Over half of 20-year-olds in urban India likely to develop diabetes in their lifetime: Study

Those who were free of diabetes at age 60 were at lower risk, with around 38% of women and 28% of men developing diabetes at a later age, found the study that used data from Delhi and Chennai

A little over one in two men (56%) and close to two-thirds (65%) women who are currently 20 years old are likely develop diabetes later in life, found an international study on the lifetime risk of diabetes in people living in urban India. Lifetime risk is the cumulative probability of developing diabetes over the course of one’s lifespan.

Obesity raises the chances of developing diabetes substantially, with the lifetime risk being highest among obese metropolitan Indians, which is as high as 86% among 20-year-old women and 87% among the men.

“The numbers are alarming across the spectrum of weight and rise dramatically with higher weight. The risk is 85% for people who are obese, which is massive. People with healthy or lower weight have considerably higher diabetes-free life expectancy, which means diabetes prevention, testing and treatment must be made a national priority, particularly given the rapid increase in urban obesogenic environments,” said study co-author professor Nikhil Tandon from the department of endocrinology and metabolism, All India Institute of Medical Sciences, Delhi.

Being thin lowers the risk. People who had a normal or low BMI (body mass index, which is measure of weight) lived out 80-85% of their remaining years diabetes-free, compared to obese 20-year-olds who have only 46-52% of their remaining life years disease free, according to the paper published in Diabetologia, which is the journal of the European Association for the Study of Diabetes.

Those who were free of diabetes at age 60 were at lower risk, with around 38% of women and 28% of men developing diabetes at a later age, found the study that used data from Delhi and Chennai. Women consistently had a higher lifetime risk across their lifespan.

Adult-onset diabetes would account for 95% of the cases, found researchers from India, US and the UK, who were led by Dr Shammi Luhar from the department of public health and primary care, University of Cambridge, UK.

The study used age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010–2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research-India Diabetes Study (2008–2015).

A US study using data from 2000–2011 reported a lifetime diabetes risk of 40% among men and women aged 20 years from the general population. “Our new estimates from India are much closer to estimates of lifetime risk of diabetes of 20-year-olds among the Black and Hispanic populations in the USA (above 50%), groups considered at a higher risk of developing diabetes than the general population,” said the study.

“Indians seem to have a more rapid decline in beta cell function at much lower BMI, and progress towards diabetes at least a decade earlier than Caucasians. So while genes do have a pre-disposive role, the gene-environment interaction is also important as an unhealthy lifestyle can tilt the balance,” said Dr Tandon.

“High risk of diabetes in urban populations has been shown in other studies, and this detailed analysis further consolidates it. It also means that the load of diabetes-related complications and infections in the urban population is going to escalate. However, we need further studies to corroborate these since this research are based on a modelling analysis,” said Dr Anoop Misra, chairman, Fortis-CDOC Centre for Diabetes, Metabolic Diseases and Endocrinology, New Delhi.

In India, 77 million adults have diabetes and this number is expected to almost double to 134 million by 2045. Urbanisation, unhealthy diets and increasing inactivity, coupled with the relatively high predisposition of Indians and other South Asian populations to developing diabetes at both lower ages (up to a decade earlier) and lower BMIs when compared to white European populations, are fuelling a hidden epidemic.

“Such high probabilities of developing diabetes will have severely negative implications for India’s already strained health system and also out-of-pocket expenditure on diabetes treatment by patients, unless diabetes is immediately acknowledged for what it is: one of the most important threats to public health in India.,” said Dr Shammi Luhar, department of public health and primary care, University of Cambridge, UK, who led the study.

“The government offers universal screening at age 30 and above, with that a target of ‘90-90-90’ (90% of people with diabetes detected, 90% of those detected treated, and 90% of those treated controlled), would help control diabetes. Currently, 50% people with diabetes are diagnosed, of which 50% receive treatment, and 50% on treatment control their diabetes,” said Dr Tandon.