Despite the fact that type 2 diabetes has long been a health problem associated with rich and developed regions such as Europe and North America, the disease is now affecting more and more developing countries – sometimes with much more dramatic consequences. As a matter of fact, it is considered that nearly 80% of diabetes-related deaths today occur in developing countries with weak health and medical resources. This is particularly the case in India, where, according to the latest WHO report in 2019, more than 74 million people have type 2 diabetes, making it the second most affected country in the world, after China. Some forecasts even predict that these two countries will account for almost a third of all diabetics by 2045. But what is really happening with the diabetes epidemic in India? What are the reasons for the surge in type 2 diabetes? What are the prevention mechanisms put in place by the authorities? And what are the socio-economic impacts of diabetes in India? Let’s take a closer look.
Current status of the diabetes epidemic in India
Diabetes in India is a relatively new disease. While cases began to explode from the late 1950s in France, Europe, and North America, diabetes really took off from the late 1970s and early 1980s in India.
For example, in the early 1970s, the prevalence of diabetes among urban Indians aged 20-79 years was 2.1%. Thirty years later, in the early 2000s, this prevalence increased to 12%. Today, the prevalence for the same population group is 21%.
The same is true for the growth of diabetes in rural populations, although the prevalence rate is a few percentage points lower than in urban areas. Higher prevalence rates (around 25% prevalence) are also seen in the northern part of the subcontinent. These are more economically developed than the southern regions of the country, which have a prevalence rate of around 18%.
Nationally, the prevalence rate of diabetes among Indians in all categories (rural and urban) is around 10-11%.
Today, India reports over 74 million people with diabetes. Type 2 diabetes represents the vast majority of cases observed (about 95%). The number of people with diabetes has doubled in the last 20 years: there were “only” 32 million Indians with diabetes in 2001.
However, these figures are only the tip of the iceberg: the International Diabetes Federation (IDF) estimates that nearly half of all diabetics in India are undiagnosed, which would tally up to about 40 million people.
And the forecasts are even bleaker. The same federation predicts that India will have 92 million diabetics by 2030 and 124 million by 2045, not counting undiagnosed cases.
The various causes of the diabetes epidemic in India
It is widely accepted that type 2 diabetes can be caused by many factors, both exogenous and endogenous. Let’s have a look at them in more detail.
Today, one of the main causes of the surge in diabetes cases in India is, according to many scientists, exogenous. Indeed, the etiology of type 2 diabetes (unlike type 1 diabetes, which is genetic in origin) is considered to be partly related to lifestyle.
A sedentary lifestyle, lack of exercise, obesity, high sugar intake, stress and lack of sleep are all risk factors for the development of type 2 diabetes.
While these risk factors were mainly found in developed countries from the late 1950s onwards (which explains the rise in diabetes cases in Europe and the United States at that time), they have been found in India for the past 30 years.
Thus, the change in the lifestyle of Indians – induced by the economic development of the country and a change in consumption patterns – would be the cause for the increase in the prevalence rate of the disease. For example, the prevalence of type 2 diabetes and the number of overweight and obese people in the country can easily be superimposed. Other studies have clearly shown that there is a surprisingly high prevalence of diabetes among obese and overweight people.
There has also been a change in the diet of urban Indians, which has led to an increase in diabetes. Traditional dietary habits are disappearing and unrefined wheat, rice or millet are being replaced by refined wheat or rice, leading to an increase in calorie intake and saturated fatty acids, which are responsible for the development of type 2 diabetes.
Thus, the transition from a traditional to a more modern lifestyle is believed to be responsible for the increase in diabetes cases in India.
However, while the increase in the prevalence of diabetes in India is mainly caused by exogenous factors, it is not the sole cause. There are some endogenous factors which, together with exogenous factors, explain the diabetes epidemic in India.
First of all, numerous studies have shown that some Indians, especially those of Asian origin, are more resistant to insulin than other human groups, such as Caucasians for example.
This genetic condition leads Indians to develop insulin resistance from an early age, and sometimes even during their intrauterine development. This is associated with the accumulation of abdominal fat, which is linked to the development of type 2 diabetes.
Other studies have shown that Indian migrants are more likely to develop type 2 diabetes than host country populations. This is explained both by the change in lifestyle, but also by the propensity of their bodies to develop insulin resistance.
It was also found that Indians developed diabetes earlier than other populations.
India: a country at the end of its demographic transition
Another reason for the surge in diabetes in India is the state of its demographic transition.
In recent decades, India has considerably reduced its infant mortality rate and increased its life expectancy. While developed countries have long since completed this demographic transition, India is only at a transitional stage.
This means that today the country continues to enjoy a high fertility rate and has managed to reduce its mortality rate. As a result, with higher life expectancy and lower infant mortality rates, more Indians are likely to suffer from diabetes.
Pre-diabetes, prevention and management of diabetes
The rising prevalence of pre-diabetes (a 2020 study indicated that one in six Indians had pre-diabetes) and diabetes – as well as their potential socio-economic impact on the country – is of great concern. In the space of thirty years, this prevalence has become a major public health problem.
However, tackling diabetes (and a health problem in general) in the world’s second most populous country is a challenge. There are problems with diabetes prevention and management, a lack of strong local and national partnerships, and the amount of money allocated to diabetes control.
This is compounded by the fact that there is a general lack of awareness of diabetes and pre-diabetes in India, due to its status as a “new disease”.
The lack of economical resources also delays the diagnosis and even treatment of diabetes. For example, a diabetes treatment (including consultation, equipment and insulin) costs between 1500 and 3000 rupees per month (i.e., between 20 and 40 euros), an amount that many Indians cannot afford to spend, as the average monthly income per inhabitant is around 170 euros per month.
The authorities are therefore relying more on awareness and prevention campaigns to limit the spread of the epidemic.