Diabetes in India’s undergoing a demographic transformation, shifting from largely afflicting the affluent to increasingly burdening the poor and middle income population.
According to a new study, this metabolic disorder that is often brought on due to dietary practices and lifestyle behavior is increasingly affecting the urban poor in part due to the improving economy.
The study, published this week in the The Lancet Diabetes & Endocrinology journal, is the largest nationally representative study of diabetes in India. Previous studies, according to the authors, were too small and localized to accurately assess and characterize the disease burden in India as a whole.
Measuring each person’s body weight, height, waist circumference and blood pressure, the researchers administered glucose blood tests to more than 57,000 people across 14 states and one union territory to test for the disease, and indicators of pre-disease states. According to the study, the prevalence of diabetes across all 15 states was 7.3 percent.
Until they were tested, almost half of the people in the study did not know they had the disease.
On average, the study found that diabetes was twice as common in urban areas as rural – 11.2 percent and 5.2 percent respectively. And although the disease was still more common, for the most part, in wealthier populations, it was actually higher among the urban poor in seven of the more economically advanced states.
“Our study suggests that cities in the country’s more affluent states have transitioned further along the diabetes epidemic,” senior author Viswanathan Mohan, president of the Madras Diabetes Research Foundation in Chennai, said in a press release.
For example, in Chandigarh – which has the highest gross domestic product (GDP) – the rate of disease was about 27 percent among the urban poor, compared to about 13 percent among the affluent. Chandigarh as a whole also had the highest rate of prevalence across all 15 states at 13.6 percent compared to 4.3 percent in Bihar – which has the lowest per capita GDP in India – at the other end of the spectrum.
“As the overall prosperity of individual states and the country as a whole increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of society, a transition that has already been seen in high income countries,” Mohan added.
Even in the U.S., the American Diabetes Association found that counties with the greatest rates of poverty also have the highest rates of diabetes. And according to the World Health Organization (WHO), the prevalence of this disease has been rising more rapidly in middle- and low-income countries.
The global health community has become increasingly concerned in general about the vicious cycle in which poverty is contributing to rising rates of non-communicable diseases, but non-communicable diseases are also exacerbating poverty.
“This trend is a matter of great concern because it suggests that the diabetes epidemic is spreading to individuals who can least afford to pay for its management,” R. M. Anjana, lead author of the study and vice-president of the Madras Diabetes Research Foundation, said in a press release.
Although the study in India did not distinguish between type 1 and type 2 diabetes, the correlation between rates of poverty, diabetes and other non-communicable disease have been linked to factors such as access to fresh foods, safe places to exercise and health care. In India, a lifestyle change among the poor and middle class may be the biggest factor.
“Those who were walking to work can now afford to take a bus or buy a motorbike and they are discouraged from being physically active,” Anjana told Scroll.in. “Also, as affordable fast-food and sweetened beverages become more and easily available, people are encouraged to consume these in large quantities putting their health at risk.”
The fact that “most treatment costs are paid out-of-pocket by patients” underscores the urgent need to increase access to effective prevention measures, the authors noted.
Also concerning is the finding that rates of diabetes in rural areas rose significantly from previous studies. With 70 percent of India’s population residing in rural areas, even small increases in prevalence rates can mean millions more people require chronic care in areas that still have poor access to health care.
Diabetes is still more prevalent in people of higher socio-economic status in rural areas of all states. But if the trend holds true, the burden may shift toward the poor even in rural areas as the entire country continues to develop.