Type 2 Diabetes mellitus has become a major public health problem all over the world. The burden of diabetes has tremendously increased even in developing economies like India to the tune that globally India is now the country with second highest number of individuals with type 2 diabetes.
Type 2 diabetes is a lifestyle related disease. The primary reason for increasing rates of diabetes are socioeconomic transition and industrialization leading to increase in the consumption of excess calories and reduction in physical activity. This phenomenon is no more limited to urban areas, and we clearly see increasing rates of type 2 diabetes even in rural areas. One of the strongest risk factor for development of diabetes is excess weight specially excess fat deposition around the waist. The other worrisome trend is increasing rates of type 2 diabetes in younger individuals and adolescents.
As per ICMR (Indian Counsel of Medical Research) the number of people with diabetes in India has increased from 26·0 million in 1990 to 65·0 million in 2016. Due to limited access to healthcare in many parts of the country, lack of awareness among public and lack of symptoms during initial years of the disease, almost 50% of the individuals affected by diabetes remain undiagnosed. Also, if we look at the level of diabetes control among Indians, it is evident that only 30% of the patients with diabetes are at there target blood glucose level. Poorly controlled diabetes can lead to a variety of serious complications like heart attacks, strokes, kidney failure, neuropathy, eye damage and foot amputations. This can potentially put huge burden on our healthcare infrastructure which already has numerous challenges. Essentially, we are looking at an explosion of type 2 diabetes leading to massive economic burden and loss of productivity. The covid-19 pandemic has made the situation worse by worsening of pre-existing diabetes as well as development of new onset diabetes.
Diabetes is a chronic disease that requires ongoing monitoring, long-term treatment, and education of patients for self-management. There are several challenges in delivering effective diabetes care in India in the form of lack of trained health care providers in remote and rural areas, poor affordability, unavailability of antidiabetic medications and especially insulin in rural areas, poor adherence to medications and lifestyle changes and poor follow-up. The problem of treatment adherence and follow up is specially more pronounced in younger people who are at higher risk of developing complications as shown by ICMR study “Youth onset diabetes in India”.
To improve the current situation, we need paradigm shift in the diabetes care in our country. The first is foremost being an effective preventive strategy to be implement at the level of schools, colleges, public and private offices by increasing awareness about healthy diet, regular exercise and avoiding excess weight gain. The percentage of undiagnosed patients can be reduced by identifying at risk individuals, adopting self-administered diabetes risk scores, and keeping high degree of suspicion for diabetes at every encounter with the health care provider. Universal access to diabetes care can be achieved by training more paramedical staff, nurses and ANMs to enable them to deliver the basic care to diabetes patients and to identify the individuals who need referral to higher centres. A good public-private collaboration and implementation of structured diabetes care program at every level will definitely bring about humongous change in the situation of diabetes in our country.
The author is a consultant-Endocrinologist and Diabetologist, Fortis Hospital, Mulund.