A presentation on epidemiology and recent advances in 2 common NCDs - Diabetes and Obesity.

1. EPIDEMIOLOGY AND RECENT ADVANCES IN
DIABETES
&
OBESITY
DR HARIMU BARGAYARY
PG RESIDENT, COMMUNITY MEDICINE
1

2. CONTENTS
2
INTRODUCTION
PROBLEM STATEMENT
EPIDEMIOLOGICAL DETEMINANTS
SCREENING / ASSESSMENT
PREVENTION AND CARE / CONTROL
NPCDCS
REFERENCES

3. 3

4. INTRODUCTION
4

5. DEFINITION
5
 According to both World Health Organisation (WHO) & American
Diabetic Association (ADA):-
“ Diabetes is a group of metabolic disorders characterized
by hyperglycemia resulting from defects in insulin
secretion, insulin action or both.”

6. Contd…
6
 On the basis of etiology, pathogenesis, biochemical features and
implications of diabetes mellitus:
“Diabetes is a metabolic cum vascular syndrome of multiple
etiology characterized by chronic hyperglycemia with
disturbances of carbohydrate , fat and protein metabolism
resulting from defects in insulin secretion and action or both
leading to changes in both small vessels (microangiopathy) and
large blood vessels (macroangiopathy).”

7. CLASSIFICATION
7
 WHO classification of diabetes mellitus:
1. Diabetes mellitus (DM)
• Type 1 or insulin - dependent diabetes mellitus.
• Type 2 or non insulin - dependent diabetes mellitus.
• Malnutrition related - diabetes mellitus.
• Other types (secondary to pancreatic, hormonal, drug-induced, genetic and
other abnormalities)
2. Impaired glucose tolerance (IGT)
3. Gestational diabetes mellitus (GDM)

8. TYPE 1 - INSULIN DEPENDENT DM
8
 Most severe form of disease.
 Abrupt onset.
 Incidence is higher among 10-14 yrs old group.
 Immune mediated in 90% and idiopathic in < 10%.
 Catabolic disorder => circulating insulin is virtually absent,
plasma glucagon is elevated and
beta cells fail to respond to all insulinogenic stimuli.
 Exogenous insulin is required to reverse catabolic state, prevent ketosis,
reduce hyperglucagonaemia and reduce blood glucose.

9. 9
TYPE 2 – NON-INSULIN DEPENDENT DM
9
 More common.
 Gradual onset.
 Middle-aged and elderly.
 Most frequently mild, slow ketosis and is compatible with long
survival if given adequate treatment.
 Clinical picture usually complicated by the presence of other disease
processes.

10. 10
 GESTATIONAL DIABETES
 Hyperglycemia with blood
glucose values above normal but
below those diagnostic of
diabetes, occuring during
pregnancy.
 High-risk pregnancy.
 Women and their children are at
increased risk of type 2 DM in
the future.
 IMPAIRED GLUCOSE
TOLERANCE
 A state indermediate – “ at-risk
group” – between diabetes
mellitus and normality.

11. Insulin resistance syndrome (Syndrome X)
11
 In obese patients with type 2 diabetes , the association of hyperglycemia,
hyperinsulinaemia , dyslipidemia and hypertension, which leads to
coronary artery disease and stroke , may result from a genetic defect
producing insulin resistance with latter being exaggerated by obesity.

12. 12
Insulin resistance
Hyperglycaemia
Hyperinsulinaemia
High levels of TGs
Increase sodium retention by renal tubules
Hypertension

13. Problem statement
13
 WORLD:-
 In 2014, the number of cases of diabetes were estimated to be 422
million, of these > 90 % are type 2 diabetes.
 In 2016 , an estimated 1.6 million people died from consequences of
high blood sugar.
 More than 80 % diabetes death occur in low and middle income
countries.

