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New Research Shows Diabetes Set to Devastate India’s Metropolitan Cities
November 30, 2020

More than half of men and two thirds of women currently aged 20 years in Indian cities projected to develop the condition in their lifetime.

New research published in Diabetologia (the official journal of the European Association for the Study of Diabetes) shows that more than half of men (55%) and some two thirds (65%) of women currently aged 20 years in India will likely develop diabetes in their life time, with most of those cases (around 95%) likely to be type 2 diabetes (T2D). The research is from a team of authors in India, the UK and the USA, led by Dr. ShammiLuhar, Department of Public Health and Primary Care, University of Cambridge, UK, collaborating with Dr.V.Mohan of Madras Diabetes Research Foundation, Chennai and Dr.Nikhil Tandon of All India Institute of Medical Sciences, New Delhi.

India already has a significant health burden caused by diabetes: estimates suggest 77 million adults currently have diabetes and this number is expected to almost double to 134 million by 2045. Urbanization, decreasing diet quality, and decreased levels of physical activity are all contributing to this hidden epidemic. Since urban centres are continuing to grow rapidly across the country, the authors, in this new research, aimed to estimate the probability of a metropolitan (urban-based) Indian of any age or body mass index (BMI) developing diabetes in their lifetime.

The data for the study came from using age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research IndiaDIABetes study (2008-2015).

The authors estimate that lifetime risk of developing diabetes in 20-year-old men and women free of diabetes today is 56% and 65%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk of developing diabetes declined with age: the authors estimated that for those currently aged 60 years and currently free of diabetes, around 38% of women and 28% of men would go on to develop diabetes in their lifetime.

Obesity had a substantial impact on these projections.

Lifetime risk was highest among obese metropolitan Indians: 86% among 20-year-old obese women and 87% among obese men. In those who were normal or underweight BMI the risk was around 41.2% among 20- year old underweight/normal weight men and 51.6% among under-weight/normal-weight women.

Dr.V.Mohan, one of the authors of the study says: “The remarkably high lifetime risk of developing diabetes in India’s metropolitan cities, especially for individuals with obesity, implies that interventions targeting the incidence of diabetes are be of paramount importance.

Dr.R.M.Anjana, another author of the study states, “Indians living in large city have an alarmingly high probability of developing diabetes compared with those living in high income countries. Hence, proactive efforts to prevent diabetes in metropolitan cities are urgently needed, given the rapid increase in urban obesogenic environments across the country”. She adds,“The fact that Indians and other South Asian populations already have a higher predisposition to developing diabetes at lower ages (up to a decade earlier) and lower BMIs when compared with white European population makes prevention of diabetes even more of a priority”.

One study from the USA, using data from 2000-2011, reported a lifetime risk diabetes of 40% among men and women aged 20 years in the white Caucasian population. Dr.Venkat Narayan, one of the collaborators of the study says: “Our new estimates from India are much closer to estimates of lifetime risk of diabetes of 20-year olds among the black and Hispanic populations in the USA (above 50%), groups considered at a higher risk of developing diabetes than the white population.”

Dr. Luhar adds: “Such high probabilities of developing diabetes will have severely negative implications for India’s already strained health system and also out-of-pocket expenditure on diabetes treatment by patients, unless diabetes is immediately acknowledged for what it is: one of the most important threats to public health in India.”

Adding an optimistic note, Dr. V. Mohan added:  “Despite these very high predicted lifetime risks of diabetes, it is possible to prevent or postpone diabetes by effective lifestyle modification, such as following a healthy diet, by increasing physical activity and reducing body weight in those who are obese or overweight.”

Professor Nikhil Tandon from the Department of Endocrinology and Metabolism, All India Institute of Medical Sciences in New Delhi, and co-author of the paper also added: “We need policy and investment with clearly spelt out targets and commitments to meet by 2030. Perhaps an aspirational target of ’90-90-90′ (90% of people with diabetes detected, 90% of those detected treated, and 90% of those treated controlled), is imminently needed. Such a target could operate in the same way as the 90-90-90 targets introduced some years ago for HIV, which has since been replaced by even more ambitious 95-95-95 targets.”

Reference: “Lifetime risk of diabetes in metropolitan cities in India” by ShammiLuhar, Dimple Kondal, Rebecca Jones, Ranjit M. Anjana, Shivani A. Patel, Sanjay Kinra, Lynda Clarke, Mohammed K. Ali, Dorairaj Prabhakaran, M. Masood Kadir, Nikhil Tandon, Viswanathan Mohan and K. M. Venkat Narayan, 23 November 2020, Diabetologia.

DOI: 10.1007/s00125-020-05330-1

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Dr. Mohan’s Diabetes News 

Lifetime risk of diabetes in metropolitan cities is alarming, warns study

The paper notes that women generally had a higher lifetime risk across the lifespan. “Remaining lifetime risk of developing diabetes declined with age, note the authors. They estimated that for those currently aged 60 years and free of diabetes, around 38% of women and 28% of men would develop diabetes. Obesity had a substantial impact on these projections.’’ It said the risk was highest among obese metropolitan Indians — 86% among 20-year-old women and 87% among men.Professor Viswanathan Mohan of the Madras Diabetes Research Foundation in Chennai and co-author of the paper said: “Despite these very high predicted lifetime risks of diabetes, it is possible to prevent or postpone diabetes by effective lifestyle modification, such as following a healthy diet, increasing physical activity and reducing body weight in those who are obese or overweight.”

The Hindu

Lifetime risk of diabetes in metropolitan cities is alarming, warns study with disturbing trends

A new study by well-known experts through research published in Diabetologia (the official journal of the European Association for the Study of Diabetes) shows that more than half of men (55%) and some two- thirds (65%) of women currently aged 20 years in India are likely develop diabetes in their lifetime, with most of those cases (around 95%) likely to be type 2 diabetes (T2D). The research is from a team of authors in India, the UK and the USA, led by Dr. Shammi Luhar, Department of Public Health and Primary Care, University of Cambridge, UK, collaborating with Dr.V.Mohan Chairman and Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre, President and Director of the Madras Diabetes Research Foundation in Chennai and Dr.Nikhil Tandon of All India Institute of Medical Sciences, New Delhi.

APN News

Over half of men and two-thirds of women in India below 20 years likely to develop diabetes: Study

“The remarkably high lifetime risk of developing diabetes in India’s metropolitan cities, especially for individuals with obesity, implies that interventions targeting the incidence of diabetes are be of paramount importance,” said Mohan.The study showed obesity as having a substantially negative impact on the population. It also showed that the lifetime risk was highest among obese metropolitan Indians ― at 86 per cent among 20-year-old obese women, and 87 per cent among obese men.“The fact that Indians and other South Asian populations already have a higher predisposition to developing diabetes at lower ages (up to a decade earlier) and lower BMIs compared with white European population makes prevention of diabetes even more of a priority,” said Dr RM Anjana, MD and Diabetologist, Dr Mohan’s Diabetes Specialities Centre and Vice President, Madras Diabetes Research Foundation, Chennai, and another author of the study.

The Hindu Business Line

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