By Invitation. Diabetes control remains sub-optimal in India

The prevalence of diabetes is rising rapidly, globally and in India. Today there are an estimated 74 million people with diabetes in India and this number is expected to increase to 125 million by the year 2045. More than the diabetes itself, what we are worried about is the complications of diabetes. Diabetes is the leading cause of blindness, kidney failure, amputation and heart attack. It is also significant contributor to neuropathy and strokes.

Extensive studies all over the world and our own data have shown that if the ‘ABCD mantra’ is followed, complications of diabetes can be prevented and people can live a long and healthy life. Indeed, we have shown that survival of people with both type 1 and type 2 diabetes is possible for over 60 or 70 years without any complications if the ABCD goals of treatment are achieved.

What are the ABCD goals of treatment?

‘A’ stands for A1c or HbA1c (Glycated Hemoglobin) which should be below 7 percent; ‘B’ for Blood pressure which should be at least below 140/90 mm/Hg; ‘C’ for cholesterol or LDL (bad cholesterol) which should be less than 100 mg/dl and ‘D’ is discipline, which includes diet, physical activity, not smoking, stress reduction and no excess alcohol.

Unfortunately, although these goals are achievable, the status of the diabetes control targets, still remain sub optimal in many parts of the world including India, but there is no data on a national level.

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New data on diabetes control

The Indian Council of Medical Research-India Diabetes (ICMR_INDIAB) study is a nationally representative population-based survey of adults of age 20 years or older, in all 30 states and union territories of India.

The study was done using a stratified multistate sampling design in urban and rural areas and is highly representative of India’s population. In the INDIAB study, the level of diabetes control was assessed in those with known diabetes.

Out of a total of 113,043 individuals screened, (33537 from urban areas and 79506 from rural areas), 5789 adults with self-reported diabetes were included in the study.

The results of the study published in Lancet Diabetes & Endocrinology showed: only around a third of individuals with diabetes (36 percent) in India have good control of their glycemic status; fewer than half have good control of blood pressure (48.8 percent) and LDL cholesterol (43.1 percent); the proportion of individuals attaining all three ABC goals (A1c, blood pressure and cholesterol) was only 7.7 percent of all those with diabetes in India; there are no significant differences in attainment of glycemic targets between urban and rural residents; there is considerable heterogeneity between regions and among states in achievement of diabetes treatment goals; a majority of individuals with diabetes relied on private healthcare facilities for management of diabetes (62.0 percent); less than a fifth of all individuals with diabetes performed any self-monitoring of glucose (16.7 percent); less than 20 percent of the diabetes population reported consuming three servings of fruits and vegetables per day (compared to the WHO recommendation of five servings a day); less than 25 percent of people with diabetes performed any moderate to vigorous physical activity; higher education, male sex, rural residence and shorter duration of diabetes were associated with better achievement of combined goals; the glycemic and cardiovascular risk factor control remains suboptimal in the Asian Indian population with diabetes.

This is the first time that a national survey of the healthcare status and control of diabetes has been assessed in the whole of India. The primary message from the paper is that diabetes control remains suboptimal. It therefore urges governmental and non-governmental agencies to increase awareness about the need for diabetes control.

During the Covid pandemic, it was seen that those who had comorbidities like uncontrolled diabetes who did badly, the morbidity and mortality was very high in them. During the second wave of Covid 19, when the deadly fungal disease, mucormycosis was seen in India, 90 percent of patients with mucormycosis had uncontrolled diabetes. This further underscores the fact that diabetes control is essential not only to prevent the complications of diabetes related to the eye, kidney, heart and feet, but also to prevent communicable diseases and infections like Covid-19.

If left uncontrolled, diabetes can produce havoc in terms of overburdening the already stretched healthcare systems with need for dialysis and transplantation, coronary bypass surgery and treatment of eye diseases. Moreover, since type 2 diabetes is now affecting young people, it can lead to a significant burden, not only to the individual, but also to the family and the nation.

The results of the ICMR INDIAB study published in the Lancet Diabetes and Endocrinology is an urgent wakeup call to all stakeholders including the central and state Governments, to healthcare professionals, civil society and to all individuals with diabetes and their families.

The writers are diabetologists, and Chairman and Managing Director, respectively, of Dr Mohan’s Diabetes Specialities Centre, Chennai. Views are personal