14. 14
 The global prevalence of diabetes was estimated to be 8.5% in
adults aged 18+ years.
 Low income countries showed the lowest prevalence (8% for both
sexes), and the upper-middle-income countries showed the highest
(10% for both sexes).
 The age adjusted mortality rates among the people with diabetes
are 1.5 - 2.5 times higher than in the general population.
Contd…

15. Estimated number of adults (20-79) suffering from
diabetes by region in 2017.
15

16. People living with diabetes worldwide per region in
2017 and 2045 (20-79 years)
16

17. 17

18. Problem statement - INDIA
18

19. SYPMTOMS OF TYPE 2 DIABETES
19

20. Epidemiological determinants
20

21. Agent
21
 Underlying cause => insulin deficiency.
 May be due to wide variety of mechanisms:-
 Pancreatic disorders: inflammatory , neoplastic, and others such as cystic
fibrosis.
 Defects in formation of insulin.
 Destruction of beta cells.
 Decreased insulin sensitivity genetic defects
 Auto immunity.

22. Host factors
22
 Age:- Type 2 diabetes begins to rise in the middle years of life.
- The prognosis is worse in younger diabetes who tend to develop
complications earlier than older diabetes.
 Sex :- In some countries the overall male – female ratio is about equal.
- In South-east Asia, an excess of male diabetes has been observed.

23. 23
 Genetic factors:-
The genetic nature of type 2 diabetes is undisputed. Twin studies showed that in
identical twins who developed type 2 diabetes concordance was approximately
90% showing strong genetic component.
 Genetic markers:-
Type 1 diabetes is associated with HLA B-8 & HLA B-15 ,HLA-DR3 AND DR4.
Type 2 is not associated with HLA.
Contd…

24. 24
 Immune mechanisms:- Evidence of both cell mediated and of humoral
activity against islet cells.
 Obesity:- Is a risk factor for type 2 diabetes and risk is related to both
duration and degree of obesity.
 Central obesity is also an important determinant of insulin resistance.
 Voluntary weight loss improves insulin sensitivity and reduce risk of
progression from impaired glucose tolerance to type 2 diabetes.
 No role in type 1 diabetes.
Contd…

25. 25
 Maternal diabetes:-
- Offsprings of diabetic pregnancies including gestational diabetes are
often large and heavy at birth, tend to develop obesity in childhood and
risk of developing type 2 diabetes at early age.
- Maternal diabetes associated with IUGR and LBW , appears to
increase the risk of subsequent diabetes in the child.
Contd…

26. Environmental risk factors
26
 Sedentary lifestyle
 Diet
 Dietary fibres
 Malnutrition
 Alcohol
 Viral infection ( by rubella, mumps and human coxsackie virus)
 Chemical agents ( alloxan, streptozotocin, valcor , etc.)
 Stress
 Other factors such as social class.

27. SCREENING FOR DIABETES
27

28. Urine Examination
28
 Urine test for glucose:- 2 hours after meal.
 All those with glucosuria are considered diabetic unless otherwise proved by a standard
oral glucose tolerance test.
 The test yield too many false negatives.
 Glucosuria may also be found in perfectly normal people which give rise to false
positives.
 For these reason urine testing is not considered an appropriate tool for case finding.

29. Blood sugar testing
29
 Standard oral glucose test remains the cornerstone of diagnosis of
diabetes .
 Mass screening programs have used glucose measurements of fasting ,
PP or random samples.
 For epidemiological purposes, the 2-hour value after 75 g oral glucose
may be used either alone or with the fasting value.

30. The WHO recommendation for diagnostic criteria for diabetes (2019)
30
* Overnight fast of 8-14 hours.
** If laboratory measurement not available, point of care, (“finger-stick”) devices can be used (they report glucose
values in capillary plasma).
*** Plasma glucose is preferred in people with symptoms who are suspected of having type 1 diabetes.
Measurement Diagnostic cut-off value
Fasting venous or capillary* plasma
glucose
> 7.0 mmol/L (126 mg/dL)
2-hour post-load venous plasma
glucose
> 11.1 mol/L (200mg/dL)
2-hour post-load capillary** plasma
glucose
> 12.2 mmol/L (220 mg/dL)
Random plasma glucose > 11.1 mmol/L (200 mg/dL)
HbA1c*** 6.5% (48 mmol/mol)

31. American Diabetes Association (2019)
classification:
31

32. Target population
32
 Screening of high risk groups.
 Those in age group of > 40 years.
 Those with a family history of diabetes
 The obese
 Women who have had a baby weighing more than 4.5 kg
 Women who show excess weight gain during pregnancy
 Patients with premature atherosclerosis.

