Diabetes has the highest prevalence and comorbidities among all NCD’s in India.

More than 56 percent respondents stated that they are seeking treatment for more than 1 year, attesting to diabetes’ morbidity

Highest prevalence of diabetes found in southern and eastern states

The Associated Chambers of Commerce and Industry of India (ASSOCHAM), the apex trade association of the country, as part of its ‘Illness to Wellness’ campaign and in the light of the  ‘World Diabetes Day’ has unveiled a report on the findings of a National Level Survey conducted on the state of Diabetes in India. The release was followed by a webinar on “Diabetes Free India” organized with the objective of cascading awareness and disseminating wisdom on diabetes management and its prevention and which was attended by a panel of eminent experts and doctors from across the country.

The survey report entitled “Diabetes in India” was produced by ASSOCHAM and the Delhi-based think tank, Thought Arbitrage Research Institute (TARI). The survey was designed and conducted by IMRB-Kantar and covered 2,33,672 people and 673 public health offices in 21 state clusters covering appropriate regions and age segments.

The key findings of the survey relate to the burden of diabetes and its primary causes or risk factors which lead to its rise and increasing spread in the country. According to the report, the prevalence of diabetes cases in India almost doubled from 42.6 million cases in 2005 to 85.4 cases in 2019. Globally, on the other hand, the prevalence of diabetes increased from 273.4 cases in 2005 to 460 million cases in 2019. Small wonder then that India has the dubious distinction of becoming the global hub for diabetes cases with prevalence of cases increasing from 15.6 percent to 18.6 percent cases in the same interval. Globally, diabetes accounts for 70.9 million DALYs (Disability-Adjusted Life Years) and 36.7 YLDs (Years Lived with Disability) in 2019. In India, Diabetes accounts for 12.8 million DALYs, 6.7 million YLDs and 0.3 million deaths during the same time-period.

Risk factors for diabetes

In terms of risk factors for diabetes, dietary habits related to high intake of junk / fried foods, most common in younger people today, has highest relative risk of 47 percent. The next highest risk factors as elicited by the survey report relate to low physical activity (38 percent), low intake of fruits and vegetables (28 percent), and other causes such as stress, pollution, and high consumption of alcohol & carbonated/ sugary drinks.

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Over the time, uncontrolled diabetes leads to serious body’s systems damage, especially the nerves and blood vessels. There are ample studies conducted by RSSDI (Research Society for the Study of Diabetes in India) which emphatically depict and highlights that diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation.

Prevalence of diabetes is highest in southern states

The survey outlines the prevalence landscape of diabetes in that it accounts for 25 percent of all NCDs in India at a rate of 2.9 percent. The disease incidence increases significantly in individuals above 35 years of age and affects men more than women.  The report also finds that about 16.8 percent of the male adult population (>15 years) and 14.6 percent of the female adult population (> 15 years) on average are estimated to be diabetic. Prevalence of diabetes is highest in southern states including Puducherry, Kerala, Tamil Nadu, Andhra Pradesh and Telangana and lowest in UP and Rajasthan.

In terms of sufferers seeking treatment for diabetes, the survey presented some important insights in this regard too. About 7 percent of the respondents who were suffering from diabetes stated that they were not seeking any treatment at all. However, more than 56 percent of the respondents stated that they are seeking treatment for more than one year, a fact testifying to the indisputable and inevitable morbidity of this disease.

Diabetes during the COVID-19 pandemic

Diabetes is proven through studies to be associated with a high risk of cardiac arrest and there have been substantial increases in new cases of diabetes during the COVID-19 pandemic due to various reasons. In the current situation, diabetes has become a serious health concern since large numbers of patients are already vulnerable to the Corona virus. Thus, diabetic patients affected by COVID-19 can cause a major health crisis. Reports show that large occurrence of diabetes makes it a serious comorbidity in COVID-19 patients. Diabetes also imposes a substantial burden on society in the form of higher medical costs, lost productivity, premature mortality, and intangible costs in the form of reduced quality of life.

Setting the tone for the panel discussion at the webinar, Shri Anil Rajput, Chairperson, ASSOCHAM CSR Council, said, “This year marks the 100^th anniversary of the discovery of insulin. It is, however, unfortunate that Diabetes has been underrated as a global public health issue. This needs to be addressed on priority and we as a nation need to take urgent important steps to address this challenge. It is a fact that Diabetes is one of the top three NCDs in India and with each year the burden of this disease is rising.”

