With a genetic predisposition brought to the fore by changing lifestyles, deaths due to diabetes increased 50 per cent in India between 2005 and 2015, and is now the seventh-most common cause of death in the country, up from 11th rank in 2005, according to data published by the Global Burden of Disease (GBD).
Ischemic heart disease continues to be the highest cause of death, followed by chronic obstructive pulmonary disease, cerebrovascular disease, lower respiratory infection, diarrhoeal diseases and tuberculosis.
In 2015, 346,000 people died of diabetes, which caused 3.3 per cent of all deaths that year, with an annual increase of 2.7 per cent from 1990, according to the GBD study.
Nearly 26 people die of diabetes per 100,000 population; diabetes is also one of the top causes of disability and accounts for 2.4 per cent of the disability-adjusted life-years lost (sum of years lost due to disability or premature death due to the disease).
There are 69.1 million people with diabetes in India, the second-highest number in the world after China, which has 109 million people with diabetes. Of these, 36 million cases remain undiagnosed, according to a 2015 Diabetes Atlas released by the International Diabetes Federation (IDF). Nearly nine per cent in the age group of 20-79 have diabetes.
The figures are alarming since diabetes is a chronic disease that not just affects the pancreas’ ability to produce insulin but impacts the entire body. Complications caused due to diabetes include heart disease, stroke, kidney failure, vision loss and neuropathy or nerve damage leading to leg amputation.
Unlike other countries, where a majority of people with diabetes are over 60 years old, the prevalence in India is among the 40-59 years age group, affecting productivity of the population.
“Diabetes strikes Indians a decade earlier than the world,” Anoop Misra, chairman, Fortis Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, told IndiaSpend. “This causes reduced productivity, increased absenteeism in working population and gives more time for complications to arise.”
Indians are especially predisposed to diabetes due to social and genetic reasons. Peculiar genetic composition of Indians known as “Asian Indian Phenotype” makes them appear thin but with fat depositions around their internal organs.
It makes them prone to greater abdominal fat, insulin resistance, higher levels of bad fat and increased chances of suffering from diabetes and coronary artery disease.
Lifestyle changes with reduced physical activity and carbohydrate-rich diets, along with environmental factors, are increasing India’s diabetes burden, IndiaSpend reported in June 2015.
It is estimated that diabetes patients in urban areas spend Rs 10,000 and patients in rural areas spend Rs 6,260 every year on treatment, according to a 2013 study published by The Association of Physicians of India.
Since most of the healthcare cost is borne out of pocket in India, those in lower economic groups have to bear the greatest burden. Urban poor spend as much as 34 per cent while rural poor spend 27 per cent of their income on diabetes treatment, the study found.
India is predicted to have 123 million diabetes cases aged between 20 and 79 by 2040, according to estimates by IDF. “We need a national campaign on the level of pulse polio to tackle diabetes, it is soon going to be a problem bigger than TB, HIV and malaria together,” Misra said.
Even though diabetes features in the National Health Mission’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke for district-level intervention to prevent non-communicable diseases, it needs to do more to screen, create awareness and monitor and treat the disease to stem the tide.