The Global and Indian Diabetes Crisis – Key Insights

The global diabetes crisis has escalated dramatically in recent decades. A recent report from The Lancet revealed that the number of people living with diabetes worldwide has surged from 200 million in 1990 to over 800 million in 2022, with global prevalence in adults rising from 7% to 14% in the same period. India, with 212 million people affected, now has the highest number of diabetes cases in the world, highlighting a growing public health crisis.

Growing Prevalence of Diabetes

• Global Diabetes Surge: The global number of people with diabetes quadrupled from 200 million in 1990 to over 800 million by 2022. This represents a staggering rise in diabetes prevalence, reflecting a global health emergency that needs comprehensive intervention.
• India’s Diabetic Population: India has emerged as the country with the highest number of people living with diabetes, reaching 212 million. This number far exceeds that of China, which has 148 million cases. Additionally, India leads the world in the number of undiagnosed cases, with 133 million individuals over 30 years old unaware of their condition.
• Revised Data Methodology: The increase in reported diabetes cases is also partly due to changes in data collection methods. The inclusion of individuals with elevated HbA1c levels alongside those with elevated fasting plasma glucose has led to a more accurate assessment, capturing more people at risk, especially in regions like South Asia.

Risk Factors for Diabetes: A Closer Look

• Unhealthy Diet and Sedentary Lifestyle: The primary controllable risk factors for diabetes include unhealthy diets, rich in processed carbohydrates and saturated fats, alongside sedentary lifestyles. These factors contribute significantly to obesity, a key driver of diabetes onset, particularly in urban settings.
• Tobacco Use and Diabetes: While diet and inactivity are well-known risk factors, tobacco use, especially cigarette smoking, has not been sufficiently highlighted. Studies show that nicotine increases the risk of developing diabetes by 30%-40% by impairing insulin production and inducing insulin resistance, thus directly contributing to the onset of type 2 diabetes.
• Gestational Diabetes: A Critical Concern The management of gestational diabetes is crucial in preventing long-term diabetes risk for both mothers and children. Poor management of gestational diabetes increases the likelihood of type 2 diabetes later in life, underlining the need for better prenatal care and postnatal monitoring.

Urgent Need for Diagnosis and Control

• Undiagnosed Diabetic Population: In India, a significant portion of the diabetic population remains undiagnosed, with an estimated 133 million individuals over 30 years of age unaware of their condition. This underscores a critical gap in healthcare services and the need for widespread diabetes screening programs.
• WHO 2030 Target for Diabetes: The WHO has set a target for 2030: 80% of people with diabetes should be diagnosed, and 80% of those diagnosed should have good control over their glycaemic levels. Achieving this target requires urgent scaling up of healthcare infrastructure, diagnostic tools, and public health campaigns.
• The Importance of Tobacco Cessation: Avoiding tobacco use is essential not only for reducing diabetes risk but also for improving overall cardiovascular health, especially among people already living with diabetes. The ethical responsibility lies in providing education, support, and resources to encourage tobacco cessation on a larger scale.

Practice Question:

Q. Discuss the key factors contributing to the global rise in diabetes, with a specific focus on the Indian context. What ethical considerations should guide public health responses to this crisis?