India stands at the cusp of an epidemic over the worrisome trend of increasing diabetes cases in the country in recent years. About 10 crore Indians would turn diabetic by 2023, according to a national survey conducted by ICMR-India Diabetes, which was released in June, raising concerns among doctors and policymakers. Initially, it was estimated that India would have 10 crore diabetic patients by 2050. The disease has spread like wildfire across the country, with high prevalence observed in states such as Goa, Kerala, Puducherry and West Bengal.
Even more alarming is that around 14 crore people are in the pre-diabetes stage. This means that many of them are at risk of developing diabetes, further burdening the healthcare system. Several factors contribute to the rise in diabetes cases in India. Genetics, unhealthy diets, lack of exercise and socioeconomic disparities - all play a role. More people are consuming processed foods and sugary drinks instead of traditional and healthier meals. Simultaneously, physical activity has decreased significantly. These lifestyle changes have led to higher incidence of diabetes.
At the core of this lifestyle disease is expanding in waist lines due to excess food consumption and lack of physical activity. There are over 15 crore people with general obesity and 35 crore with abdominal obesity in India. While some individuals are aware of their condition and strive to make lifestyle changes, many struggle to maintain them in the long run. People may initially go to the gym, restrict their food intake or try popular fad diets.
However, most individuals eventually revert to previous habits, even after being diagnosed with diabetes. "Diabetes is a lifelong lifestyle disease that requires continuous maintenance. Many patients are unable to sustain dietary regulations and exercise regimens. Some patients even fail to adhere to their prescribed medications. It is worrying that 70% of patients have uncontrolled diabetes," said Dr P K Jabbar, director and CEO of Indian Institute of Diabetes, Thiruvananthapuram. Uncontrolled diabetes not only increases treatment costs, but also leads to complications.
There was a misconception that diabetes would affect only the urban upper middle class and the rich. But the ground situation begs to differ. A study report from Odisha found rising prevalence of diabetes among the rural population and tribal hinterlands in the state. "It is a myth that diabetes afflicts the affluent. People living in rural and tribal areas of the state are getting affected due to abrupt changes in lifestyle and diet,” said Dr Abhay Kumar Sahoo, a professor and a senior endocrinologist.
“The better socio-economic status of the people leads to higher obesity rates and this is one of the driving forces. Also, with affluence the use of junk foods and high-calorie foods which are rich in sugar, fat and calories goes up and physical activity comes down because people can afford two-wheelers and cars,” said Dr V Mohan, chairman of the Madras Diabetes Research Foundation, adding that stress levels can also be high in these individuals.
Tackling the diabetes challenge requires a comprehensive approach that addresses individual behaviour as well as social, economic and environmental factors contributing to the disease. Various factors hinder patients from making positive changes. Limited opportunities for physical activity, such as lack of dedicated walkways, can discourage people.
Dr Ridhhima Batra, of Nutrition Defined, explained that post-pandemic people’s food habits have changed, especially for the ones living away from home. “Consumption of packaged food has changed significantly with changing working patterns and lifestyles. With the work-from-home culture, there is no work-life balance resulting in extended working hours and overeating at night. People’s poor diet habits with no physical exercise have resulted in an increased incidence of diabetes in India,”
Additionally, the absence of clear food labelling prevents consumers from making informed choices. While the focus often lies on managing diabetes and its numbers, health experts emphasise the need to prevent the progression of this epidemic. "It is not always a lack of awareness but rather the unsupportive environment that poses challenges. Pre-diabetes, diabetes and the entire spectrum of metabolic conditions are social diseases. Understanding the social factors contributing to diabetes development and implementing large-scale policy measures are vital for its prevention in India," said Dr Jeemon Panniyammakal, additional professor (epidemiology) at the Sree Chitra Tirunal Institute for Medical Sciences and Technology.
Policy Interventions for Prevention
Simplified classification of food items to choose healthy options
Subsidise healthy food options by taxing unhealthier options
Infrastructure development like dedicated cycling paths, walking path, parks
Incentive for farmers to produce more fruits and vegetables
Focus on the quality of food items distributed through PDS
Diabetes care
(With inputs from Hemant Kumar Rout, Namrata Sindwani and Kavita Bajeli-Datt)