33. PREVENTION AND CARE
33

34. PRIMARY PREVENTION
34
Primary
Prevention
Population
strategy
High risk
strategy

35. Population strategy
35
 Scope for prevention of Type 1 diabetes - LIMITED.
 For Type 2 diabetes - Development of prevention programmes to
eliminate environmental risk factors.
 To press need for PRIMORDIAL PREVENTION.

36. Contd…
36
 Preventive measures:-
 Maintainance of normal body weight.
 Healthy Nutritional habits and physical exercise.
 These measures maybe integrated with other community-based
programmes for the prevention of non-communicable diseases
(e.g coronary artery diseases).

37. High risk strategy
37
 Since NIDDM appears to be linked with sedentary life style , over nutrition
and obesity, correction of these may reduce the risk of diabetes.
 Since alcohol may directly increase the risk of diabetes, it should be avoided
 Subjects at risk should avoid diabetogenic drugs like oral contraceptives.
 Reduce factors that promote atherosclerosis e.g smoking, high BP, elevated
cholesterol and high TG levels.

38. SECONDARY PREVENTION
38
 The aim of treatment are :-
 To maintain blood glucose levels as
close within the normal limits
 To maintain ideal body weight
 Treatment is based on :-
 Diet alone – small balanced meals
more frequently.
 Diet and oral anti diabetic drugs
 Diet and insulin

39. 39
 Proper management of diabetes is more important to prevent complications.
 Routine checking of blood sugar, of urine for proteins and ketones, of BP,
visual acuity and weight should be done periodically.
 Examination of feet for any defective blood circulation, loss of sensation
and health of skin.
 Primary health care is of great importance to diabetic patients since most
care is obtained at this level.
Contd…

40. 40
 GLYCOSYLATED HAEMOGLOBIN :-
 Should be estimated at half yearly intervals.
 Provides a long term index of glucose control.
 The percentage of such glycosylated haemoglobin reflects the mean blood
glucose levels during the red cell life-time (i.e. past 2-3 months)

41. 41
 SELF CARE:-
 Crucial element in secondary
prevention.
 By adherence to diet and drug
regimens.
 Blood glucose monitoring
 Self administration of insulin
 Abstinence from alcohol
 Maintenance of optimum weight
 Attending periodic check-ups.
 Recognition of symptoms associated
with hypoglycaemia.

42. Individual intervention in diabetes with evidence of
efficacy.
42
Interventions with evidence of efficacy Benefits
Lifestyle interventions for preventing type 2 diabetes
in people of high risk
Reduction of 35-58 % in incidence
Metformin for preventing type 2 diabetes for people
at high risk
Reduction of 25-31 % in incidence
Glycaemic control in people with HbA1c greater
than 9%
Reduction of 30% in microvascular disease per 1%
drop in HbA1c
Blood pressure control in people whose pressure is
higher than 130/80 mmHg
Reduction of 35% in macrovascular and
microvascular disease per 10mmHg drop in BP
Annual eye examinations Reduction of 60-70% in serious vision loss
Foot care in people with high risk of ulcers Reduction of 50-60% in serious foot disease
ACE inhibitor use in all people with diabetes Reduction of 42% in nephropathy; 22% drop in
cardiovascular disease.

43. 43
 Home blood glucose monitoring:- capillary blood glucose measurements.
 Education of patients and their families.
Contd…

44. TERTIARY PREVENTION
44
 The main objective at the tertiary level is to organize specialized
clinics and units capable of providing diagnostics and
management skills of a high order.
 To limit the development of further disability in a diabetic
person, who came late with complications
 The tertiary level should also be involved in basic, clinical and
epidemiological research.

