New data on the population-level prevalence of diabetes in India underscore the need for a major public health initiative aimed at prevention and control of the condition. Small-scale studies highlighted the problem earlier, but the just-out results of the first phase of the Indian Council of Medical Research-INdia-DIABetes (ICMR-INDIAB) study in Maharashtra, Tamil Nadu, Jharkhand, and Chandigarh present more robust evidence that diabetes is growing in urban and rural areas. The scale of the challenge is clear from what is now empirically established. In just three States and one Union Territory, the number of people classified as pre-diabetic is an estimated 14.73 million, and 11.88 million are confirmed to be diabetic. These groups represent a significant percentage of the total population. Diabetics form 10.4 per cent of the total population in Tamil Nadu, 8.4 per cent in Maharashtra, 5.3 per cent in Jharkhand and 13.6 per cent in Chandigarh. For pre-diabetics, the percentages are 8.3, 12.8, 8.1 and 14.6 respectively. It is reasonable to assume that the story is not very different in demographically similar States and future data are likely to confirm that. Going by medical evidence, a quarter of the patients with diabetes are at risk for coronary artery disease, eye and kidney damage, foot complications, and the like. These trends are bound to increase disease burdens and health care costs over time.
The policy imperative is to identify those at risk through established protocols, initiate prevention strategies, and offer good health care to diabetics. Data from the ICMR-INDIAB study demonstrate that periodic screening can reduce the ratio of new cases of diabetes to known cases. Tamil Nadu fares the best in this regard among the States studied, which points to higher public awareness. A significant finding is that urban residents in all the States had higher Body Mass Index, waist circumference, and systolic and diastolic blood pressure, and also a higher prevalence of diabetes, than residents in rural areas. Many studies have shown that lifestyle modification plays a major role in preventing the onset of diabetes in pre-diabetics, who have Impaired Fasting Glucose or Impaired Glucose Tolerance. Treating diabetes involves a much lower cost than managing the serious complications that set in later. The ICMR-INDIAB study presents a more complete picture of diabetes than what has been available at the population level. The insight it provides must inform public health policy. The way to go is to facilitate low-cost testing and expand specialised treatment. In parallel, governments must promote healthier lifestyles through an effective and innovative mix of policy measures.