Diabetes prevalence: Prevention strategies
We argue that the early onset of the diabetes among the South Asians (five to ten years earlier), longevity of complications and early mortality will have a significant impact on the demographic composition
One in every 11 adults globally is living with diabetes and 193 million estimated to be undiagnosed, of which LMIC comprise the largest proportion.
The global burden of diseases (GBD) study stated that diabetes-related deaths have increased by 93% in the last two decades and will be 7th leading cause of deaths by 2030.
South Asia, home to a quarter of the world’s population, has an increasing risk of developing diabetes with country level estimates ranging from 7 to 8.5%. However, these estimations for South Asian countries were not based on the recent data, hence the current true prevalence may be likely to be higher.
One estimate suggests that by 2030 the number of diabetic population will be 120.9 million in South Asia, more than double than in the North America or Europe.
This is mirrored by the higher prevalence of diabetes in most urban areas of the region and is very likely to rise to over 10% from current estimates of 8%.
For example, studies in urban areas of South Asia have reported higher diabetes prevalence (e.g. India: 13.9%, Sri Lanka: 16.4%, Pakistan: 22%). Studies in rural areas of India and Pakistan, where the majority are farmers, have also reported higher diabetes prevalence rate between 11-17%.
In Nepal, the prevalence of diabetes ranged from 1.4% to 19% according to the published studies so far. A pooled estimates of the studies among the Nepalese populations suggest that the prevalence was 8.1% in urban areas and 1% in rural areas.
The WHO STEPS survey among 4143 adult Nepalese population found 3.6% with diabetes or under anti-diabetic medication.
The escalating prevalence of diabetes in the South Asia can be attributed mostly to the traditional dietary practices laden with refined carbohydrate, sweets, oil/ghee which has high fatty acid; growing predilection towards junk foods and fizzy drinks; and sedentary lifestyles as a result of rapid socioeconomic growth.
In addition, there is a growing consensus in the expert scientific community that the risk of diabetes in South Asian populations is further raised due to the increased fat deposition in the central abdominal area which leads to the central obesity, insulin resistance and diabetes.
Genetic factors have been implicated for this tendency and several underpinning hypotheses have been published.
We argue that the early onset of the diabetes among the South Asians (five to ten years earlier), longevity of the complications and early mortality will have a significant impact on the demographic composition, health expenditure and economic development unless the current trends are halted on time.
Majority of the population from LMICs (all the South Asian countries are classified as LMICs by WHO) spends over a quarter of their income on treating their diabetic condition, and hence incur higher economic burden leaving little income with them to spend on other essential requirements such as proper nutrition and education.
While the developed world have progressed enormously around technology for diabetes treatment/care and on-going trials (e.g. artificial pancreas) are encouraging, these advancements are however still far away from the reach of South Asians due to their low purchasing power and government’s low expenditures (around 4-5%) on health.
In light of the increasing rates of diabetes in South Asia, prevention strategies should be well-planned and executed effectively.
Primordial preventive measures should be initiated from the school age population which may be pivotal to promote healthy food and active lifestyle in the later life. These activities may be promoting physical activity and sports in the school, prohibiting junk foods and sugary drinks in the schools, activities to promote healthy food and active lifestyle in the community etc.
Most of the South Asian countries also do not have strict measures to regulate the production and consumption of sugary drinks and junk foods. Likewise, primary prevention strategies such as screening for earlier detection and diabetes care services must be reflected in policies.
Time has come to focus on diabetes education and personalised care planning support as it is still not widely practiced in the region.
While all the countries in the region have compromised human resources for health care (e.g. doctor-patient ratio in the region is very low than the WHO recommended level), specialised care for people with diabetes may be challenging.
For example in Nepal, only one endocrinologist per 1000000 populations and one ophthalmologist for every 200000 people is available and there is also a lack of national guidelines for diabetes care.
As the United Nations goal #3 of the Sustainable Development (ensure healthy lives and promote well-being) has set a target to reduce by one third premature mortality from non-communicable diseases, this achievement will however greatly depend on the concerted efforts on prevention, health services and health policies.
Let’s gear up to halt the increasing gradient of diabetes in the region!
The authors are public health researchers affiliated with Bournemouth University, UK; University of Otago, New Zealand.