India breached the 100 million mark in the number of people living with diabetes, as per the recently released ICMR-INDIAB study. But the real reckoner in the report is that, among the 136 million people with prediabetes across the country, a prominent share of them hail from rural and semi-urban areas.
Experts point out that it is high time to adopt effective countermeasures like choosing a healthy lifestyle with physical activity and a healthy diet to control the growing prevalence of diabetes in rural India. Prediabetes is the stage just before diabetes; it is medically defined as intermediate hyperglycemia, where the individual could progress into being diabetic within a couple of weeks in the absence of proper intervention.
Diabetes prevalence in rural India on the rise
“Type 2 diabetes is a growing concern in both urban and rural areas of India. While typically considered a problem of the urban affluent, recent studies have shown that this disease has become increasingly prevalent in rural populations as well,” says Dr V Mohan, diabetologist and chairman, Dr Mohan’s Diabetes Specialities Centre (DMDSC) and Madras Diabetes Research Foundation (MDRF) in an email conversation with Happiest Health.
Dr Mohan also adds in his email that according to an earlier study conducted by the Indian Council of Medical Research (ICMR) and the National Institute of Nutrition (NIN), approximately half of the people with diabetes are from the rural and semi-urban areas of the country.
Dr Krishnan Swaminathan, a Coimbatore-based endocrinologist and a researcher with a PhD from IIT tells Happiest Health that the prevalence of diabetes and prediabetes in rural regions is often understated and the actual statistics would be much higher. He also pointed out his research on the prevalence of NCD (non-communicable diseases) at Nallampatti, an agrarian village in Erode district with a population of around 3,000 individuals. The findings were published in the Indian Journal of Endocrinology and Metabolism in 2017.
“We found that more than 50 per cent of the people were found to have either diabetes or prediabetes after we checked their HbA1C status. Around 40 per cent of them were also found to have high blood pressure,” Dr Swaminathan adds. He also points out that prolonged exposure to fertilisers, pesticides and other toxic air pollutants especially among the agrarian communities could also lead to the onset of diabetes.
Even the most marginalised communities at risk of diabetes
In a recent grassroots survey conducted in a group of villages in Varanasi in Uttar Pradesh and Gaya in Bihar, it was revealed that even the most marginalised communities have been lured into the trap of ultra-processed food. Lenin Raghuvanshi, social activist and CEO of the People’s Vigilance Committee on Human Rights (PVHCR) points out that their survey revealed that at least 10 to 15 per cent of the daily income in these villages including that of communities like Musahars (rat catchers) in Bihar were spent on buying ultra-processed food like wafers, chips and carbonated beverages. The survey featured interviews with over 1,000 people from 330 families living in various villages in Varanasi and Gaya.
“Processed food is now easily available everywhere. It is also coming in cheaply priced small packets and bottles so that everyone can buy them. There is also an aspirational factor behind this consumption, mainly due to aggressive marketing of these products,” Raghuvanshi tells Happiest Health. He also adds that most of these communities are already malnourished to begin with and by turning towards such unhealthy zero-nutrition food, they are putting themselves at great health risk.
“These products have zero nutrients but make one feel satiated and addicted. It is high time that processed food has stern warning messages on it about the health hazards of consuming excess hidden sugars. It should be just as prominently displayed as they do in countries like Chile,” Raghuvanshi adds.
India is one of the most aggressively evolving markets for processed food manufacturers. In June 2022, Pepsico India announced that as part of its Rs 1,022 crore investment in UP, they were setting up a new potato chips and nachos manufacturing unit in Mathura. Interestingly, UP as per the latest report, has one of the lowest diabetes prevalence at 4.8 per cent and one of the highest pre-diabetes rates at 18 per cent, revealing the health paradox emerging in rural and semi-urban areas in the country.
The link between migration and diabetes in rural India
Dr Mohan says that the prevalence of prediabetes and diabetes is closely linked with socio-economic scenarios. He also points out that migration has a significant impact on the prevalence of diabetes. Remarkably, the latest ICMR-INDIAB report confirms what Dr Mohan says – most of the states with a high prevalence of prediabetes like Bihar (11.1 per cent), Rajasthan (16.1), Madhya Pradesh (20.1), West Bengal (23.5) and Uttar Pradesh (18) also have a high domestic migration rate towards bigger cities and developed states.
“Studies have shown that rural-urban migrants are at a higher risk of developing type 2 diabetes than their urban counterparts. This is due to several factors such as changes in lifestyle, access to healthcare and socioeconomic status,” Dr Mohan adds.
The slow but gradual mechanisation of agricultural activities is also boosting more rural-to-urban migration. Most of these migrants have higher chances of working jobs that are not as physically demanding as the work they used to do in their agricultural fields. Ironically, they will have easier access to processed food and beverages in the city, putting them at high risk of prediabetes and diabetes.
Dr Anura Kurpad, professor and researcher, department of physiology, St John’s Medical College, Bengaluru, points out that there are two major factors responsible for the incursion of diabetes in the rural countryside – the change in dietary patterns and the decline in physical activity.
He also adds that unlike Caucasians, Asians (especially Indians) tend to have central obesity. As a result, they look lean but will have excess visceral fat deposits in their abdominal region. Dr Kurpad has also been one of the lead authors of the study published in Nature that linked the decline in Basal Metabolic Rate during the last 30 years to the prevalence of obesity, leading to a higher prevalence of other non-communicable diseases like diabetes.
The latest ICMR-INDIAB report has been forwarded to the Union Health Secretary and it is expected that each state would also go through it and formulate its policies to bring non-communicable diseases, especially diabetes and cardiovascular conditions under control at the earliest.
Takeaways
The high prevalence of diabetes and prediabetes in the country is being seen as a wake-up call to control the spread of NCD across the country. The high prevalence of prediabetes is cited as a health priority to be addressed at the earliest. The rise of ultra-processed food consumption, decreased physical activity and exposure to external factors such as air pollution, contribute to the emergence of these health conditions.
