Image used for representation purposes. File

On International Diabetes Day (November 14), there was bitter news for nations of the world. A paper published in the peer-reviewed journal, The Lancet, based on a global study, recorded over 800 million adults living with diabetes, with more than half not receiving treatment.  

Not surprisingly, India had the highest number of diabetics in the world, but surprisingly enough, the number was nearly 100 million more than the numbers revealed as part of the nation-wide Indian Council of Medical Research (ICMR)-INDIAB study last year. Splitting hair over figures apart, there are clear indications that the number of people with diabetes is increasing in India, and investing in the prevention of diabetes, its treatment, and in the prevention of complications, is imperative.  

The study, conducted by the NCD Risk Factor Collaboration (NCD-RisC), along with the World Health Organization (WHO), used data from over 140 million people (18+ years) culled from more than 1,000 studies in different countries.  

According to the study, the total number of adults living with either Type 1 or Type 2 diabetes in the world has surpassed 800 million — over four times the total number in 1990. Of this 800 million, over a quarter (212 million) live in India, with another 148 million in China.

“Our study highlights widening global inequalities in diabetes, with treatment rates stagnating in many low- and middle-income countries, where numbers of adults with diabetes are drastically increasing. This is especially concerning as people with diabetes tend to be younger in low-income countries, and in the absence of effective treatment, are at risk of life-long complications, including amputation, heart disease, kidney damage or vision loss, or in some cases, premature death,” senior author Majid Ezzati, of the Imperial College, London, said.

One of the reasons for the huge numbers might be the use of either HbA1c value or fasting glucose, whichever data was available in different nations, explained V. Mohan, chairperson, Madras Diabetes Research Foundation. “The gold standard is fasting blood glucose and two-hour post prandial value after an oral glucose tolerance test (OGTT). This is what we used in the ICMR-INDIAB study. If they went by OGTT values alone, then the number would be half of what was recorded,” Dr. Mohan said. 

“Using HbA1c, they used a single cut-off point to determine diabetes — 6.5 %. Even in those with normal glucose, a small percentage will spill over into the 6.5% HbA1c value, depending on whether individuals are ‘fast’ or ‘normal glycators’. Glycation is influenced by many things, including anaemia, and advancing age. Of course, in a global study, there are limitations about using the data that is already available. The reality is that we need to do something urgent about preventing diabetes and its complications,” he added. 

“It is very clear that diabetes has been on the ascending limb in India for two decades. In this context, we need to undertake a war-like effort using mass media to spread awareness about nutrition, physical activity, [and] enacting more legal provisions to regulate carbs (carbohydrates) and sugar content in packaged food. We must educate women since they are prone to obesity post-pregnancy, and have a heightened risk at menopause. We need to cut off the rising trend of obesity with these efforts. A long-term vision for 10 years is required, with a dedicated task force assigned to the task,” Anoop Mishra, chairperson, Fortis CDOC Hospital for Diabetes and Allied Sciences, said.  

“Our findings highlight the need to see more ambitious policies, especially in lower-income regions of the world, that restrict unhealthy foods, make healthy foods affordable, and improve opportunities to exercise through measures such as subsidies for healthy foods and free, healthy school meals, as well as promoting safe places for walking and exercising, including free entrance to public parks and fitness centres,” Anjana Ranjit, president, Madras Diabetes Research Foundation, who was involved in the ICMR-INDIAB study, said.