On World Diabetes Day, our guest author unravels the alarming reality of T2D in India, where myriad challenges fuel this complex health crisis.
In India, Type 2 Diabetes-Mellitus (T2D) has become so commonplace, that hardly any household is without at least one person who has the condition. Meanwhile, millions of unaware prediabetic Indians are at the edge of the T2D precipice.
Although it is perceived as the issue of the elderly and obese, more and more younger people with relatively lower Body Mass Index (BMI) are falling prey to this exhausting and complex-to-manage condition. And that has only aggravated the issue.
The T2D tsunami
A recent study published in The Lancet estimates that 101 million Indians have diabetes! Meanwhile, some other studies put the number of pre-diabetics at 136 million.
These are alarming numbers, far above the earlier estimates. They probably mean that India may again overtake China, but this time as the country with the highest number of people with diabetes.
Ever-increasing T2D burden has become a global health crisis which is likely to affect more than 600 million people by 2040. However, in South Asia, especially India, the situation is dire.
The reason it is an extremely complex condition to manage in our country is due to the presence of some major challenges.
The T2D challenges in India
There are studies that indicate that Indians are genetically more likely to suffer from T2D than other ethnicities. Despite a relatively lower prevalence of generalised obesity, Indians tend to have larger waist measurements and waist-to-hip ratios, thus having a greater degree of central obesity.
Often summarised as the thin-fat phenotype – used to describe the presence of increased body fat percentage in an individual with normal BMI – this causes Indians to develop insulin resistance and hence get T2D much earlier in life.
There are other studies that indicate that we have a higher insulin resistance than Caucasians, which may be traced back to the widespread incidence of low birth weight among Indians. In fact, in Germany for example, the average age when T2D is diagnosed is between 50-60, while in India almost half of T2D diagnoses are under the age of 40.
T2D is a progressive chronic condition that is associated with serious complications and increasing costs for individuals, families, communities, and healthcare systems. One estimate puts the average direct and indirect cost of managing diabetes at roughly Rs. 30,000 p.a.
A country where the per capita income is around Rs. 1,70,000 (2023), a T2D condition may mean a whopping 20% being wiped off only on managing the disease.
On the other hand, uncontrolled diabetes often leads to micro and macrovascular diseases, including cardiovascular, cerebrovascular, nephropathy, diabetic retinopathy, and neuropathy etc.
Most Health Insurance doesn’t cover these pre-existing diseases and only covers hospitalisation due to diabetic complications. The day-to-day management expenses are not covered, leaving a huge financial burden on T2D sufferers.
Over the past few decades, there has been a shift in food habits, globally. More people are having the same kind of food. Earlier, our local mixed-cultural food habits ensured the diversity of diets.
But due to globalisation, and the availability of similar kinds of calorie-rich and packaged food, we are consuming a less diverse diet than we were having a few decades ago. This is leading to severe macro and micro deficiencies often causing health issues like T2D.
In India, majorly a vegetarian country, the change is represented in the form of increased consumption of fats and sweeteners along with refined food (stripped of their natural fibres, vitamins, and minerals).
The intake of unrefined whole grains and fruit and vegetables, which the indigenous food is rich in, has drastically gone down. Diet shift towards fast food and high glycemic index food has raised the risk of several chronic diseases, T2D being just one of them.
Another trend that may be observed is that food is now being consumed as a social activity. Modern social eating and choices including alcohol consumption greatly impact our overall health. Also, social media is also adding to this ostensible consumption cycle.
Modern India has evolved greatly. Rapid urbanisation and market expansion have also seen rising income levels. And although society is getting more prosperous, people are now time-poor.
Daily lives have also become increasingly hectic, which has in turn taken a toll on mealtimes and exercise. Erratic mealtimes and restaurant food which has on average more calories than home-cooked meals, contribute to obesity for a lot of urban Indians.
Then, the lack of open spaces in most cities due to population is a big factor leading to inactivity. Eating-out occasions have increased manifolds, leading to a significant impact on calorie intake.
