Urban India's Diabetes Epidemic Keeps Growing

What ails the urban wards of India today are not the infections that used to be the cornerstone of Indian public health problems. They are, more and more, diseases of overuse – diabetes, hypertension and dyslipidaemia – and the age of onset continues to decline.

From Rare to Routine in Fifty Years

An early multicentre study in 1972 conducted by AIIMS New Delhi, found diabetes prevalence of only 2–2.5 per cent in urban India, compared to 0.5–1.5 per cent in rural areas.

The National Medical Journal of India estimates that in metropolitan cities like Delhi and Chennai, diabetes prevalence has more than doubled in adults over 20 years of age, from the last two generations.

The ICMR-INDIAB study, the largest nationally representative survey of its kind, has conducted a survey of 113,043 people in all 31 states and union territories from 2008 till 2020 to map this shift comprehensively for the first time.

In addition to being obese, these tracks follow the same curve as obesity itself

The same national study also showed that prevalence of overweight was consistently found to be higher in urban areas than in rural areas across all regions studied, with the Chandigarh region having the smallest gap (18.9 per cent vs. 14.8 per cent) and the Jharkhand region having the largest (12.4 per cent vs. 5.7 per cent).

The report of a separate task force from the National Academy of Medical Sciences showed lipid abnormalities in 79 per cent of the study population in four states — with no significant urban-rural difference — indicating that, once dietary and lifestyle habits change, the metabolic consequences of these changes can be found equally across all regions.

What Changed After 1991

Medical researchers blame the turning point on the economic liberalisation of India. Undernutrition rates fell quickly in tandem with the improving socioeconomic situation after the country opened the economy in 1991, but so too did the rates of overnutrition, especially in urban areas — which as one review put it in the National Medical Journal of India, marked a shift "largely driven by the increasing obesity rates" responsible for the parallel rise in diabetes prevalence.

A Generation at Risk Younger Than Before

The unique characteristic of the current health burden due to non-communicable diseases in India is the age at which such burden now presents itself.

Seeds of the diseases of "old age" are being sown at a much younger age due to sedentary lifestyles while working in the city, eating junk food and having less physical activity, as these have been seen in various region-wise studies including a study among academic professionals in West Bengal, which related the sedentary lifestyle directly to increased visceral fat and cardiovascular risk factors even in people in their twenties and thirties.

Growing public health researchers are calling for a change in this course because it can only be reversed if interventions are made much earlier in life than India's current disease-management model, which is primarily reactionary, is currently intended to offer.