45. 45

46. INTRODUCTION
46
 DEFINITION:
Obesity may be defined as an abnormal growth of the adipose
tissue due to an enlargement of fat cell size (hypertrophic obesity)
or an increase in fat cell number (hyperplastic obesity) or a
combination of both.
Overweight is usually due to obesity but can arise from other

47. PROBLEM STATEMENT
47
 WORLD:-
• 5th leading risk of global deaths.
• In 2016, > 1.9 billion adults (>18yrs) were overweight.
• In 2019, > 38.2 million children (< 5yrs) were overweight/obese.
• In developing countries, nearly 30 million children are overweight.
• In developed countries, 10 million children are overweight.
• Atleast, 3.4 million adults die each year as a result of
overweight/obesity.
• It also attribute to 44% of diabetes burden, 23% of ischaemic heart
disease burden and 7-14% of certain cancer burdens.

48. 48

49. 49

50. 50

51. Percentage of overweight in Uttar
pradesh.
51
1.5%
12.5%
16.5%
3.1%
18.5%
21.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
CHILDREN MEN WOMEN
2015-16
2020-21
Source: NFHS-4 (2015-16) and NFHS-5 (2020-21) data.

52. EPIDEMIOLOGICAL DETERMINANTS
52
 AGE: - can occur at any age
- increases with age
 SEX:
Women: Higher rate of
Obesity
Men: Higher rate of
Overweight
 GENETIC FACTORS:
 Twin studies have shown a close
correlation between the weights of
identical twins even when reared
in dissimilar environments.
 Recent studies have shown that
the amount of abdominal fat was
influenced by a genetic component
accounting for 50-60% of the
individual difference.

53. Contd…
53
 PHYSICAL INACTIVITY:
 Unhealthy weight gain => Overweight => Obesity
 SOCIO-ECONOMIC STATUS:
 People in higher socioeconomic strata have higher rates of obesity.
 EATING HABITS
 Composition of diet
 Periodicity with which it is eaten
 Amount of energy derived from it

54. Contd…
54
 PSYCHOSOCIAL FACTORS:
 Depression, anxiety, frustration, loneliness, etc. => OVEREATING =>
Weight gain
 FAMILIAL TENDENCY:
 Obese parents => Obese children
 ENDOCRINE FACTORS: (occasional)
 Cushing’s syndrome, growth hormone deficiency, etc.
 ALCOHOL:
 A recent review of studies concluded that the relationship between alcohol
consumption and adiposity was generally positive for men and negative for

55. Contd…
55
 EDUCATION
 Less educated have higher
probability of developing obesity.
 SMOKING
 In most populations, smokers
weigh somewhat less than ex-
smokers.
 ETHNICITY
 Ethnic groups in many
industrialized countries appear to
be especially susceptible to the
development of obesity and it’s
complications.
 DRUGS:
 Cortico-steroids, contraceptives,
insulin, ß-adrenergic blockers,
etc. => weight gain

56. ASSESSMENT OF OBESITY
56
 Ideal measure is by ESTIMATING BODY FAT.
 Most common measures are:-
 Weight-for-height
 Body mass index (BMI) / Quetelet index
 Waist circumference
 Waist-hip ratio (WHR)
 Skin-fold thickness

57. BODY MASS INDEX (BMI)
WEIGHT (Kg)
HEIGHT2 (m2)
BMI =
Classification BMI (kg/m2) Risk of co-morbidities
Underweight < 18.50 Low (but risk of other
clinical problems
increased)
Normal range 18.50 – 24.99 Average
Overweight: > 25.00
Pre-obese 25.00-29.99 Increased
Obese class I 30.00-34.99 Moderate
Obese class II 35.00-39.99 Severe
Table 1 - WHO classification of Overweight and Obesity (acc. to BMI) in
adults:
57

