Not all is good with India’s health! Study reveals alarming burden of NCDs across the country

Over 100 million living with diabetes, 136 million with prediabetes in India — Southern states fare worse in the study on NCD burden.

ByChetana Belagere

Published Jun 09, 2023 | 9:00 AMUpdatedJun 09, 2023 | 9:00 AM

Over 100 Million Indians Living with Diabetes, 136 Million with Prediabetes in India. Southern States faring worse in the study on NCD burden

“The situation is alarming. Our study reveals the enormous burden of non-communicable diseases (NCD) across the country. There is an urgent need for all state governments to sit up and initiate intervention strategies.”

This is what renowned diabetologist and Chairman of Dr Mohan’s Diabetes Specialities Centre (DMDSC), Dr V Mohan, said while announcing the results of a unique, comprehensive, historical study funded by the Indian Council of Medical Research and Ministry of Family Welfare (ICMR-INDIAB).

The groundbreaking epidemiological research paper was published in the globally-acclaimed medical journal, The Lancet Diabetes and Endocrinology.

A first-of-its-kind comprehensive study — covering all the states and Union Territories of India — shows that the country is grappling with a silent epidemic that threatens the health and well-being of its people.

The study shows India has a substantial population at risk of cardiovascular disease and other long-term organ complications due to metabolic NCDs.

On Thursday, 9 May, the researchers and doctors who part of the study told the media at a press conference that the findings are nothing short of a wake-up call, painting a bleak picture of a country overwhelmed by the burden of diabetes, prediabetes, dysglycemia, hypertension, obesity, and dyslipidemia.

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Why is this study on NCDs important?

The ICMR-INDIAB study is the largest survey on diabetes and other metabolic NCDs undertaken in India, covering all 28 states and two of its Union Territories.

The study aimed at quantifying the prevalence of metabolic NCDs in a representative sample of adults in both urban and rural India. It also identified region-wise and state-wise differences in the status of these NCDs in the country.

According to Dr RM Anjana, Managing Director of DMDSC and President of Madras Diabetes Research Foundation (MDRF), it was a herculean task as no other country has attempted such a massive study.

This study includes representative samples as large as 4,000 from across every state, including urban and rural areas.

“A study of NCDs, including six states with six districts, was done 60 years ago. Our cross-sectional, population-based survey sampled a total of 1.13 lakh individuals, of which 33,537 were from urban and 79,506 were from rural areas. The study sampled across all states and Union Territories of the country,” Dr Mohan said.

Meanwhile, the MDRF — being the national coordinating centre for this study — along with scientists from ICMR, was involved in the detailed task of planning and executing the project successfully.

“Principal investigators — best in their field of expertise — were identified from all the states and Union Territories. These investigators, in turn, chose the team who would do the door-to-door survey. The field officers were trained for 15 days in Chennai to ensure uniformity is maintained. Extensive quality checks were done, making the study even more authentic,” explained Dr Mohan.

Also Read: Abdominal obesity surges in Kerala and TN

Methods used for the study

The study was conducted between November 2008 and December 2020 using villages in rural areas and census enumeration blocks in urban areas as primary sampling units.

The study was carried out in different phases, covering various regions and states. The study population consisted of individuals who were present at home during the survey period and were not terminally ill.

Measurements such as weight, height, waist circumference, and blood pressure were recorded, and BMI was calculated using standardised techniques.

Projection of Non communicable disease burden in the country.

Projection of NCD burden in the country. (Supplied)

Capillary blood glucose (CBG) levels were measured using a glucose meter in all individuals, and an oral glucose tolerance test (OGTT) was conducted for individuals without a previous diabetes diagnosis. Venous blood samples were collected to assess HbA1c and lipids, and biochemical assays were performed using standardised methods.

The study focused on several outcomes of interest, including diabetes, prediabetes, dysglycemia, hypertension, generalised obesity, abdominal obesity, and dyslipidemia. Prevalence estimates for these metabolic NCDs were reported in 2021.

The data analysis accounted for the complex multistage survey design by using survey-adjusted statistical methods. To determine the current prevalence of cardiometabolic risk factors in each state, the estimates were standardised based on age, sex, and region using information from the National Family Health Survey 5 (NFHS-5).

Also Read: 20% of Kerala’s population suffers from hypertension, diabetes

South & North India have highest number of diabetics

Diabetes, a condition that once seemed to affect only a fraction of the population, now afflicts more than 100 million Indians. The six-phase study estimates that there are 101 million people with diabetes and, shockingly, an additional 136 million individuals are living with prediabetes, a precursor to the full-blown disease.

