This document discusses the burden of diabetes in India. It notes that India has an estimated 77 million people with diabetes, which is the second highest number in the world. The prevalence of diabetes in India is increasing rapidly due to factors such as aging, urbanization, sedentary lifestyles, and diet. Key risk factors for diabetes in India include overweight/obesity, physical inactivity, family history, age, and diet. The document outlines approaches for primordial, primary, secondary, and tertiary prevention of diabetes in India. These include diabetes awareness programs, screening, lifestyle changes, and management of complications.

1. Burden of diabetes in India
Risk factors and method to
reduce the disease
Evangelin Ida Mary.J

2. Outline
• Diabetes – a chronic disease
• Diabetes in India
• Burden of the diabetes
• Prevalence of diabetes in India
• Risk factors
• Preventive methods
• References

3. Diabetes- a chronic disease
Diabetes mellitus, commonly known as diabetes, is a chronic
diseases that occurs when your blood glucose, also called blood
sugar, is too high. Blood glucose is your main source of energy and
comes from the food you eat. Insulin, a hormone made by
the pancreas, helps glucose from food get into your cells to be used
for energy.
• Sometimes people call diabetes “a touch of sugar” or
“borderline diabetes.” These terms suggest that someone doesn’t
really have diabetes or has a less serious case, but every case of
diabetes is serious.

4. Diabetes in India
• India has an estimated 77 million people with diabetes, the second most affected in the world,
after China. India is considered as diabetes capital of the world.
• One in six people (17%) in the world with diabetes is from India. (India’s population as
calculated in October 2018 was about 17.5% of the global total.) The number is projected to grow
by 2045 to become 134 million per the International Diabetes Federation( IDF).
• In India, type 1 diabetes is more rare than in western countries. Only about one-third of type 2
diabetics in India are overweight or obese. Approximately 85–95% of all cases of diabetes are
type 2 diabetes and the worldwide explosion of this disorder is a major health care burden. It is
estimated that nearly 380 million adults worldwide will have diabetes by 2025.

5. Cont....
• In 2020, according to the International Diabetes Federation (IDF), 463
million people have diabetes in the world and 88 million people in the Southeast
Asia region. Of this 88 million people, 77 million belong to India.
• The prevalence of diabetes in the population is 8.9%, according to the IDF.
According to the IDF estimates, India has the second highest number of children
with type 1 diabetes after the United States. It also contributes to the largest
proportion of incident cases of type 1 diabetes in children in the SEA region. As Per
the World Health Organization, 2% of all deaths in India are due to diabetes.

6. Burden of the disease
• There are estimated 72.96 million cases of diabetes in adult population of India.
The prevalence in urban areas ranges between 10.9% and 14.2% and prevalence in
rural India was 3.0-7.8% among population aged 20 years and above with a much
higher prevalence among individuals aged over 50 years (INDIAB Study).
• Diabetes is endemic in India. The International Diabetes Federation has
estimated that India currently has more than 65 million people with type 2 diabetes
and the numbers are poised to double in the next 20 years.
• Cardiovascular diseases (coronary heart disease, stroke, peripheral arterial disease)
are the major causes of morbidity and mortality in type 2 diabetes. It has been
reported that 60–80% of patients with diabetes die of cardiovascular events.
• It has been reported that 60–80% of patients with diabetes die of
cardiovascular events. Control of cardiovascular risk factors in diabetes can
prevent or delay cardiovascular events

7. Cont...
• The increased number of diabetics in India is likely to be due to a
significant increase in the incidence of type 2 diabetes, caused by
unprecedented rates of urbanization, which results in environmental
and lifestyle changes.
• Although India accounts for about 15% of the world's diabetes burden,
its spending on healthcare related to diabetes is only 6.4% of worldwide
spending; health resource allocations should reflect the burden of
disease. The greatest numbers of people with diabetes are between 40
and 59 years of age.
• Diabetes is ubiquitous, its prevalence is rising globally, and the social
and economic burden caused is very huge.

