Diabetes cases in India are rising. Some studies suggest that it is India’s fastest growing disease.
India housed an estimated 72 million cases of diabetes in 2017. This figure is expected to increase considerably to 134 million by 2025.
A victim of its own success?
The reasons for this rapid increase in diabetes cases are myriad. Many of these tie in with the great shift in the nature of India’s disease burden, from infectious disease to noncommunicable diseases (NCDs). A driving factor behind this is the increase in life expectancy, partially resulting from the reduction in rates of infectious diseases as well as falling rates of infant mortality. As life expectancies increase, more and more people are living to an age where cancers and other diseases become more common.
In the case of diabetes, it has been shown that the demographics most at risk of developing type 2 diabetes are middle aged adults and the elderly. As such, as the Indian population is living longer, the relative risk of developing diabetes across a lifetime increases.
Further factors link diabetes with India’s growing economic success. Demographics are constantly shifting towards living in India’s wealthier, urban centres. With this comes significant lifestyle changes. The wealthy are far more likely to be overweight, as are those living within the cities.
This is related to both wealth and occupation status. Higher income jobs in India’s cities are far more likely to be sedentary, office based jobs where physical exertion is all but unheard of. The result of this is a lifestyle with very little time for exercise. This is a risk factor for both diabetes as well as a host of other NCDs such as heart disease.
Lifestyle choices, a major contributing factor
Diet plays a major role in the potential for developing diabetes. In particular, diets high in sugar and processed foods are a major risk factor. In cities, it may be both cheaper, as well as far easier to access processed foods than it is to find fresh fruit and vegetables.
Those from wealthier backgrounds are leaning towards less healthy, western style diets in which unhealthy foods are common. Likewise those in the cities but from poorer economic backgrounds are finding it increasingly easy to access sugar filled processed foods. As a result, Indian cities are seeing skyrocketing diabetes rates, particularly among the rich.
Issues such as alcoholism — another prevalent concern among the urban poor in India — are also contributing to diabetes rates. According to prominent Indian diabetologists, the poor are particularly vulnerable to the condition due to a lack of knowledge of the symptoms, as well as the lack of financial means to properly manage the disease.
Diabetes has therefore become a prominent concern in India across all wealth quintiles.
Attempts are being made to curb the impact junk food has on India’s children. There has been a proposed tax on junk food, a prevention of advertising during children’s television programmes, and a requirement to note processed food on the label. However, these measures are being contested and lobbied against by India’s rapidly emerging fast food industry – one which is enjoying a robust recovery post-demonetisation and is expected to be worth $27.57 billion by 2020.
Diet and lifestyle factors play a considerable role in causing type 2 diabetes, however, Indians as a group are particularly prone to developing the condition due to common genes among the population.
These genes have been uncovered in genome wide association studies among the Indian population, and may, at least in part, explain higher rates of diabetes in India. The genes involved typically play a role in insulin production or sensitivity.
Studies have found that Indians have far more common rates of known risk alleles for diabetes. However, these same studies believe to have found entirely new alleles that may contribute to the risk of diabetes development. This would indicate that many members of the Indian population hold a uniquely high risk factor for diabetes.
Even air pollution may be putting Indians at risk
Genetic susceptibility and lifestyle factors are well documented in contributing to diabetes. Recent studies have suggested that Indians even have to worry about the air they breathe.
A study published in The Lancet Planetary Health suggests that India’s high levels of air pollution have a hand to play in the country’s continuing diabetes crisis. The research attributes 3.2 million cases of diabetes a year to air pollution worldwide.
India has more to worry about than most countries as it is home to some of the most polluted cities in the world.
The study found that even pollution levels considered safe by the World Health Organization show a positive correlation with diabetes rate. This was tested against the rate of fracture occurrence as a negative control that could not be influenced by pollution levels.
If the data is true, and even mild levels of pollution are raising the risk of diabetes, millions of Indians are suffering from the effects of levels of pollution considered to be toxic. Many Indian cities are covered in dense smog the year round.
There is no simple solution to the diabetes crisis in India, as many factors are at work raising the risks of developing the condition. Steps must be taken soon as the number of diabetes patients in India is set to double within the next decade. Such an eventuality could have a drastic toll on the health system.