A national prevalence of 11.4 percent was noted, with Goa showing the highest prevalence at 26.4 percent and Uttar Pradesh showing the lowest prevalence at 4.8 percent. Meanwhile, there was a 15.3 percent prevalence of prediabetes nationally, with Sikkim showing the highest prevalence at 31.3 percent and Mizoram showing the lowest prevalence at 6.8 percent.

Projections for metabolic disease prevalence in India

Projections for metabolic disease prevalence in India. (Lancet Journal)

“Diabetes prevalence was highest in the southern and northern regions of India, with urban areas having high prevalence throughout,” the study stated. The central and northeastern regions had a lower prevalence.

Conversely, prevalence of prediabetes was highest in the central and northern regions of India, and lowest in Punjab, Jharkhand, and some parts of the northeastern region

Also Read: Diabetes prevalence in rural TN has skyrocketed by 158% in 11 years

South Indian states that are in the red

States and Union Territories of southern India that showed above 10 percent prevalence of diabetes are Kerala, Tamil Nadu, Puducherry and Karnataka. Telangana and Andhra Pradesh have a prevalence between 7.5 to 9.9 percent for diabetes.

Dr Mohan said that dietary reasons including eating of rice, sedentary lifestyles, increase in obesity could possibly be some of the reasons for the high prevalence among southern states.

Overall and area wise weighted prevalance of diabetes and prediabetes.

Overall and area-wise weighted prevalence of diabetes and prediabetes. (Lancet Journal)

Interestingly, when it came to prediabetes, while the national prevalence is higher than that of diabetes at 15.3 percent, all southern states showed a prevalence between 10 to 14.9 percent.

However, Puducherry has shown high prediabetes prevalence as well. It can be noted that the researchers stated that the speed at which pre-diabetes is increasing is alarming and needs immediate attention. “Even if one-third of these prediabetics turn into diabetics, it’s going to be disastrous,” explained Dr Mohan.

Meanwhile, the prevalence of prediabetes was not significantly different between urban and rural areas. Dr Anjana informed that the ratio of diabetes to prediabetes was 1:2 or less in Arunachal Pradesh, Bihar, Madhya Pradesh, Meghalaya, Chhattisgarh, Rajasthan, Sikkim, and Uttar Pradesh (most of which are states with a lower human development index). The ratio was 1:1 or more in Chandigarh, Goa, Delhi, Kerala, Mizoram, Puducherry, Punjab, and Tamil Nadu (all states with a high human development index).

The study also reveals that dysglycemia, a term encompassing diabetes and prediabetes, affects nearly half the population when using both oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) as diagnostic criteria.

This finding highlights the importance of early detection and intervention to prevent the escalation of these conditions. However, the use of different diagnostic criteria by the American Diabetes Association (ADA) leads to variations in prevalence, emphasising the need for standardised guidelines in India.

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Hypertension on the rise

Hypertension and Generalised obesity prevalence.

Hypertension and generalised obesity prevalence. (Lancet Journal)

Furthermore, hypertension, a major risk factor for heart disease and stroke, afflicts a staggering 35.5 percent of Indians, noted the study.

Of this, all the southern states have a hypertension prevalence above 30 percent. Of this, Puducherry is the highest with 51.8 percent prevalence and Jharkhand is the lowest with 11.6 percent prevalence.

However, applying the more stringent criteria set by the American College of Cardiology/American Heart Association reveals an even more troubling reality, with the prevalence nearly doubling to 66.3 percent.

“Such high rates of hypertension signify a ticking time bomb, threatening the health of millions and straining an already burdened healthcare system,” Dr Mohan explained.

Obesity in India needs immediate focus

The study also unveiled the shocking extent of obesity in the country. Generalised obesity affects 28.6 percent of the population.

In the southern India region, the ICMR-INDIAB study revealed concerning statistics regarding both general obesity and abdominal obesity.

The study highlighted that a significant proportion of the population in southern India is affected by general obesity. General obesity is characterised by an overall excess accumulation of body fat and is typically assessed using body mass index (BMI) measurements.

India is turning obese. Needs attention now say docs

India is turning obese. Needs attention now, say doctors. (Lancet Journal)

Karnataka, Tamil Nadu, Telangana, Andhra Pradesh, and Kerala show generalised obesity prevalence of above 25 percent.

