World Diabetes Day 2024: India accounts for over 25% of the world’s adults with diabetes, says an alarming study published in The Lancet that expresses concern not just over the growing disease burden globally but also lagging treatment rates, especially in low- and medium-income countries.
According to the study — backed by the World Health Organization (WHO) and released to mark World Diabetes Day on Thursday — diabetes treatment coverage in India in 2022 was below 30% for adults aged over 30, a worrying statistic even though it marks a marginal increase over 1990. Lack of diabetes treatment is associated with life-long complications, including amputation and heart disease.
“In 2022, almost one third (133 million, 30%) of the 445 million adults aged 30 years or older with untreated diabetes lived in India, more than 50% greater than the next largest number, which was in China (78 million) because treatment coverage was higher in China (45% for women and 41% for men) than in India (28% for women and 29% for men),” the study notes.
The study has been conducted by the NCD Risk Factor Collaboration (NCD-RisC) — a worldwide network of over 1,500 researchers and practitioners that provides information on non-communicable disease risk factors for all countries — in collaboration with the WHO. NCD-RisC is coordinated by the WHO Collaborating Centre on NCD Surveillance, Epidemiology and Modelling at Imperial College London.
The study, which conducts a comparison between the diabetes situation in 1990 and 2022, has been described by its authors as “the first global analysis of trends in both diabetes rates and treatment which includes all countries”.
“Researchers used data from over 140 million people aged 18 years or older from more than 1,000 studies in populations of different countries,” they add.
The most alarming findings of the study include that over 50% of the estimated 828 million adults with diabetes are not receiving treatment. It also says that the global rate of diabetes (type 1 and 2 combined) in adults “doubled from approximately 7% to about 14% between 1990 to (sic) 2022, with the largest increase in low- and middle-income countries (LMICs)”.
The study, according to the authors, “highlights the urgent need for financing of medicines and comprehensive diabetes programmes that enable early detection and effective treatment of diabetes in LMICs”.
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Diabetes And The Study
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin (type 1) or when the body cannot effectively use the insulin it produces (type 2), the WHO website states. “Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels,” it adds.
Type 1 diabetes is usually genetic, and treated with daily insulin given through a pump or injections, the WHO states. Type 2 diabetes accounts for around 90% of people with diabetes and is largely preventable. The Lancet study doesn’t differentiate between the two types of diabetes in its assessment, and this has been identified as one of its limitations.
The yardsticks used by the authors to identify diabetes were a fasting plasma glucose (FPG) of 7.0 mmol/L or higher, a glycated haemoglobin (HbA1c) of 6.5% or higher, or consumption of medication for diabetes. Treatment was defined as taking medication for diabetes.
“Most previous studies looking at diabetes rates relied on high FPG as a single measure of diabetes and did not account for people who have high HbA1c, leading to likely underestimates of rates especially in south Asia, where using FPG alone misses more cases of diabetes than in other regions,” the authors note.
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Growing Diabetes Burden
The study says there were 828 million adults with diabetes globally in 2022 — over “four times the total number in 1990” (roughly 198 million).
The countries with the highest number of adult diabetics include India (212 million), China (148 million), the US (42 million), Pakistan (36 million), Indonesia (25 million) and Brazil (22 million).
Between 1990 and 2022, the study says, “rates of treatment for diabetes stagnated at low levels in many of the same LMICs where rates of the disease have drastically increased”.
This, it adds, resulted “in almost 450 million adults aged 30 and over with diabetes globally (59%) who did not receive treatment in 2022”, which is three and a half times the number in 1990.
“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,” senior author Professor Majid Ezzati, of Imperial College London, is quoted as saying in a press release accompanying the study.
“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.”
The India Picture
The study shows diabetes rates have shot up in India since 1990 for both men and women.
While 11.9% of women and 11.3% of men had diabetes in 1990, the share was 23.7% and 21.4%, respectively, in 2022. The treatment coverage in 1990 was estimated at 21.6% for women aged 30 and older and 25.3% for men in the same group. This had grown to 27.8% for women and 29.3% for men, respectively, by 2022., the study says.
The study notes that the “changes in diabetes rate from 1990 to 2022 varied drastically across different countries with mostly LMICs experiencing the largest increases”.
For example, the diabetes rate among women in Pakistan rose from 9.0% in 1990 to 30.9% in 2022, the authors note, saying it is “the largest increase across all countries”.
“…Some higher-income countries, such as Japan, Canada and some countries in western Europe (eg. France, Spain and Denmark), saw no change or even a small decrease in diabetes rate over the last three decades,” they add.
The authors say a significant factor in the rise of type 2 diabetes rates, and its variation across countries, “is obesity and poor diets”.
“Given the disabling and potentially fatal consequences of diabetes, preventing diabetes through healthy diet and exercise is essential for better health throughout the world,” Dr Ranjit Mohan Anjana, Madras Diabetes Research Foundation, India, is quoted as saying in the press release.
“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,” he said.
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