Diabetes: The ticking time bomb


The warning bells about India’s fast-growing diabetes crisis have been sounded off for some time now. A recent health ministry-funded study by the Indian Council of Medical Research (ICMR) has confirmed the worst. Over 100 million Indians aged 20 and above are now estimated to be living with diabetes, constituting 11.4% of the population in this age group, while another 136 million (15.3%) are prediabetic, with sugar levels higher than normal but not high enough to qualify as diabetes.

The prevalence is higher than previously estimated. The National Family Health Survey of 2019-21 had found that 15.6% of men and 13.5% of women had high to very high random blood sugar levels or were on medication to control it.

R.M. Anjana, lead author of the study and managing director at Dr. Mohan’s Diabetes Specialities Centre, said the numbers were a cause of concern, in particular the prediabetes rates.“We need urgent prevention strategies to prevent conversion from prediabetes to diabetes,”Anjana warned. “If we don’t actively intervene now, the number of people with diabetes will increase even further over the next five years.”

Diabetes was found to be more prevalent in southern states—some of which are on top of NITI Aayog’s health index rankings—and certain northern states. Experts attribute this to these states’ relative success with active screening programmes for non-communicable diseases. Prediabetes is commonest in some central and northern states, where the prevalence of diabetes is currently low. Herein lies the danger as well as a window of opportunity: an accelerated focus on the prediabetic group.

Drug demand

Sales of drugs for treating diabetes have been rising in India. Anti-diabetes drugs were the fourth-largest category in the Indian pharma market in May, only lagging behind cardiovascular, gastro and anti-infectives categories, showed data from PharmaTrac. The category clocked sales of 16,769 crore in the 12 months ending May 2023, a 5.6% growth. In volume terms, sales grew 1.5%.

The Pradhan Mantri Bhartiya Janaushadhi Pariyojana, launched in 2008 to provide affordable generic drugs through over 9,000 dedicated outlets, also mirrors a similar trend. Drugs to treat Type-2 diabetes such as metformin hydrochloride and glimepiride are among top 10 products by sales in the last 12 months, according to data shared withMintby Pharmaceuticals and Medical Devices Bureau of India, the government arm that executes the scheme. In September last year, the popular anti-diabetic drug sitagliptin was included under the scheme two months after coming out of patent.

Pocket pinch

Notwithstanding the efforts to provide affordable drugs, the cost of diabetes care remains high, making it out of reach for several citizens. The overall diabetes and prediabetes care market in India is likely to touch about $60 billion in eight years from now, from $17 billion in 2020-21, shows a study by RedSeer Consulting. On average, a type-2 diabetes patient in India spends 11,000 per year, of which around 55% is towards medications, the report stated. Non-medicine expenses such as monitoring devices and doctor consultations constitute 28%, whereas lifestyle changes-related expenses on diet and weight take up 13% of the expense pie. From shelling out 6,000 annually at age 30, the care cost grows close to three times by the time one reaches 60. With 75% of the diabetic population having a monthly household income of 40,000 and lower, the case for affordable and accessible diabetes care is stronger than ever.

Sedentary bane

Sitting for long hours is an unavoidable fallout of modern life and work styles. This, combined with poor diet choices, has come back to bite us through rising Type-2 diabetes numbers. Sedentary lifestyles are all too common, with a study by researchers at ICMR published in May 2022 showing insufficient physical activity among Indian adults (physical activity was defined as one that made a person breathe harder than normal). Indians were found sedentary for over five hours a day on average, excluding sleeping time. Men were physically more active, averaging 110 minutes a day (close to two hours), while women spent half of that (52 minutes) on some form of physical activity.

With the risk of lifestyle diseases like diabetes real and ticking, the big question is whether there is any consensus on how much exercise is needed to avert a crisis? At least 150-300 minutes a week if you’re opting for moderate intensity, says the latest WHO guidelines.

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Updated: 26 Jun 2023, 01:00 AM IST



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