Overview of Diabetes Burden


Every year, around 5.8 million Indians die from noncommunicable diseases including heart diseases, lung diseases, stroke, cancer, diabetes and others These diseases now affect younger and younger people. The greatest risk factors contributing to NCDs are unhealthy diet, physical inactivity, tobacco and alcohol use and air pollution. The good news is that the majority of illnesses and deaths due to NCDs can be delayed or avoided by preventing and controlling the risk behaviours.

Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin (type 1 diabetes), or when the body cannot effectively use the insulin it produces (type 2 diabetes). This leads to raised blood glucose (sugar) level and over time, serious damage to many of the body's systems, especially the nerves and blood vessels.

About 422 million people worldwide have diabetes. India has over 60 million diabetics out of a population of 1.3 billion. In 2015, over 0.9 million deaths in India were attributed to diabetes directly or indirectly. The number of diabetics in the country is expected to increase to a staggering 109 million cases by 2035 out of an estimated population of 1.5 billion1.

The World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death by 2030. The NCD Country Profiles 2014 published by WHO reveals the large share of mortality is due to NCDs. In India, an estimated 7.8% of the population above 18 years of age has raised blood glucose level or are on treatment for diabetes. 2However, nearly half of the population with diabetes is unaware about their disease. Apart from the health burden, diabetes also imposes an economic burden. The costs associated with diabetes include cost of care, productivity loss and disability, which can be a considerable burden to the individual, families and society.

A recently reported Indian Council of Medical Research - INdia DIABetes (ICMR-INDIAB) study conducted in four different zones of rural and urban India showed that the prevalence of diabetes and prediabetes are higher compared to previous studies. The inter-state variations in prevalence, ranging from 4.3% in Bihar, 10.4% in Tamil Nadu and 13.6% in Chandigarh.3

In 2012, the survey carried out by the National Nutrition Monitoring Bureau among the rural population showed 8.2% and 6.8% among adult men and women for diabetes, respectively. The prevalence was reported to be high in the states of Kerala, Tamil Nadu and Gujarat (8.2 – 16.4%) among both genders. Analysis of secular trends revealed an increase in diabetes prevalence in the rural population at a rate of 2.02 per 1000 population per year.4

Economic burden of diabetes care: A World Economic Forum report on economic implications of NCDs in India has estimated that India stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions with diabetes alone being responsible for US$0.15 trillion. Health care expenditure for people with diabetes is two to three times higher than people without diabetes. The average cost is estimated to vary between INR 3 000 and INR10 000 per annum in various studies. The high cost of treatment leads to higher incidence of non-compliance, particularly among the lower socio-economic groups. Risk factors for diabetes The most common risk factors are obesity, poor diet, physical inactivity, advancing age, family history of diabetes, ethnicity and high blood glucose during pregnancy affecting the unborn child. Indians have a peculiar genetic composition and Asian Indian phenotype predisposes them to a higher propensity of metabolic syndrome, diabetes mellitus and coronary artery disease.

Diabetes in Elderly: India has 104 million elderly (defined as 60 years of age and above), constituting 8.6% of the total population.23 The number of elderly is expected to reach more than 300 million by 2050, accounting for 20% of the population5. The self-reported prevalence of diabetes among people aged over 50 years was 6.9% in 2010, of which 49.2% were on treatment6. Diabetes in the elderly is associated with a large number of comorbidities. Kidneys and eyes are more likely to be affected. Diabetic elderly often suffer from falls and fractures, neuropathy, cognitive decline, drug-related hypoglycemia, visual impairment, etc. Mortality due to cardiovascular causes increases due to greater risk of arteriosclerosis. As the number of older people with diabetes increases, outcomes such as cognitive and physical disability become growing concerns, with implications on quality of life, loss of independence and demands on caregivers.

