India the largest country of South Asia is the largest contributor of the non-communicable diseases (NCVD) in the region: Diabetes, high blood pressure, obesity and dyslipidaemia (High cholesterol, high triglycerides with low HDLc etc) are its components. Cardiovascular disease is the most common cause of mortality in India already.
In one of the largest surveys representing the country Indian Council of Medical Research (ICMR) on diabetes and metabolic NCVD has published the data after completing the first 2 phases of the study. Jammu Kashmir and Ladakh both union territories (UT’s) are being surveyed in the ongoing third phase.
The study ICMR-INDIAB is a cross-sectional study which sampled 31 states and UT’s using a well-accepted multistage sampling design both for rural and urban areas of the country using a systematic sampling method by going door to door for assessment of questionnaire and measuring all the anthropometric measurements depending on their socio-economic status. All the relevant blood tests for diabetes and dyslipidaemias were done by internationally accepted methods. Diabetes, pre-diabetes, hypertension, obesity (generalized and abdominal) and dyslipidaemias were diagnosed using well defined international criteria. A total of 1,13, 043 individuals participated (79506 from rural and 33537 from urban areas, 2.4:1). The mean age of the cohort was 43 years with 46.5% being males. 27% had no formal education.
The overall prevalence of diabetes was 11.4%, pre-diabetes 15.3%, Hypertension 35.5%, generalized obesity 28.6%, abdominal obesity 39.5% and dyslipidaemia (high cholesterol, high triglycerides or low HDL cholesterol). All the parameters except pre-diabetes were significantly higher in the urban areas.
Regional Variations
It was variable as expected; UttarPradesh with lower human development index, diabetes was 4.8% vs Goa with 26.4% and pre-diabetes figures of 6.8% vs 31.3% for Goa.
The diabetes prevalence was higher in Southern and Northern regions of the country, with urban having higher rates. Likewise states with lower human development indices like Arunachal Pradesh, Jharkhand, Bihar, Meghalaya, Chhattisgarh, Madhya Pradesh, Meghalaya, Rajasthan, Sikkim and Uttar Pradesh.
There was a regional variation in hypertension with figures varying from 24.3% to 51.8% (average figure was 35.5%). Overall hypertension was highly prevalent throughout except in the central region.
Overall central or abdominal obesity and high triglycerides with low HDL cholesterol were highly prevalent throughout. on the other hand, high LDL cholesterol had a much higher prevalence in Northern India, Kerala and Goa.
Projections for the Country as a whole:
As per the authors on the basis of the figures obtained during the periods 2008 to 2020: diabetes in 101 million, pre-diabetes (HbA1c 6 to6.5%) in 136 million, Hypertension (BP > 140/90) in 315 million, generalized obesity (BMI> 25) in 254 million and abdominal obesity (waist circumference > 90 cm’s, in men and > 80 cm’s in women) in 351 million individuals. In addition, 213 million persons had high cholesterol levels and 185 million had high LDL cholesterol levels.
Implications of these data:
The very concerning figures as seen in this study are not surprising, seeing the increasing occurrence of vascular events like heart attacks, strokes, kidney problems occurring in huge numbers with younger ages of involvement.
The cost of treating these problems is enormous and crippling for the individuals, the society and the country as a whole.
The steps taken in the form of Ayushman Bharat Mission are laudable but in view of the numbers involved are miniscule efforts. With the poor health insurance with abysmally poor coverage of 18% in urban and 12% in rural speaking for itself.
Early detection and treatment of diabetes, hypertension and dyslipidaemia are the cornerstones to prevent or at least reduce the mortality and morbidity from cardiovascular diseases and chronic complications of diabetes like kidney failure, heart failure, blindness etc. Unfortunately, as per the figures not even 10% of the diagnosed diabetics meet the treatment targets and it does not include the unknown diabetics.
It calls for a complete re-orientation of the health care policies directed at recognizing and managing the non-communicable diseases particularly in the states and UT’s where the prevalence is high. As a significant population in the country lives in rural areas anddepends upon the government for the provision of health care facilities and strengthening the existing health care net work of primary health centres upwards to district hospitals. Provision of healthcare is primarily the responsibility of the state governments. states with high diabetes prevalence need to gear up their resources and have effective programs to detect and treat it along with its complications at an early date. There also needs to be an evidence-based approach toprevent the conversion of pre-diabetes to diabetes or even to reverse it to normal. These call for propagation of life style modification and judicious use of drugs.
Lessons for Jammu and Kashmir:
Although the 3rd phase of the ICMR-INDIAB including Jammu and Kashmir is just starting with all the infra-structure in place, we already know that we have a very high figures of diabetes, hypertension, dyslipidaemias and obesity. We need not wait for the figures to confirm them, which could be matching or be even higher than the national average. The small studies from various parts of the UT all indicate that. Even the recent study by Dr Mohammad Ashraf Ganie in tribals with a very low prevalence shows high figures of pre-diabetes to diabetes ratio indicates the future trend in this socially disadvantaged population.
The study of Gauri Kaul foundation, led by the author reported prevalence of 63% of uncontrolled hypertension in the rural Jammu and Kashmir in known patients prescribed drugs for treating high BP.
The UT administration with the help of key opinion leaders should take urgent and priority measures to handle this. The statistics from all the govt hospitals points towards an alarming increase of acute vascular events like heart attacks, strokes and kidney failure all complications of increasing prevalence of non-communicable diseases with diabetes, hypertension and dyslipidaemias as the core issue. It needs a top priority and pragmatic health care approach.
Acknowledgement: Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB – 17). www.thelancet.com/diabetes-endocrinology. Published on line 7 June 2023
Dr Upendra Koul is a Padmashree and Founder Director Gauri Kaul Foundation
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.