medwireNews: Results of the ICMR–INDIAB study suggest that the prevalence of diabetes in India is increasing among poorer people living in affluent cities.
“[T]he diabetes epidemic in India is in a state of transition,” say the study authors, noting that “the spread of the epidemic to economically disadvantaged sections of society is a matter of great concern [because] most diabetes treatment expenses are borne out of pocket by patients.”
Viswanathan Mohan (ICMR Centre for Advanced Research on Diabetes, Chennai, India) and colleagues analyzed oral glucose tolerance tests from 57,117 participants aged 20 years and older in 15 states, and found that the overall prevalence of diabetes was 7.3%, varying from 4.3% in Bihar to 10.0% in Punjab. The incidence in urban areas was approximately double that in rural areas, at 11.2% versus 5.2%, and the overall prevalence of prediabetes was 10.3%.
While diabetes was more prevalent among participants in higher than lower socioeconomic status (SES) groups in rural areas, the opposite was true in urban areas of some more affluent states, including Chandigarh, Gujarat, and Tamil Nadu, where there was a greater prevalence among people in lower, compared with higher, SES groups.
The ICMR-INDIAB data, so elegantly presented by RM Anjana et al, will help policymakers and diabetes care professionals formulate appropriate strategies for each state and region of the country.
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“These results suggests that as the overall prosperity of states and India as a whole increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of the society, a transition that has already been noted in high-income countries,” write the study authors in The Lancet Diabetes & Endocrinology.
They add: “Preventive measures need to be directed at these individuals, who have previously been deemed at fairly low risk of developing diabetes.”
The team also found that nearly half (47.3%) of participants identified as having diabetes had not been diagnosed previously.
“This finding has far-reaching implications for health-care providers in the country, as many currently undiagnosed people in the community carry the risk of being diagnosed only when advanced diabetic microvascular complications are present,” says Vijay Viswanathan (M V Hospital for Diabetes, Tamil Nadu, India) in an accompanying commentary.
The researchers caution that although their study is “the largest epidemiological study of diabetes in the country to date,” the prevalence of diabetes in children and adolescents was not assessed, and it was not possible to differentiate between type 1 and type 2 diabetes.
Nevertheless, Viswanathan believes that the findings should “serve as an important eye opener for policy makers and other stakeholders.”
He continues: “Several findings from the study have important public health implications, which will hopefully motivate health authorities in these Indian states and beyond to develop comprehensive strategies for the prevention and management of diabetes in those areas with limited resources.”
And the commentator concludes: “Addressing the increasing prevalence of diabetes in India will require solutions at many levels, including increased awareness of the disease and its complications throughout the country—especially in rural areas—and the establishment of cost-effective prevention programmes.”
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