Coupled with more time spent indoors playing video games or watching a plethora of entertainment options, all this has contributed to the sedentary lifestyles we are leading and just opens the gateway for diseases to enter.
Additionally, because of the hot and humid climate of India, rising income levels and burgeoning options of transport at all price points, the culture of walking is falling out of favour, even in smaller Indian cities. Thus, deducting a crucial source of activity for the larger part of the population.
The absence of a preventative mindset among Indians is a giant contributing factor towards many people remaining undiagnosed. A lot of us exhibit the Ostrich Effect or the cognitive bias – “It will never happen to me!”. This prevents us from regularly going in for health checkups, leaving people more susceptible to a severe disease impact when diagnosed at an advanced stage.
The infrastructure of health checkups is also riddled with problems, especially in the rural areas. Getting tested in rural or even semi-urban India involves travelling long distances and spending a lot of time (and money). These inconveniences deter people who are already inclined towards regret aversion and therefore keep them from being diagnosed timely.
Apart from this, the cultural dynamics of women not stepping out of homes leaves a large part of the population susceptible to remaining undiagnosed, from not just diabetes but even more life-threatening issues, like breast cancer.
The shortage of doctors to look after, say an uncontrolled diabetic, is also a major factor in why people often don’t receive the right treatment and advice. Every year diabetic foot leads to thousands of amputations in India just because the uncontrolled diabetics or their caregivers are not properly informed about the risks, and they don’t take adequate care.
A simple measure like the use of a specially designed slipper can prevent a debilitating amputation, yet it is out of reach for the vast majority.
So, what shall we do now?
T2D is a mammoth issue and much needs to be done if we don’t want it to become a full-blown emergency. Each challenge mentioned earlier must be addressed, in a pragmatic and committed fashion.
For example, although genetic factors may not work in our favour, it is also important to consider epigenetics – how the environment and our behaviour affect our genes’ functions.
By raising awareness and facilitating behaviour change it is possible to make a positive difference which may help prevent more Indians from getting T2D early and even hold it off for long for those who already have it.
In the US, CDC (Centers for Disease Control) along with AMA and Ad Council had earlier released Public Service Announcements (PSAs) with hard-hitting messages. The communication then encouraged people to take a one-minute prediabetes risk assessment test and visit the nearest National Diabetes Prevention Program centre for more support.
Some campaigns take it even further. The recent ‘This is Diabetes’ campaign by Diabetes UK aims to provide support to people living with diabetes. The digital films direct the traffic to a website that has a helpline as well as useful diabetes-related content. Diabetes UK also actively uses social media channels to build awareness through always-on content. The messages range from myth busters to patient stories, to management tips.
Recently, Research Society for the Study of Diabetes in India (RSSDI)’s Defeat Diabetes campaign saw its members (HealthCare Professionals) come together to raise public awareness about diabetes. WhatsApp and other digital channels were used to provide authentic medical information at the grassroot level. Live videos on social media platforms ran along with community outreach programs on ground. FM radio was employed for those who were not reachable by conventional digital media.
However, more mass awareness campaigns are the need of the hour. To create a meaningful impact among 1.4 billion Indians and score a win over diabetes, we must learn from these initiatives and develop relevant messaging strategies along with an always-on approach to building awareness. Responsible consumer brands, especially in food & beverages sector, have a wonderful opportunity here to become even more relevant to their target groups. Why not, for example, use packaging to not only inform about nutritional information, but also nudge and encourage people to get a regular blood glucose test done?
On the other hand, an ecosystem of support measures and reforms (infrastructural, medical & financial) needs to be instated for the millions who are suffering from T2D. This shall help improve the quality of life and reduce the T2D disease burden in India.
The task of bringing the T2D monster under control can only be achieved if the government, communities, and commercial enterprises, preeminent CPG brands collaborate.
It will need take deep resolve, resource commitment, and a massive behaviour shift movement from every quarter of society to transform the way we view our health and lives today and tomorrow.
(Our guest author is Atin Roy, Senior Vice President - Health & Wellness at Ogilvy)