Prof Mithilesh Kumar Sinha
Nagaland University, Lumami
Diabetes and poverty are inextricably intertwined: diabetes can cause poverty and poverty can cause diabetes. Diabetes is increasingly common among the poor and marginalised. The cost of treatment and/or loss of employment and income push vulnerable people and families deeper into poverty cycle. According to the World health Organisation (WHO), diabetes is currently one of the biggest health concerns that the world is faced with.
Often known as the diabetes capital of the world, India has been witnessing an alarming rise in the incidence of diabetes. So, poverty and diabetes has become twin burdens for India. According to a recent study by the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB), about 7.3 per cent Indians are currently living with this condition. The prevalence varied from 4.3 per cent of the population in the case of Bihar, to 10 per cent in Tamil Nadu; Chandigarh was found to have prevalence of 13.6 per cent.
The study showed that Tripura has the highest percentage of population (9.4 per cent) who suffer from diabetes in North-East India followed by Mizoram (5.8 per cent), Assam (5.5 per cent), Arunachal Pradesh and Manipur (5.1 per cent) and Meghalaya (4.5 per cent). Tripura and Mizoram are the second and third states in terms of GDP (1750 and 1700 US$ respectively) and higher prevalence of diabetes (see Table 2).
The Northeast States registered lesser prevalence compared with mainland States. In North-East States the prevalence of diabetes in urban areas is higher as compared ton rural areas. In Tripura, the prevalence of diabetes is 7.2 per cent in rural areas and 15.5 per cent in urban areas; in Assam, it is 4.4 per cent in rural areas and 12.4 per cent in urban areas; in Meghalaya, 3.5 per cent in rural areas and 8.9 per cent in urban areas; in Mizoram, 3.6 per cent in rural areas and 7.9 per cent in urban areas.
In Meghalaya, the prevalence of diabetes is lower in rural areas compared with urban areas but the difference is huge. Assam too, showed a similar trend- 12.4 per cent in urban areas and 4.4 per cent (Table 3). Similarly, in the urban areas, people with low socio-economic status had a higher prevalence than people with high socio-economic status in the States like Tripura, Manipur and Assam.
In the case of rural areas, people with high socio-economic status have higher prevalence than those with low socio-economic status in all the North-East States.
The prevalence of pre-diabetes varied from 6 per cent (Mizoram) to 14.7 per cent (Tripura). People progress faster through the pre-diabetes stage to frank diabetes; this could add greater burden to already strained health resources.
India’s economic development has drastically modified lifestyles over a single generation, particularly with respect to decrease in physical activity levels and adoption of western-style fast foods and sweetened beverages, especially by the younger generation in the urban areas. Dietary patterns that include high intake of refined grains, processed meats, added sugars, and low-fibre diets, have been associated with increased diabetes risk.
Table-1: Prevalence of Diabetes Stratified by Socio-Economic Status (%)
Source: ICMR-INDIAB Survey
Table-2: Prevalence of Diabetes and GDP per capita by state
Source: ICMR-INDIAB Survey
Table-3: Weighted Prevalence of Diabetes (%)
Source: ICMR-INDIAB Survey
Way out: Lifestyle management is essential not only for diabetics but also for pre-diabetics and those who have a history of the disease in the family. Diet, exercise and regular monitoring of blood glucose levels form the three main pillars of lifestyle management for diabetics.