Comorbidities and complications: It is estimated that complications are common in 10-20% of diabetic patients and diabetic retinopathy is one of the commonest complications. Diabetes and hypertension are often reported as the common comorbidities as is tuberculosis and diabetes. Diabetes triples a person's risk of developing tuberculosis. Multisectoral and intersectoral coordination for diabetes prevention and control The control of risk factors influencing occurrence of NCDs including diabetes require actions from beyond the health sector and hence there is need for multisectoral approach involving other key ministries, the private sector, civil society organizations and the community.

Diabetes and health system response in India: The National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) launched in the year 2009 covers more than 200 districts in the country. The NPCDCS aims at integration of NCD interventions in the National Health Mission (NHM) framework for optimization of scarce resources. NCD cells with additional manpower have been recommended at national, state and district level. In the 12th Five Year Plan (FYP), it has been envisaged that NCD clinics would be set up in each community health centre in the country.

Health interventions: Prevention of diabetes is possible through a mix of individual, population level, whole of government and whole of society level interventions. Many sectors of society have a role to play in preventing and treating diabetes, including governments, employers, educators, industry, civil society, private sector, media and individuals themselves. Cost-effective interventions already exist — these include methods for early detection of NCDs and their diagnoses using inexpensive technologies; non-pharmacological and pharmacological approaches for modification of NCD risk factors, and affordable medications for prevention and treatment of heart attacks and strokes, diabetes, cancer and asthma.

1WHO and International Diabetes Federation — Diabetes Atlas, 2015

2NCD Country Profiles 2014 http://who.int/features/qa/65/en/ iii http://www.who.int/diabetes/country-profiles/en/

3Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, Bhansali A, Joshi SR, Joshi PP, Yajnik CS et al. ICMR–INDIAB Collaborative Study Group Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011 Dec;54:3022-7

4Diet and nutritional status of rural population, prevalence of hypertension and diabetes among adults and infant and young child feeding practices – report of third survey. Hyderabad: National institute of nutrition; 2012

5United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision. New York: United Nations; 2015.

6Arokiasamy P, Parasuraman S, Sekher TV, Lhungdim H. India: Study on global AGEing and adult health (SAGE), Wave 1. International Institute for Population Sciences. Geneva: World Health Organization; 2013

Overview of Diabetes Burden


Every year, around 5.8 million Indians die from noncommunicable diseases including heart diseases, lung diseases, stroke, cancer, diabetes and others These diseases now affect younger and younger people. The greatest risk factors contributing to NCDs are unhealthy diet, physical inactivity, tobacco and alcohol use and air pollution. The good news is that the majority of illnesses and deaths due to NCDs can be delayed or avoided by preventing and controlling the risk behaviours.

Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin (type 1 diabetes), or when the body cannot effectively use the insulin it produces (type 2 diabetes). This leads to raised blood glucose (sugar) level and over time, serious damage to many of the body's systems, especially the nerves and blood vessels.

About 422 million people worldwide have diabetes. India has over 60 million diabetics out of a population of 1.3 billion. In 2015, over 0.9 million deaths in India were attributed to diabetes directly or indirectly. The number of diabetics in the country is expected to increase to a staggering 109 million cases by 2035 out of an estimated population of 1.5 billion1.

The World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death by 2030. The NCD Country Profiles 2014 published by WHO reveals the large share of mortality is due to NCDs. In India, an estimated 7.8% of the population above 18 years of age has raised blood glucose level or are on treatment for diabetes. 2However, nearly half of the population with diabetes is unaware about their disease. Apart from the health burden, diabetes also imposes an economic burden. The costs associated with diabetes include cost of care, productivity loss and disability, which can be a considerable burden to the individual, families and society.

