Study shows fairly strong correlation between GDP of a state and prevalence of diabetes
Dr V Mohan, Chairman, Dr Mohan’s Diabetes Specialities Centre and President, Madras Diabetes Research Foundation and Dr RM Anjana, MD, Dr Mohan’s Diabetes Specialities Centre, talks about ICMR – India DIABetes [INDIAB] Study and the growing prevalence of diabetes in urban and rural India
The ICMR – India DIABetes [INDIAB] Study, the population-based cross-sectional study, is aimed to estimate the national prevalence of diabetes and pre-diabetes in India. Could you elaborate on the takeaways from the study?
The ICMR – INDIAB Study is one of the largest epidemiological studies on diabetes ever done and certainly the largest on diabetes done in India. It is also the first study in India to look at whole states of the country. In the publication in Lancet Diabetes Endocrinology, the prevalence of diabetes and pre-diabetes in 15 whole states of the country were reported. The results show several findings.
- There are huge variations in the prevalence of diabetes and pre-diabetes in different states of India. Some states like Bihar and Jharkhand still have relatively low rates of diabetes while states like Tamil Nadu, Punjab and Chandigarh have very high rates of diabetes. In some of the states where the diabetes rates are low, the pre-diabetes rates are high suggesting that the genetic tendency is there, but they have not yet converted to diabetes.
- The study also showed that there was a fairly strong correlation between the GDP of a state and the prevalence of diabetes showing that as the state become more affluent, diabetes rates are increasing. This is probably related to obesity levels increasing as well as physical activity coming down as well as possibly changes in dietary habits of the people.
As diabetes is a major constituent of growing NCDs in India, is there an action plan in place to approach the policy makers to devise strategies to control diabetes?
The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was started by the Government of India in the year 2010. It’s a comprehensive programme which looks at the control of diabetes at different settings, i.e., at the primary care setting, secondary care setting and the tertiary care settings. The programme emphasises on changing life styles, preventing obesity, increasing physical activity and healthy eating. There is also some emphasis on stress reduction through yoga and meditation and relaxation techniques as well. This kind of primary prevention measures is adopted, will help to control, not only diabetes, but also other metabolic NCDs like obesity, hypertension, dyslipidemia and coronary artery disease.
The study states that diabetes epidemic seems to be maturing in the more economically advanced states of India. What are the factors influencing the growth in various states? Do these factors overlap?
The ICMR – INDIAB Study has shown clear evidence of epidemiological transition. In more economically developed states of India, there is not only an increase in the prevalence rates of diabetes but also a shift in the burden from the high and middle income group to the lower income groups, especially in the urban areas. Thus in urban areas of Tamil Nadu, Punjab, Maharashtra and Chandigarh, poor people seem to have more diabetes than the middle and the higher income groups. However, in rural areas of all the states studied, the more affluent people suffered from diabetes.
The advantage of the ICMR – INDIAB Study is that since each state has its data on diabetes, pre-diabetes and other NCDs, health being a state subject, each state can then prioritise what policies need to be adopted to curtail the diabetes epidemic.
Factors influencing the growth of diabetes are similar in various states. There is a clear increase in diabetes with affluence because with affluence, mechanisation in the way of motorised transport becomes available. So, instead of walking or cycling, people now use two wheelers or cars which brings down the physical activity considerably. They also tend to eat food which is rich in calories, carbohydrates and fat, all of which are obesogenic and thereby lead to increased diabetes rates.
Examining the factors, would you recommend a general or a customised plan of action?
To control the diabetes epidemic, may things need to be done. The first is primary prevention of diabetes. For this, a generalised plan encouraging people to increase their exercise levels, ie., 30 minutes of brisk walk, atleast five times a week and cutting down on carbohydrate (e.g., polished rice or wheat) in the food and replacing this with plenty of green leafy vegetables and protein. It was shown that this can reduce the diabetes incidence by more than 30 per cent as shown in the Diabetes Community Lifestyle Improvement Program (D-CLIP) carried out by Dr V. Mohan and colleagues at the Madras Diabetes Research Foundation (MDRF) in collaboration with Dr Venkat Narayan and his team at the Emory University. This can be called as a ‘population-based approach’ or a ‘generalised approach’. In addition, those who are at ‘high risk’, for example those who have the family history of diabetes or obese or physically inactive or have other NCDs like hypertension, dyslipidemia, etc., are at much high risk of getting diabetes, should undergo early screening to detect diabetes and most intensive life style changes to prevent diabetes.
In the study, it is evident that the prevalence of the disease in urban India is twice that of rural India. What are the learnings needed to be incorporated from the rural setting in order to curtail diabetes?
Yes, it is true that in all the 15 states studied, the prevalence of diabetes was higher in the urban areas compared to the rural areas. However, the rural areas of India are fast urbanising and the habits of people in urban areas. Example, less physical activity, eating junk food, etc is fast being introduced in the rural areas of India as well. The lessons learned from urban India can be transferred to rural India. This is important because 70 per cent of India’s population now still lives in rural areas and even a small increase in the prevalence of diabetes in rural areas can result in millions of people in India developing diabetes.
The Chunampet Rural Diabetes Prevention Project (CRDPP) is a study conducted by Dr V Mohan and colleagues in Chunampet in Kanchipuram district and this has been widely acclaimed as a good model to prevent diabetes in rural India.
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