NEW DELHI: An estimated 101 million people in India were detected with diabetes, 136 million were found to be prediabetes and 315 million people from hypertension in 2021, a first-of-its-kind study by ICMR-INDIAB, which measured the prevalence of metabolic non-communicable diseases (NCDs) in the country, said Thursday.
The survey, one of the largest, conducted in 31 states and union territories, also found that 254 million people had generalised obesity, 351 million had abdominal obesity, and in addition, 213 million people had hypercholesterolaemia (high cholesterol), and 185 million had high LDL cholesterol or bad cholesterol.
The survey, conducted by the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB), covered 1,13,043 people - 33,537 urban and 79,506 rural populace between 2008 and 2020; it also said that some states like Kerala, Puducherry, Goa, Sikkim, and Punjab report the highest prevalence of NCDs as compared to other parts of India.
It also found that diabetes prevalence was highest in the southern and northern regions of India, with urban areas having a high plurality throughout. The central and northeastern regions had lower prevalence, said the study, which was published in The Lancet Diabetes and Endocrinology on Thursday.
What is more worrisome is that the number of people with prediabetes is higher than that of those with diabetes, said Dr V Mohan, Chairman Madras Diabetes Research Foundation (MDRF), who coordinated the national survey.
“This shows that the epidemic is far from over, and we can expect further prevalence in diabetes in the years to come,” he told this paper, adding that the diabetes figure had seen a massive jump from previous years when the figure stood at an estimated 74 million.
The cross-sectional, population-based survey conducted on people above 20 years found that generalised obesity was significantly higher in females.
Of the lipid parameters, only high cholesterol was significantly higher in males, while hypercholesterolaemia, low HDL cholesterol, and high LDL cholesterol were significantly higher in females.
The 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. However, the prevalence of prediabetes was not significantly different between urban and rural areas.
The prevalence of other cardiometabolic risk factors, such as obesity, hypertension, and dyslipidaemia, is uniformly high across the country, particularly in urban areas.
Overall, hypertension was highly prevalent throughout the country except in the central region, more in the urban areas.
High prevalence rates of both generalised and abdominal obesity were seen in urban areas as compared to rural areas.
While abdominal obesity was high in all the regions of India, generalised obesity was more prevalent in the south, followed by the northern and eastern areas.
The prevalence of hypertriglyceridaemia and low HDL cholesterol was high in all the regions of India, with very little urban-rural difference. In contrast, hypercholesterolaemia and high LDL cholesterol showed comprehensive interstate and inter-regional variability, with the highest prevalence in the northern region, Kerala, and Goa.
Dr R M Anjana, President of MDRF, said that the study shows “dramatic increases of all the metabolic NCDs in the country. The rates have risen in almost all the states but with wide urban-rural differences in the prevalence of NCDs. Except in some states like Kerala where the rural prevalence is equal or higher than the urban prevalence in NCDs.”
“In more developed states, diabetes prevalence seems to be plateauing off, while in less developed states, further steep increases in prevalence appeared to be likely. Southern states had higher rates of NCDs, and some states in the north, while in the east and northeast are still on the lower side,” she said.
The study said that there is a very high prevalence of diabetes and related NCDs in the country, which translates to a large population of individuals at risk of not only cardiovascular disease but also of chronic complications of diabetes such as kidney, foot, and eye disease, the costs of treating which are crippling to the individual, society, and country as a whole.
“Moreover, the high prevalence rates of obesity and prediabetes across the country (even in regions where the prevalence of diabetes is currently low) suggest that the epidemic will continue to accelerate, especially since Asian Indians tend to develop diabetes at lower levels of obesity, and to progress faster from prediabetes to diabetes compared with white Caucasians,” the study said.
It said that the uniformly high prevalence of prediabetes in rural areas is of grave concern since these areas, in general, lack the infrastructure to care for increasing numbers of people with diabetes and its complications
“A significant proportion of India’s population (particularly in rural areas) depends on the government for the provision of health care; strengthening the public health-care system is an essential step towards improving diabetes and NCD care in these regions,” the study added.
The focus should therefore be on implementing interventions to minimise the progression of prediabetes to diabetes in states where the diabetes epidemic has yet to peak and providing optimal care to ensure comprehensive risk factor reduction in individuals with diabetes to prevent complications in those states where the epidemic has already stabilised, it added.