58. Table 2 – WHO BMI classification for Asian population:-
Nutritional status BMI (kg/m2)
Underweight < 18.5
Normal range 18.5 – 22.9
Overweight 23 – 24.9
Obese I 25 – 29.9
Obese II > 30
58

59. Other Indicators of Obesity
 Brocca Index = Height (cm) minus 100
e.g. for Ht=160 cm, Ideal Weight = 160-100=60Kg.
 Ponderal index =
Height (cm)
Cube root of body weight (kg)
1. BODY WEIGHT
59

60. Ht (cm) - 150
 Lorentz’s formula = Ht (cm) – 100 -------------------------------
-
2 (women) or 4 (men)
Actual Weight
 Corpulence Index = -----------------------------------
Desirable Weight
[This should not exceed 1.2]
60

61. 2. SKINFOLD THICKNESS
- It is a rapid and “non-invasive” method for assessing body fat.
- Instrument most widely used: Harpenden skin callipers.
- Sites of measurement: a) Mid-triceps
b) Biceps
c) Subscapular
d) Suprailiac regions
-The sum of the measurements should be: < 40mm in Boys
< 50mm in Girls
61

62. 3. Waist circumference
& Waist : Hip Ratio
(WHR)
 There is increased risk of metabolic complications
with waist circumference of:
> 102cm in men & > 88cm in women.
 Abdominal fat accumulation indicated by WHR:
> 1.0 in men & > 0.85 in women.
62

63. Overweight & Obesity (in CHILDREN <
5years):-
63
 Weight-for-height WHO Child Growth Standards median
chart.
 Overweight: > 2-SD
 Obesity: > 3-SD

64. Overweight & Obesity (5-19years age
group):-
64
 BMI-for-Age WHO Growth Reference median chart.
 Overweight: > 1-SD
 Obesity: > 2-SD

65. 65

66. PREVENTION AND CONTROL
66
 PREVENTION of Obesity is the key solution at Community level.
 Creating enabling and Supportive environments in the communities.
 Healthier food choices
 Encouraging regular physical activity
 Health education
 Policy-level decisions like higher taxes on sweets, etc.
 Policy and guidelines for nutrition content of foods manufactured
 Restriction of marketing of unhealthy food items to certain target groups,

67. NATIONAL PROGRAMME FOR PREVENTION
AND CONTROL OF CANCER, DIABETES,
CARDIOVASCULAR DISEASES AND STROKE
67
NPCDCS

68. 68
BACKGROUND
 Non-communicable diseases
(NCDs) => leading cause of adult
mortality and morbidity
worldwide.
 NCDs are rapidly increasing
globally and have reached
epidemic proportions in many
countries.
 Major Public Health challenge.
 Largest contribution (upto
70%) by 4 types of NCDs viz.
Cardiovascular Diseases,
Cancer, Chronic respiratory
diseases and Diabetes.

69. 69
DISEASE BURDEN
 Globally, NCD deaths are projected to increase from 38 million in
2012 to 52 million by 2030.
 The 4-major NCDs are responsible for 82% of NCD deaths.
 Approximately 42% of all NCD deaths occurred before the age of
70years globally.
 48% of NCD deaths in low- and middle- income countries and
28% in high-income countries were in individuals aged under
70years.

70. Contd…
70
 In India, NCDs contribute to around 5.82 million deaths that
account for 61% of all deaths.
 India shares more than 2/3rd of the total deaths due to NCDs in
the South-East Asian Region (SEAR) of WHO.
 The probability of dying between ages 30 and 70 years from 4-
major NCDs is 26%.

