​Growing epidemic: The Hindu Editorial on diabetes and India

From around 200 million in 1990, the number of people with diabetes has quadrupled globally to over 800 million in 2022 while the global diabetes prevalence in adults rose from 7% to 14% between 1990 and 2022, as in data released in The Lancet on November 13. At 212 million, India has the highest number of people with diabetes as against China’s prevalence of 148 million. India also topped the list of countries with 133 million people over the age of 30 years with untreated diabetes as against 78 million in China. One reason for the steep increase in the number of those with diabetes was the methodology used for pooling and analysing the data — being on medication for diabetes, or having a fasting plasma glucose of 7·0 mmol/L or more, or an HbA1c of 6·5% or more. Unlike earlier studies that mostly relied on elevated fasting plasma glucose or other single-biomarker data, the analysis by the NCD Risk Factor Collaboration with support from the World Health Organization (WHO) included people whose fasting plasma glucose or glycated haemoglobin (HbA1c) was elevated. Taking into account elevated fasting plasma glucose alone without including those with elevated glycated haemoglobin, the study notes, misses out many people with diabetes, particularly in south Asia. That diabetes prevalence in India has increased in the last three decades is beyond doubt even if the absolute numbers are contested.

While consumption of unhealthy food, particularly high-calorie foods rich in carbohydrates and saturated fat, and a sedentary lifestyle are two major controllable risk factors for diabetes, the role of tobacco in causing diabetes has not been highlighted sufficiently. According to a November 2023 WHO report, there is overwhelming evidence that cigarette smoking raises the risk of developing diabetes by 30%-40% compared with those who do not smoke. Nicotine, the addictive substance in tobacco, impairs the function and amount of insulin producing beta cells, thereby affecting insulin production and regulation of glucose production, which together play an important role in the onset of diabetes. Nicotine also induces insulin resistance, another factor causing diabetes. Besides sharply lowering the risk of diabetes, avoiding tobacco in all forms is associated with a reduced risk of cardiovascular disease and mortality in people with diabetes. The role of managing gestational diabetes in reducing the risk of both mother and child developing diabetes at a later date cannot be overemphasised. With 133 million people remaining undiagnosed, India has to rapidly scale up diagnosis to meet the 2030 WHO target for diabetes — 80% of people with diabetes are diagnosed and 80% of people with diagnosed diabetes have good control of glycaemia.