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The Rediff Special/Shobha Warrier

For reasons of genetics and lifestyles, Indians form the world's largest diabetic population, writes Shobha Warrier.

Until the 1970s, it was widely believed that the prevalence of diabetes in India was low compared to the western world. But recent statistics now show that India has the world's largest diabetic population.

It is reported that in urban areas, 12 per cent of the adult population suffers from diabetes, compared to six per cent in the United States and the United Kingdom. Strangely, from India's vast rural population [comprising 70 per cent of India's one billion people], a mere two to three per cent suffer from diabetes.

Today, India has 25 million diabetic patients, more than any other country, and the number is expected to rise to 35 million by 2010 and to 57 million by 2025!

For the first time in over 30 years, the Chennai-based MV Hospital for Diabetes and Diabetes Research Centre conducted a 'national urban diabetes survey'. Led by the centre's director, Prof A Ramachandran (left), the survey covered Mumbai, Kolkata, Delhi, Chennai, Bangalore, and Hyderabad, [India's six largest cities]. The survey screened 12,500 people, and found that other than the genetic factor, obesity and sedentary life habits are the main reasons for Indians getting diabetes.

Startlingly, epidemiological studies have revealed that Indians are susceptible to diabetes, irrespective of the place they live in. Migrant Asian Indians living in different parts of the world shown a higher prevalence of diabetes than other ethnic groups living in the same countries.

The survey also found, from a sample study of Medavakkam town near Chennai, which was a village a decade ago, that the prevalence of diabetes rose from 2.4 per cent to 5 per cent within five years of urbanisation.

Dr Ramachandran warned that for Indians to avoid diabetes, they must remain thin. "When we talk about obesity, we are talking about a body-mass index, which is based on the height and weight at a particular age. While most people get diabetes if their body-mass index is 30-31, in the case of Indians, a body-mass index of above 25 is enough for them to get diabetes. The ideal body weight by international standards is 25 and below, but the ideal body mass index for an Indian should be 23 and below. So you have to be thin if you want to prevent diabetes in your lifetime."

Ramachandran added that this phenomenon applies to the whole of South Asia.

Their study also has found that compared to the Chinese, the Europeans, or the Koreans, urban Indians do not have the habit of exercising. Sporting activities are not part of the Indians' lifestyle, who prefer a sedentary life to an active life. Indians, frankly, prefer sitting in front of the television to taking a walk.

Genetics adds to the Indians' woes. An American whose father is diabetic has a 20 per cent chance of contracting the disorder; but an Indian has a 30 per cent probability of getting diabetes. And if both the parents are diabetic, the risk of an Indian getting it is as high as 60 per cent while it is a mere 25 per cent for an American.

Again, most diabetes occur in the age group 50-60 for an American or a Briton, but an Indian is most likely to get it at 45.

And the reasons for an urban Indian's proclivity to pick up diabetes? "That is a million dollar question," said Dr Ramachandran. "It looks as though ethnically, we are prone to developing diabetes. One reason being Indians are a homogenous race. Consanguinity could also be a good reason."

Other than diabetes, urban Indians also suffer from a condition called the impaired glucose tolerance, a condition that is a precursor to diabetes, and found in the age group 20 to 40. The IGT incidence among urban Indian is as high as diabetes, or higher. Fourteen per cent of India's urban population has been found suffering from IGT. Putting IGT and diabetes together, it means that almost 26 per cent -- or more than a quarter of India's adult urban population -- have some form of glucose intolerance.

"We have not reached the peak level of diabetes even today. You will find more diabetic patients in India in future," warned Ramachandran, "But the good news is that we can identify the young people who have the risk of diabetes and prevent diabetes."

Diabetes and IGT are associated with hypertension, high cholesterol levels, and cardiovascular diseases. Those with IGT run the same risk as those with diabetes of contracting cardiovascular diseases. "The worrisome aspect is not just the fact that treating diabetes is expensive but that it is affecting those Indians who are at the most productive stage of their lives," lamented Ramachandran.

Another study conducted by the hospital among the school children of Chennai found that a majority of urban children are overweight, and not because they eat more but because they play less. "I can only blow the whistle. What has to be done is to make people aware of the problem, educate those who are at higher risk, and publicise the need to exercise. After having conquered communicable diseases, now the time has come to spread knowledge about non-communicable but dangerous disorders like diabetes," Ramachandran concluded.

Incidentally, the World Health Organisation has chosen MV Hospital for Diabetes and Diabetes Research Centre as its sole collaborating centre in India, designating it the WHO Collaborating Centre for Research, Education and Training in Diabetes'.

The WHO letter says the "Centre has been instrumental in demonstrating the high prevalence of diabetes in South Indians, the marked impact of urbanisation on prevalence of diabetes and its risk factors, and the adverse association between poverty and the incidence of diabetic complications."

Also see:
Special footwear for diabetic patients

External link:
Official site of Diabetes India

Image: Uday Kuckian

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