A recent ICMR study recorded about 100 million individuals with diabetes and 136 million with prediabetes in India, a 44 per cent increase in the last four years. Its lead author Dr R M Anjana, managing director, Dr. Mohan's Diabetes Specialities Centre, talks to Gunjan Sharma about how the study is unique, what has led to this whopping increase, and what needs to be done to control the silent epidemic…

Numerous studies on diabetes have been done so far, how is this study different?

Though there have been a number of studies to study diabetes prevalence in the country, most were not nationwide. The earlier ICMR study was done in a few parts of the country. Some studies covered only metropolitan cities, some were done only in small towns and villages. It is for the first time that we have looked at the prevalence of diabetes, pre-diabetes, obesity, hypertension, and dyslipidaemia at a national level. The study covered every state keeping into account its geography, population size, and socioeconomic status. It also looked at the urban-rural split, male-female ratio, etc. The samples were chosen carefully to represent the area being studied.

We have used the most stringent method for diagnosing diabetes. The sample size is huge—about 1,13,000 people have participated in the study—and selected from different parts of the states so that it represents the entire country. Every investigator who was part of underwent rigorous training to understand the methods we used for the study, including how to collect blood samples, measure height and weight and other parameters of the body. There are more than 40 quality logs in the study!!

Seventy per cent of the Indian diet is carbohydrate, either wheat or rice. If we reduce this 70% to 60% or 50%, it can bring a remarkable change in terms of health benefits, especially in reducing diabetes cases.

How will this study help in bringing down the cases of diabetes in the country?

The study is so detailed that it gives us some very unique results. Moreover, every state in India now has its own data. Health is a state subject in India and so state governments can use this data while devising any policy.

In a disease like diabetes, you need lifestyle changes at an individual, family, as well as community level. Besides, we need interventions to prevent people at high risk of developing diabetes, including those with obesity and prediabetes, from developing diabetes.

Second, we need proper treatment for those with diabetes so that their HbA1c, blood pressure, and cholesterol remain under control.

The study says that over 100 million Indians are now diabetics, a 44% rise within the last four years. What are the major causes of the burgeoning burden of diabetes in India?

There are multiple factors responsible for it, but primarily it is a lifestyle. People are eating unhealthy, they are physically inactive. Especially during Covid-19, people were stuck inside their homes. People, who work from home, don’t step out of their homes until it's the weekend. They don’t realise that such long hours of just sitting can have devastating effects on their health. Stress levels have also gone up.

Then, people are hooked to food apps. When I was a kid, eating ice cream used to be a monthly affair and we used to walk to our nearby ice cream parlour. But now ice cream or for that matter any food you crave is just a click away.  People don’t mind multiple servings in a day. They don’t realise it is so high in sugar and fat.

What people don’t understand is that while these food apps are important service apps, representing technological advancement, they need to be cautious about what they are ordering, and how much they should consume.

Why do some states have a higher prevalence of diabetes?

Goa has the highest incidence of diabetes, and UP has the lowest. Diabetes goes very closely with the GDP of the state or the Human Development Index. So states with a better GDP have a higher prevalence of diabetes.

Is it also related to the culture, traditions, and food habits?

Yes. High carbohydrate consumption has clearly been linked to increased diabetes. Seventy per cent of the Indian diet is carbohydrate, either wheat or rice. If we reduce this 70% to 60% or 50%, it can bring a remarkable change in terms of health benefits, especially in reducing diabetes cases.

People need to replace the extra carbs in their diet with protein and increase their fibre intake from the current 3 per cent to 6 %. To control the diabetes explosion, we don’t need massive changes in diet or fad diets, we need small simple changes. This study should be considered a wake-up call for everybody. Regulating diet, one hour of exercise per day, and adding a bit of pranayama and yoga to reduce stress, should be one’s gift to oneself.

As a family, we can reduce outings to movies, where we primarily sit and eat for hours and include outings to parks where we can play games that involve some running around.  We can all go cycling together.