Dr. Banshi Saboo, President, Research Society for Study of Diabetes in India (RSSDI), said, “Diabetes prevention must be part of a larger national mission. Students should be taught ‘Health Science’ as a subject in schools which can help in preventing this disease and crating awareness about healthy lifestyles among our future generations. We must also change the age limit for the cyclical three-year testing protocol for sugar from 30 years presently to 25 years of age.”

Dr. (Col.) Sudhir Tripathi, Chairperson & HOD, Endocrinology & Metabolism, Sir Ganga Ram Hospital New Delhi, said, “Diabetes can be prevented even at the pregnancy stage. Healthy mothers give birth to healthy children. We must also educate and inform people that this disease is reversible with healthy lifestyle and timely interventions. Babies who are healthier, not obese, have a far lesser risk of developing diabetes in adulthood. It is advised that we must now have a National Diabetes Month in November to spread awareness and access about Diabetes amongst people.”

Dr. Dinesh Agarwal, Senior Consultant Internist & Head of Department, Department of Medicine Marwari Hospitals, Vice Chairman, RSSDI Assam Chapter, said, “One of the key risk factors and causes of diabetes is stress and junk food. Even children undergo a huge amount of stress these days due to a highly competitive and strained environment. It is a fact that stress leads to hormonal changes which in turn can trigger diabetes in individuals. Add to this the fact that lack of exercise among both children and adults leads to an onset of the disease which could have easily avoided by following simple steps.”

Dr. Rajesh Kesari, Founder and Director, Total Care Control, Delhi-NCR, said, “Diabetes free India is a dream for all of us. Diabetes, a chronic disease, has so many affected all of us either as families or as individuals. It is important to control this disease because not only does it cause many other diseases or co-morbidities and complications to take place, but also leads to a huge economic burden. The interesting aspect here is that 95 percent of diabetes can be prevented, and it is important that we all work towards this.”

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• The average HbA1c level – the best indicator of a patient’s long-term blood sugar control, stood at 8.23% for people living with diabetes in Mumbai.
• The risk of fatal outcome and severe health complications from COVID-19 is up to 50% higher in people with diabetes.
• 12900 people with an average age of 57 years were part of the analysis in the city, out of which 78% were male and 22% were female.

26^th November 2020, Mumbai: In the run-up to World Diabetes Day, the Novo Nordisk Education Foundation had unveiled the second-year report of its Impact India: 1000-Day Challenge’ programme. The programme was launched two years ago to address the issue of sub optimally controlled diabetes in India. According to the report, the average HbA1c level in Mumbai was recorded at 8.23% in September 2020.

Though the average HbA1c level has decreased marginally compared to last year’s figures, the overall high HbA1c levels is still a matter of deep concern especially in the light of the COVID-19 pandemic which puts people with uncontrolled diabetes at a higher risk of a fatal outcome and serious health complications. HbA1c is the best recommended indicator of long-term blood sugar control and gives an average blood sugar control over the preceding three months. 12900 people with an average age of 57 years were part of the analysis in the city, out of which 78% were male and 22% were female.

Speaking about the report, Dr Manoj Chadha, Consultant Endocrinologist, P D Hinduja Hospital and Medical Research Centre, Mumbai  said, “The receding level of HbA1c in Mumbai indicates that irrespective of the COVID-19 pandemic and the doctor unavailability, people with diabetes are taking care of their health within the confines of their residences. They should continue doing so, since the risk of fatal outcome and adverse health complications from COVID-19 is up to 50% higher among people living with diabetics. It is important to maintain a healthy lifestyle to keep the glucose level well monitored because uncontrolled diabetes can cause organ failures as well.”

With the existing pandemic situation with COVID-19, people with diabetes should keep an adequate stock of medications and supplies for monitoring blood glucose at home. If symptoms like difficulty in breathing or shortness of breath, fever, dry cough, tiredness, aches and pains, sore throat, headache, loss of taste or smell are experienced, immediate medical attention should be sought.^[1]

IDCI is a part of the ‘Impact India: 1000-Day Challenge’ programme by Novo Nordisk Education Foundation and serves as a guiding tool for the status of diabetes care across India. iDCI was introduced in 2018 as part of the programme to monitor the diabetes care status in the country. Based on big data analytics, iDCI has been providing a real-time view of the average HbA1c in India, a key indicator of the state of diabetes control across select cities.