Abdominal obesity is typically assessed using waist circumference measurements, which provide an indication of the distribution of fat around the waist. The overall prevalence is 39.5 percent in almost every state in India except for Bihar, Maharashtra, and Assam shows prevalence above 25 percent. It is considered a major risk factor for various NCDs, including diabetes and cardiovascular diseases.

These conditions not only impact individuals’ physical appearance but also significantly increase the risk of developing serious health conditions. “Addressing these obesity-related issues should be a priority for public health interventions and policies in the region,” Dr Anjana added.

Also Read: Lifestyle prescriptions and their importance in treating diabetes

Changes that can be made

Focusing on promoting healthy lifestyles, encouraging regular physical activity, and advocating for balanced and nutritious diets, we can combat the rising prevalence of obesity, stated the study.

representative pic

Concerted efforts and proactive measures can help tackle the obesity crisis, said the study. (Commons)

Additionally, raising awareness about the risks associated with obesity and implementing targeted interventions can help individuals make informed choices and take proactive steps to maintain a healthy weight.

Dr Mohan added that it is crucial for the government and healthcare authorities to prioritise the prevention and management of obesity, both general and abdominal, through comprehensive strategies that encompass education, access to healthcare services, and the creation of supportive environments for healthy living.

Only through concerted efforts and proactive measures can we effectively tackle the obesity crisis and safeguard the well-being of the population in India, he stated.

Meanwhile, dyslipidemia, characterised by abnormal cholesterol and lipid levels, is present in a staggering 81.2 percent of Indians, primarily driven by low levels of high-density lipoprotein (HDL) cholesterol.

Also Read: Night owls could have greater risk of type-2 diabetes, heart disease

What should the government do with this data?

The doctors present at the conference said, “The findings of this study serve as a call to action for policymakers, healthcare professionals, and individuals alike. Prevention, early detection, and access to affordable healthcare must be prioritised to mitigate the devastating impact of these diseases on individuals, families, and the nation as a whole,” opined the doctors unanimously.

prevalance of diabetes

Prevalence of diabetes as part of the study. (Supplied)

Doctors stressed that the ICMR-INDIAB study has provided a wake-up call, compelling people to recognise the urgent need for government action. The repercussions of inaction are dire, they warned.

Dr RS Dhaliwal, Scientist ‘G’ & Head, Non-communicable Disease Division, ICMR, said, “It is quite evident from the study results that India has a substantial population at risk of cardiovascular disease and other long-term organ complications due to NCDs. We must act now,” he said.

Dr Mohan told South First, “Without concerted efforts to tackle the root causes of NCDs, India risks facing a future where an ever-increasing number of its citizens suffer from preventable, debilitating illnesses.”

He said that this data will be submitted to health secretaries and health minister of each state and the individual states can look into tailor-made solutions, specifically for their state, keeping the study finding in mind.

It is imperative that the government, healthcare providers, educational institutions, and civil society work together to implement effective preventive measures, promote healthy lifestyles, and ensure access to quality healthcare for all. Only then can we hope to build a healthier, more resilient India, where the burdens of diabetes, hypertension, obesity, and dyslipidemia are truly lifted, added Dr Mohan.

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Short-term remedies

Changing dietary habits and lifestyle habits can be a short-term remedy to at least manage diabetes and prevent prediabetics from turning to diabetics, explained Dr Mohan.

He also added that public awareness is a crucial weapon in the battle against NCDs. Individuals must be equipped with the knowledge to make informed choices about their lifestyle and healthcare.

By disseminating accurate information through mass media campaigns, educational programs, and community outreach initiatives, we can empower our citizens to take charge of their health and make the necessary changes to prevent and manage NCDs.

Meanwhile, the doctors stressed on prevention. They said that it is high time we allocate resources and funding accordingly. The government must invest in comprehensive preventive measures that target the root causes of NCDs.

To effectively combat NCDs, we need a robust healthcare infrastructure that can provide timely and quality care to those affected. Hospitals, clinics, and primary healthcare centers must be adequately staffed, equipped, and accessible across the country, they added.

“The findings of the ICMR-INDIAB study leave no room for complacency. We call upon the government to demonstrate true leadership and prioritise public health. It is imperative that sufficient funds are allocated and evidence-based policies are formulated to combat this growing crisis. The time for half-hearted measures is over. Our elected representatives must rise to the occasion, address the root causes of NCDs, and secure a healthier future for all,” stated the authors of the study.

Also Read: Minor change in the Indian diet can reverse, manage diabetes