8. Prevalence of diabetes in India
• The International Diabetes Federation has reported that the prevalence of
diabetes in adults in India is 7.1%. The prevalence in urban areas is 9%.This study
shows a greater prevalence among the middle-class urban Indians.
• Recent studies have reported urban diabetes prevalence rates of 8–20% and rural
diabetes prevalence rates of 5–15%.There are only a few multisite studies of diabetes
prevalence in India. A 2004 study suggests that the prevalence of type 2 diabetes in
Indians may be due to environmental and lifestyle changes resulting from
industrialization and migration to urban environment from rural.
• In India, prevalence of foot ulcers in diabetic patients in clinic population is 3%. The
crude prevalence of diabetes and pre-diabetes among adults were 5.1 and
13.5%, respectively, while the prevalence of pre-diabetes in youth aged 10–17
years was 5.1%. Intervention reduced fasting blood glucose levels of pre-diabetic
adults by 11%, pre-diabetic youth by 17%, and type 2 diabetic adults by 25%.

9. Cont..
• The rising prevalence of diabetes in India and other developing countries is
chiefly attributed to urbanization. India will continue to have the largest
number of diabetic subjects as a result of the rapid urbanization and
economic development .
• The crude prevalence of diabetes and pre-diabetes among adults were 5.1
and 13.5%, respectively, while the prevalence of pre-diabetes in youth aged
10–17 years was 5.1%. Intervention reduced fasting blood glucose levels of
pre-diabetic adults by 11%, pre-diabetic youth by 17%, and type 2 diabetic
adults by 25%.

10. Why is the prevalence of diabetes
increasing?
• Aging of the population
• Urbanization especially in the developing countries
• More sedentary lifestyle
• Food consumption patterns
more foods with high fat contents
more refined carbohydrates

13. Risk factors
• Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
• Inactivity. ...
• Family history. ...
• Race or ethnicity. ...
• Age. ...
• Gestational diabetes. ...
• Polycystic ovary syndrome. ...
• High blood pressure.
• Overweight and lack of physical exercise
• Smoking
• A low-fiber, high-fat, and sugary diet
• Medications that can affect the body’s metabolism of carbohydrates
• Genetic factors which may cause some families to more likely develop diabetes.
• Age group (45–69 years), marital status, hypertension, obesity and family history of DM were found to be the risk
factors

14. Pre- modial prevention
• Primordial prevention was provided to the whole population in the
form of mass- scale diabetes awareness programs. This part
of the program used VHWs to increase awareness and to screen all
subjects in the community.
• Primordial prevention was provided to the whole population in the
form of mass- scale diabetes awareness programs. This part of the
program used VHWs to increase awareness and to screen all
subjects in the community.
• such as family and self-help groups, the performing arts, peer-
group support, and one-on-one sessions.

15. Primary prevention
• A healthy diet, together with regular physical activity, maintenance
of a healthy body weight, consumption of moderate amounts of
alcohol, and avoidance of sedentary behaviours and smoking,
secondary prevention
• The purpose of secondary prevention activities such as screening is
to identify asymptomatic people with diabetes
• population screening
• selective screening
• opportunistic screening
• Home blood glucose monitoring
• Self care
• Proper management of diabetes

16. Tertiary prevention
• Includes action taken to prevent and delay the development of acute
or chronic complications
• Strict metabolic control, education and effective treatment
• Screening for complications in their early stages when intervention
is more effective
• Screening for eye and renal problems
• Managing foot problems
• Muscular complications

18. National Diabetes Control Programme
• Government Of India started National Diabetes control
programme which focuses on prevention of diabetes through
identification of high risk subjects and early intervention in the form
of health education.
• Early diagnosis of disease and appropriate treatment morbidity and
mortality with reference to high risk group.
• Prevention of acute and chronic metabolic, cardiovascular, renal
and ocular complication of the disease
• Provision of equal opportunity for physical attainment and
scholastic achievement for the diabetic patients
• Rehabilitation of those partiality or totally handicapped diabetes
people.
• “The ultimate aim is to integrate control of diabetes into
that of hypertension and heart disease”

19. References
• https://www.niddk.nih.gov/health-information/diabetes/overview/what-
is-diabetes
• https://en.wikipedia.org/wiki/Diabetes_in_India
• https://drc.bmj.com/content/2/1/e000048
• https://onlinelibrary.wiley.com/doi/full/10.1111/j.1753-
0407.2008.00004.x
• https://www.annualreviews.org/doi/full/10.1146/annurev.publhealth.