71. Contd…
71
 Of all NCD deaths:
CVD contributes to - 45%
Chronic respiratory disease - 22%
Cancers - 12%
Diabetes - 3%

72. Contd…
72
 It is estimated that the people with diabetes will increase from 40.9
million to 69.9 million by 2025; and obesity, which is associated with
hypertension, CVD, diabetes, and some cancers, will affect 52.1 million
by 2030.
 CVD is expected to be the main cause of death (37%) by 2030.
 During 2011-2025, cumulative economic losses due to NCDs in low-

73. 73
EVOLUTION OF NPCDCS

74. 74
Objectives of NPCDCS
1. Prevent and control common NCDs through behaviour and lifestyle
changes.
2. Provide early diagnosis and management of common NCDs.
3. Build capacity at various level of health care.
4. Train human resource within the public health set-up.
5. Establish and develop capacity for palliative and rehabilitative care.
6. Support for development of database of NCDs through Surveillance
System and to monitor NCD morbidity and mortality and risk factors.

75. 75
Strategies
1. Health promotion, awareness generation and promotion of healthy life
style.
2. Outreach camps for opportunistic screening at all levels of healthcare
facility.
3. Management of chronic NCDs through setting up of NCD clinics.
4. Build capacity at various levels of health care.
5. Provide support for diagnosis and cost-effective treatment at all levels of
healthcare.
6. Provide support for development of database of NCDs through

76. 76
Risk Factor and Levels of Non-Communicable
Diseases/Prevention and Management
Behavioural risk
factors
Intermediate risk
factors
Disease
 Tobacco
 Alcohol
 Physical inactivity
 Diet
 Raised BMI
 Raised Blood pressure
 Raised Blood glucose
 Dyslipidemia
 Cardiovascular disease
 Diabetes
 Cancer
 Chronic respiratory
disease
Primary prevention
(Health Promotion)
Secondary prevention
(Early diagnosis and
Case Management)
Tertiary prevention
(Case Management and
Rehabilitation)

77. 77
Package of Services to be made Available at
Different Levels under NPCDCS.
HEALTH FACILITY PACKAGES OF SERVICES
 SUB-CENTRE  Health promotion & awareness generation of early
warning signals of common cancer & other risk factors of
NCDs
 ‘Population based/Opportunistic’ Screening of common
NCDs including cancer.
 Referral of suspected cases to PHC/CHC/ nearby health
facility. Follow up of patient put on treatment.
77

78. 78
HEALTH
FACILITY
PACKAGE OF SERVICES
 PHC  Health promotion.
 ‘Population based/Opportunistic’ Screening of Diabetes, hypertension
and three common cancers (oral, breast, and cervical by VIA).
 Clinical diagnosis and treatment of common NCDs including
Hypertension and Diabetes, referral of complicated cases of
DM/HTN to CHC/DH.
 Identification of early warning signals of common cancer.
 Referral of suspected cases to CHC/DH and follow up of patient put
on treatment.

79. 79
HEALTH
FACILITY
PACKAGE OF SERVICES
 CHC/FRU  Prevention and health promotion including counselling. Early
diagnosis through clinical and laboratory investigations.
 Diagnostics Facilities: Blood sugar, Total Cholesterol, Lipid
Profile, Blood Urea,Creatinine, X-Ray, ECG,USG (To be
outsourced, if not available) ‘Opportunistic’ Screening of
common cancers (Oral, Breast and Cervix).
 Management of common NCDs
 Referral of complicated cases to District Hospital/higher health
care facility

80. 80
HEALTH
FACILITY
PACKAGE OF SERVICES
DISTRICT
HOSPITAL
Diagnosis and management of cases of CVDs, Diabetes,
COPD Stroke and Cancer (outpatient, inpatient and
intensive Care) including emergency services particularly
for Myocardial Infarction & Stroke.
Lab. investigations and Diagnostics: Blood sugar, Lipid
Profile, KFT, LFT, X-Ray, ECG,USG ECHO, CT Scan,
MRI etc (To be outsourced, if not available)
Referral of complicated cases to higher health care facility.
‘Opportunistic’ Screening of NCDs including common
cancers (Oral, Breast and Cervix).
Follow up chemotherapy in cancer cases, Rehabilitation
and physiotherapy services.