A recently reported Indian Council of Medical Research - INdia DIABetes (ICMR-INDIAB) study conducted in four different zones of rural and urban India showed that the prevalence of diabetes and prediabetes are higher compared to previous studies. The inter-state variations in prevalence, ranging from 4.3% in Bihar, 10.4% in Tamil Nadu and 13.6% in Chandigarh.3

In 2012, the survey carried out by the National Nutrition Monitoring Bureau among the rural population showed 8.2% and 6.8% among adult men and women for diabetes, respectively. The prevalence was reported to be high in the states of Kerala, Tamil Nadu and Gujarat (8.2 – 16.4%) among both genders. Analysis of secular trends revealed an increase in diabetes prevalence in the rural population at a rate of 2.02 per 1000 population per year.4

Economic burden of diabetes care: A World Economic Forum report on economic implications of NCDs in India has estimated that India stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions with diabetes alone being responsible for US$0.15 trillion. Health care expenditure for people with diabetes is two to three times higher than people without diabetes. The average cost is estimated to vary between INR 3 000 and INR10 000 per annum in various studies. The high cost of treatment leads to higher incidence of non-compliance, particularly among the lower socio-economic groups. Risk factors for diabetes The most common risk factors are obesity, poor diet, physical inactivity, advancing age, family history of diabetes, ethnicity and high blood glucose during pregnancy affecting the unborn child. Indians have a peculiar genetic composition and Asian Indian phenotype predisposes them to a higher propensity of metabolic syndrome, diabetes mellitus and coronary artery disease.

Diabetes in Elderly: India has 104 million elderly (defined as 60 years of age and above), constituting 8.6% of the total population.23 The number of elderly is expected to reach more than 300 million by 2050, accounting for 20% of the population5. The self-reported prevalence of diabetes among people aged over 50 years was 6.9% in 2010, of which 49.2% were on treatment6. Diabetes in the elderly is associated with a large number of comorbidities. Kidneys and eyes are more likely to be affected. Diabetic elderly often suffer from falls and fractures, neuropathy, cognitive decline, drug-related hypoglycemia, visual impairment, etc. Mortality due to cardiovascular causes increases due to greater risk of arteriosclerosis. As the number of older people with diabetes increases, outcomes such as cognitive and physical disability become growing concerns, with implications on quality of life, loss of independence and demands on caregivers.

Comorbidities and complications: It is estimated that complications are common in 10-20% of diabetic patients and diabetic retinopathy is one of the commonest complications. Diabetes and hypertension are often reported as the common comorbidities as is tuberculosis and diabetes. Diabetes triples a person's risk of developing tuberculosis. Multisectoral and intersectoral coordination for diabetes prevention and control The control of risk factors influencing occurrence of NCDs including diabetes require actions from beyond the health sector and hence there is need for multisectoral approach involving other key ministries, the private sector, civil society organizations and the community.

Diabetes and health system response in India: The National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) launched in the year 2009 covers more than 200 districts in the country. The NPCDCS aims at integration of NCD interventions in the National Health Mission (NHM) framework for optimization of scarce resources. NCD cells with additional manpower have been recommended at national, state and district level. In the 12th Five Year Plan (FYP), it has been envisaged that NCD clinics would be set up in each community health centre in the country.

Health interventions: Prevention of diabetes is possible through a mix of individual, population level, whole of government and whole of society level interventions. Many sectors of society have a role to play in preventing and treating diabetes, including governments, employers, educators, industry, civil society, private sector, media and individuals themselves. Cost-effective interventions already exist — these include methods for early detection of NCDs and their diagnoses using inexpensive technologies; non-pharmacological and pharmacological approaches for modification of NCD risk factors, and affordable medications for prevention and treatment of heart attacks and strokes, diabetes, cancer and asthma.

1WHO and International Diabetes Federation — Diabetes Atlas, 2015

2NCD Country Profiles 2014 http://who.int/features/qa/65/en/ iii http://www.who.int/diabetes/country-profiles/en/

3Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, Bhansali A, Joshi SR, Joshi PP, Yajnik CS et al. ICMR–INDIAB Collaborative Study Group Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011 Dec;54:3022-7

4Diet and nutritional status of rural population, prevalence of hypertension and diabetes among adults and infant and young child feeding practices – report of third survey. Hyderabad: National institute of nutrition; 2012

5United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision. New York: United Nations; 2015.

6Arokiasamy P, Parasuraman S, Sekher TV, Lhungdim H. India: Study on global AGEing and adult health (SAGE), Wave 1. International Institute for Population Sciences. Geneva: World Health Organization; 2013