GLOBAL DIABETES EPIDEMIC

THE CONTEXT: The global diabetes landscape has dramatically transformed over the past three decades. According to data released in The Lancet on November 13, 2024, the number of people with diabetes has quadrupled globally from around 200 million in 1990 to over 800 million in 2022. The global diabetes prevalence in adults rose from 7% to 14% between 1990 and 2022.

THE COUNTRY-WISE DISTRIBUTION SHOWS ALARMING TRENDS

• • India leads with 212 million people with diabetes.
  • China follows with 148 million.
  • The United States has 42 million.
  • Pakistan has 36 million.
  • Brazil has 22 million.
  • India also tops the list of countries with untreated diabetes, with 133 million people over the age of 30 years, compared to 78 million in China.

FACTORS CONTRIBUTING TO THE DIABETES EPIDEMIC:

• • Methodological changes: The study methodology includes people on diabetes medication, those with fasting plasma glucose of 7·0 mmol/L or more, or an HbA1c of 6·5% or more.
  • Dietary factors: Consumption of unhealthy food, particularly high-calorie foods rich in carbohydrates and saturated fat, has been identified as a significant risk factor.
  • Sedentary lifestyle: Lack of physical activity is strongly associated with increased diabetes risk.
  • Tobacco use: According to a November 2023 WHO report, cigarette smoking raises the risk of developing diabetes by 30%-40% compared to non-smokers.
  • Air pollution: Recent studies have identified air pollution as an important cause of Type 2 diabetes, an endocrine disruptor that affects both the pancreas and liver.
  • Genetic factors: Studies have shown that genes responsible for insulin deficiency are more prominent in Indians than in White Europeans.

INDIA-SPECIFIC DIABETES LANDSCAPE:

• • Historical perspective: In the 1970s, diabetes was relatively rare in India. An Indian Council of Medical Research study in 1972 showed only 2% prevalence in cities and 1% in rural areas.
  • Impact of economic changes: The Green Revolution and financial liberalization in 1991 increased food availability and changed dietary patterns, contributing to the diabetes epidemic.
  • Urban vs. rural prevalence: Major cities in India now show over 25% prevalence among adults over 20, with rural areas catching up rapidly.
  • Age-wise distribution: In major Indian cities, almost half of all adults age 50 have Type 2 diabetes.

COMPLICATIONS AND ASSOCIATED HEALTH RISKS:

• • Diabetic retinopathy: A 2022 study found that 12.5% of people with diabetes in India (30 lakh) had diabetic retinopathy, with 4% at immediate risk of vision loss.
  • Hearing loss: Uncontrolled diabetes increases the risk of hearing loss due to damage to blood vessels and nerves essential for hearing.
  • Cardiovascular risks: Diabetes significantly increases the risk of heart disease and stroke.
  • Cognitive decline and dementia: With declining mortality from vascular diseases, dementia has become a leading cause of death among people with diabetes in some regions.

PREVENTION AND MANAGEMENT STRATEGIES:

• • Early intervention: Starting from pre-marriage and pregnancy stages to reduce gestational diabetes risk.
  • Lifestyle modifications: Promoting healthy diets, physical activity, and tobacco cessation.
  • Screening and diagnosis improvements: Rapid scaling up of diagnosis to meet WHO’s 2030 target.
  • Diabetes reversal and remission: Possible in some individuals, especially if identified at the pre-diabetes stage.

POLICY IMPLICATIONS AND RECOMMENDATIONS:

• • Meeting WHO targets for 2030: Ensuring 80% of people with diabetes are diagnosed and 80% of diagnosed cases have reasonable glycemic control.
  • Improving diagnosis and treatment access: Treatment gaps widen in low- and middle-income countries.
  • Dietary recommendations: Promoting low-AGE (Advanced Glycation End products) diets, which have shown improvement in insulin sensitivity.
  • Physical activity promotion: Implementing policies to encourage regular exercise and active lifestyles.
  • Air pollution control: Recognizing and addressing air pollution as a diabetes risk factor.

THE CONCLUSION:

Studies show that South Asians tend to accumulate more intra-abdominal fat when overfed than Europeans due to fewer small adipocytes (fat cells), leading to higher rates of type 2 diabetes. The Diabetes Prevention Program (DPP) demonstrated that lifestyle interventions involving weight loss (7%) and moderate-intensity exercise (150 minutes per week) can reduce the incidence of type 2 diabetes by up to 58%.

UPSC PAST YEAR QUESTIONS:

Q.1 In order to enhance the prospects of social development, sound and adequate health care policies are needed, particularly in the fields of geriatric and maternal health care. Discuss. 2020

Q.2 Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All ‘in India. Explain. 2018

MAINS PRACTICE QUESTION:

Q.1 “India has become the global epicenter of the diabetes epidemic.” Discuss

SOURCE:

https://www.thehindu.com/opinion/editorial/%E2%80%8Bgrowing-epidemic-the-hindu-editorial-on-diabetes-and-india/article68878483.ece#:~:text=%E2%80%8BGrowing%20epidemic%3A%20On%20diabetes%20

and%20India&text=From%20around%20200%20million%20in,The%20Lancet%20on%20November%2013.