Lifetime risk of diabetes in metropolitan cities is alarming, warns study with disturbing trends

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A new study by well-known experts through research published in Diabetologia (the official journal of the European Association for the Study of Diabetes) shows that more than half of men (55%) and some two- thirds (65%) of women currently aged 20 years in India are likely develop diabetes in their lifetime, with most of those cases (around 95%) likely to be type 2 diabetes (T2D). The research is from a team of authors in India, the UK and the USA, led by Dr. Shammi Luhar, Department of Public Health and Primary Care, University of Cambridge, UK, collaborating with Dr.V.Mohan Chairman and Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre, President and Director of the Madras Diabetes Research Foundation in Chennai and Dr.Nikhil Tandon of All India Institute of Medical Sciences, New Delhi.

 

India already has a significant health burden caused by diabetes with estimates suggesting 77 million adults currently having diabetes and this number is expected to almost double to 134 million by 2045. As a serious warning to the Urban Indians in the cities,   the study effectively highlights the potential dangers in the risk of developing Diabetes owing to a number of factors. Major factors are namely Urbanization, decreasing diet quality, and decreased levels of physical activity which together have inflated the burden of the hidden epidemic. The authors  in this new research have  aimed to estimate the probability of a metropolitan (urban-based) Indian of any age or body mass index (BMI) developing diabetes in their lifetime based on the rapidly growing urban centres.

With Obesity having a substantial negative impact in this study, the research also stated that the lifetime risk was highest among obese metropolitan Indians: 86% among 20-year-old obese women and 87% among obese men. For people with normal or underweight BMI, the risk was around 41.2% among 20- year-old underweight/normal-weight men and 51.6% among under-weight/normal-weight women.

Dr.V.Mohan, Chairman and Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre, President and Director of the Madras Diabetes Research Foundation in Chennai, one of the authors of the study says: “The remarkably high lifetime risk of developing diabetes in India’s metropolitan cities, especially for individuals with obesity, implies that interventions targeting the incidence of diabetes is to be of paramount importance.

Dr.R.M.Anjana, Managing Director and Diabetologist, Dr. Mohan’s Diabetes Specialities Centre and Vice President, Madras Diabetes Research Foundation, Chennai another author of the study states, “Indians living in the large city has an alarmingly high probability of developing diabetes compared with those living in high-income countries. Hence, proactive efforts to prevent diabetes in metropolitan cities are urgently needed, given the rapid increase in urban obesogenic environments across the country”. She adds,“The fact that Indians and other South Asian populations already have a higher predisposition to developing diabetes at lower ages (up to a decade earlier) and lower BMIs when compared with the white European population makes prevention of diabetes even more of a priority”.

One study from the USA, using data from 2000-2011, reported a lifetime risk diabetes of 40% among men and women aged 20 years in the white Caucasian population. Dr.Venkat Narayan, one of the collaborators of the study says: “Our new estimates from India are much closer to estimates of lifetime risk of diabetes of 20-year olds among the black and Hispanic populations in the USA (above 50%), groups considered at a higher risk of developing diabetes than the white population.”

Dr. Luhar adds: “Such high probabilities of developing diabetes will have severely negative implications for India’s already strained health system and also out-of-pocket expenditure on diabetes treatment by patients, unless diabetes is immediately acknowledged for what it is: one of the most important threats to public health in India.”

Adding an optimistic note, Dr. V. Mohan added:  “Despite these very high predicted lifetime risks of diabetes, it is possible to prevent or postpone diabetes by effective lifestyle modification, such as following a healthy diet, by increasing physical activity and reducing body weight in those who are obese or overweight.”

Professor Nikhil Tandon from the Department of Endocrinology and Metabolism, All India Institute of Medical Sciences in New Delhi, and co-author of the paper also added: “We need policy and investment with clearly spelt out targets and commitments to meet by 2030. Perhaps an aspirational target of ’90-90-90′ (90% of people with diabetes detected, 90% of those detected treated, and 90% of those treated controlled), is imminently needed. Such a target could operate in the same way as the 90-90-90 targets introduced some years ago for HIV, which has since been replaced by even more ambitious 95-95-95 targets.”

The data for the study came from using age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research IndiaDIABetes study (2008-2015). The authors estimate that lifetime risk of developing diabetes in 20-year-old men and women free of diabetes today is 56% and 65%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk of developing diabetes declined with age: the authors estimated that for those currently aged 60 years and currently free  of diabetes, around 38% of women and 28% of men would go on to develop diabetes in their lifetime.

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