81. 81
HEALTH
FACILITY
PACKAGE OF SERVICES
MEDICAL
COLLEGE
Mentoring of District Hospitals, Early diagnosis and management
of Cancer, Diabetes, CVDs and other associated illnesses, Training
of health personnel,
Operational Research.
TERTIARY
CARE
CENTRE
Mentoring of District Hospital and outreach activities,
Comprehensive cancer care including prevention, early detection,
diagnosis, treatment, palliative care and rehabilitation.
Training of health personnel &
Operational Research
81

82. 82
MANAGEMENT STRUCTURE OF NCD
CELL

83. 83
NEW INITIATIVES UNDER THE PROGRAMME
 Population based screening (PBS): initiated under the umbrella of
NHM in 100 districts of the country in the first phase.
 Intervention for prevention of control of COPD and CKD.
 Intervention for prevention and control of Rheumatic Heart Disease
under NPCDCS and RBSK: Here, role of RBSK would be to screen
suspected cases and refer them to the nearest NPCDCS health
facilities.

84. Contd…
84
 Integration of RNTCP with NPCDCS: National framework for “Joint
Tuberculosis-Diabetes collaborative activities”
 Integration of AYUSH with NPCDCS.
 Opportunistic screening of common NCDs including Diabetes,
Hypertension and Cancer is being done among the attendees of the
India International Trade Fair (IITF) at New Delhi every year.

85. 85
WHO Global Action Plan and Monitoring
Framework for Prevention and Control of
Non-Communicable Diseases
2013 - 2020

86. 86

87. 87

88. 88
National Action Plan and Monitoring
Framework for Prevention and Control of
Non-Communicable Diseases in India
 India is the first country to adopt the WHO Framework in the national
context.
 The framework outlines 21 indicators and 10 targets, as recommended,
which will be used to track progress of actions designed to prevent and control
NCDs until 2025.
 All these targets for 2025 are the same as laid by WHO.
In addition, India has given mid-term targets to be met by 2020 and

89. Targets for NCD Prevention and Control in
India
89 Framework
element
TARGETS
OUTCOME 2020 2025
Premature mortality
from NCDs
Relative reduction in overall mortality from
cardiovascular disease,cancer,diabetes, or copd
10% 25%
Alcohol use Relative reduction in alcohol use 5% 10%
Obesity and diabetes Halt the rise of obesity and diabetes prevalence No mid
term
target
set
Physical inactivity Relative reduction in prevalence of insufficient
physical activity
5% 10%
Raised B.P Relative reduction in prevalence of raised B.P 10% 25%

90. 90
Framework element TARGETS
OUTCOME 2020 2025
Salt/sodium intake Relative reduction in mean population intake
of salt, with aim of achieving recommended
level of less than 5 gms per day
20% 30%
Tobacco use Relative reduction in prevalence of current
tobacco use
15% 30%
Drug therapy to prevent
heart attacks and
strokes
Eligible people receiving drugbtherapy and
counselling
30% 50%
Essential NCD
medicines and basic
technologies to treat
major NCD
Avaialability and affordability of quality, safe
and efficacious essential NCD medicines and
basic technologies
60% 80%
Household indoor air
pollution
Relative reduction in household use of solid
fuels
25% 50%

91. 91
SUMMARY
 The global burden and threat of non-communicable disease constitutes a
major public health challenge that undermines social and economic development
throughout the world.
 It is estimated that the people with diabetes will increase from 40.9 million to
69.9 million by 2025; and obesity, which is associated with hypertension, CVD,
diabetes, and some cancers, will affect 52.1 million by 2030.
 Prevention is the key measure to decrease the disease burden of both obesity

92. REFERENCES
92
 Park’s Textbook of Preventive and Social Medicine - K. Park; 26th edition.
 IAPSM’s Textbook of Community Medicine - AM Kadri; 2nd edition.
 International Diabetes Federation Atlas; http://idf.org
 http://who.int
 http://diabetes.org ; American Diabetes Association
 http://rchiips.org/nfhs/factsheet
 National Health Programs of India - J. Kishore, 14th edition.
 Health Policies & Programmes in India - DK Taneja, 16th edition.
 http://www.nhp.gov.in/npcdcs