5%, respectively, while the prevalence of pre-diabetes in youth aged 10–17 years was 5.1%. Intervention reduced fasting blood glucose levels of pre-diabetic adults by 11%, pre-diabetic youth by 17%, and type 2 diabetic adults by 25%. 

10. Why is the prevalence of diabetes increasing? Aging of the population Urbanization especially in the developing countries More sedentary lifestyle Food consumption patterns more foods with high fat contents more refined carbohydrates

11. Risk factors Weight. The more fatty tissue you have, the more resistant your cells become to insulin. Inactivity. ... Family history. ... Race or ethnicity. ... Age. ... Gestational diabetes. ... Polycystic ovary syndrome. ... High blood pressure. Overweight and lack of physical exercise Smoking A low- fiber , high-fat, and sugary diet Medications that can affect the body’s metabolism of carbohydrates Genetic factors which may cause some families to more likely develop diabetes. Age group (45–69 years), marital status, hypertension, obesity and family history of DM were found to be the risk factors

12. Pre- modial prevention Primordial prevention was provided to the whole population in the form of mass- scale diabetes awareness programs . This part of the program used VHWs to increase awareness and to screen all subjects in the community. Primordial prevention was provided to the whole population in the form of mass- scale diabetes awareness programs. This part of the program used VHWs to increase awareness and to screen all subjects in the community. such as family and self-help groups, the performing arts, peer-group support, and one-on-one sessions.

13. Primary prevention A healthy diet, together with regular physical activity, maintenance of a healthy body weight, consumption of moderate amounts of alcohol, and avoidance of sedentary behaviours and smoking, secondary prevention The purpose of secondary prevention activities such as screening is to identify asymptomatic people with diabetes population screening selective screening opportunistic screening Home blood glucose monitoring Self care Proper management of diabetes

14. Tertiary prevention Includes action taken to prevent and delay the development of acute or chronic complications Strict metabolic control, education and effective treatment Screening for complications in their early stages when intervention is more effective Screening for eye and renal problems Managing foot problems Muscular complications

15. National Diabetes Control Programme Government Of India started National Diabetes control programme which focuses on prevention of diabetes through identification of high risk subjects and early intervention in the form of health education. Early diagnosis of disease and appropriate treatment morbidity and mortality with reference to high risk group. Prevention of acute and chronic metabolic, cardiovascular, renal and ocular complication of the disease Provision of equal opportunity for physical attainment and scholastic achievement for the diabetic patients Rehabilitation of those partiality or totally handicapped diabetes people. “The ultimate aim is to integrate control of diabetes into that of hypertension and heart disease”

16. References https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes https://en.wikipedia.org/wiki/Diabetes_in_India https://drc.bmj.com/content/2/1/e000048 https://onlinelibrary.wiley.com/doi/full/10.1111/j.1753-0407.2008.00004.x https://www.annualreviews.org/doi/full/10.1146/annurev.publhealth.