Here is some sobering news for the country: Diabetes is no longer a disease of the affluent urban resident. Clearly it is creeping up on rural and low-income groups as well.
A couple of recently-concluded studies have contributed to this sobering view of the epidemic. While Vijayakumar et al have concluded that the prevalence in rural Kerala is as high as 14.6 per cent, the Chennai Urban Population Study [CUPS] has showed that in a low-income locality in Chennai the prevalence of diabetes had risen from 6.5 per cent in 2001 to 15.3 per cent in 2009.
V. Mohan, Chairman of the Madras Diabetes Research Foundation that conducted the study, says, “If in a low income group, the prevalence has more than doubled in a nine-year period, it is certainly a cause for worry. There is another message - one of hope and is contained in the second part of the study. We have also shown that with intervention – mere lifestyle modification – it is possible to stem the rapid climb of the epidemic.”
This trend is a reflection of what happened many years ago in the West, Dr. Mohan points out. With the increasing affordability and availability of fast foods, more people belonging to lower economic groups began developing diabetes, he adds. Complemented by an increasingly sedentary lifestyle, the diet wreaked havoc among certain populations thought to be immune to diabetes.
In India, now, the lack of exercise and a shift in the dietary patterns is fuelling a similar shift. The CUPS study also showed that the body mass index went up by higher percentage points in the low-income group than in a middle income group among whom lifestyle modifications were introduced over the same period. Similarly, the increase in waist circumference and waist-hip ratio was also higher. All these could be markers of diabetes in a population.
“If more people in the low-economic groups are being affected, it is going to throw up questions of cost and affordability. We have to work out insurance and other support models in order that these people will be able to access at least maintenance care for diabetes,” Vijay Vishwanathan, Managing Director, M.V. Hospital for Diabetes, Royapuram, said.
Dr. Mohan points to the significant achievements of interventions among a middle class group in the city’s Asiad Colony in Tirumangalam, as CUPS showed. Marked slowing down of the progress of risk factors was noticed in this group when minor interventions such as walking and regular blood tests were commissioned. “There is now a new concept globally- reduction of gain. It will not be possible to reverse the trend of the epidemic just as it is not possible to get everyone thin. What we can do is to ensure that the fat, waist circumference gain and such risk factors is not drastic,” he explains.
For instance, if a person does nothing, his or her BMI climbs from 25 to 30, with simple lifestyle intervention, it can be maintained at 27. This way, one also pushes the age of onset, and thereby, the age in which the complications occur. “We have 40 million diabetics today; the projections are over 70 million by 2025. This will be the case if we do nothing. If we intervene, we can bring down the numbers down significantly,” he added.