At present, more than 77 million people are living with diabetes in India. Under the IMPACT India programme, digital platforms are being leveraged to partner with practitioners (doctors and paramedics) to evolve and implement an approach to diabetes care appropriate to India. iDCI is a dynamic tool that not only tracks the status of diabetes care but also helps to increase awareness, motivate and sensitize healthcare professionals (HCPs) and society. The last two years of the programme have seen significant contributions from HCPs and people living with diabetes from across the country. There has been an improving trend in the iDCI results every quarter, and this would lead to a reduction in the future burden of diabetes-related complications in India.

For more information visit:  Novo Nordisk Education Foundation – nnef.in

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Mumbai, November 14 2020: Nanavati Super Specialty Hospital today, lit up Chhatrapati Shivaji Maharaj Terminus and the entire Hospital in blue to raise awareness about the growing concerns about the intensifying health hazard posed by diabetes from all over the globe.

The initiative is a part of the global campaign launched by World Health Organisation and International Diabetes Federation. The campaign ‘Shine a Light on Diabetes’ aims to reach out to global audience of over one billion people across 160 countries. As a part of the campaign, historic monuments, buildings and structures worldwide are lit blue- a color that represents global solidarity for diabetes awareness.

Present at the venue, Dr Girish Parmar, Consultant Endocrinology and Metabolic Physician said “The global sentiment has exacerbated a situation that is already extremely concerning. While 6% of the world’s population has diabetes, we have seen the number rising rapidly. There is a need for a strong, united response from all organizations working in the areas of monitoring, prevention and treatment of diabetes.”

Chhatrapati Shivaji Maharaj Terminus—a 133-year-old architectural wonder & landmark of Mumbai sparkled in blue on the eve of Diwali that co-incided with Diabetes Day. The color blue signified the hospital’s unity with the global diabetes community.

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The International Diabetes Federation pins India as the epicentre of diabetes mellitus and the statistics is expected to be about 134 million people by 2045 [1] Diwali accords with World Diabetes Day in the 2020 and in light of the enduring pandemic, there is a necessary to create awareness about prevention and controlling of it.

Both fasting and feasting are not indorsed

Both fasting and feasting are not indorsed for diabetics. These both have impact blood sugar levels and without systematic activity or exercise, pandering sweets and other items can trigger health. Festivals are a time when people pander in sweets and snacks. For those with basic health illness such as diabetes, this excess processed food can be harmful. Apart from surging blood sugar levels, it can also effect immunity to combat other infections such as new COVID-19.

There are 2 chief reasons why a diabetes patient are more susceptible to complications from viral infection. The immune system of diabetics (both type 1 & 2) is feeble due to irregular blood glucose variations. The surge in levels of blood glucose could be constructive for the growth of virus in the body. Consequently, when diabetics get infected, it becomes tougher to treat and it needs prolonged treatment.

Patient should also not skip medicines or insulin dosage as prescribed by the physician. Regular Self-monitoring of blood glucose levels is mandatory. This is vigilant if fluctuating and also helps for timely intervention in case of necessary. Ensure to have a small portions and do not skip meals and choose food items that are grilled or roasted. Keep some healthy snacks accessible for hunger twinges and avoid undue alcohol consumption.”

Diabetics must take extra precautions during Diwali 

Here are some tips.

1. Have smaller meals since that will aid in controlling blood sugar levels and keep patient nourished. Make sure to be hydrated adequately.

2. Evade snacking unhealthy food or eat healthy substitutes such as nuts etc. Evade white rice and white bread as they have more glycaemic index.

3. Make sure to go for short walks or to do 15 to 30 minutes of physical activity. For example, take the steps as a replacement for lift.

4. Keep blood sugar levels under check with regular monitoring. Do not change medicines or their schedule without consulting the doctor.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299136/

Dr Manoj Chawla
Director and consultant diabetologist
Lina diabetes care & Mumbai diabetes research centre

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Inculcating awareness around diabetes is the urgent intervention required at every sphere. Lack of awareness in India has made it the second most affected diabetic-hit country of the world touching an estimated 77 million people. And during the COVID-19 pandemic the incidence of diabetes has multiplied markedly. Coincidently, first time in 20 years World Diabetes Day & Diwali are falling on the same day — 14^th Nov’ 2020. Considering the need to inculcate awareness of the increasing rate of diabetes in India, HEAL Foundation has launched Diabetes Blue Fortnight (DBF) from 1^st – 14^th Nov’ 2020, appealing the masses to make it purposeful by taking the pledge of becoming the blue messenger to spread awareness about diabetes.

“On the occasion of World Diabetes Day 2020, I wish every person with diabetes a long and healthy life despite the disorder. I also wish to congratulate the HEAL Foundation for taking up diabetes – one of the serious health issues and running campaign. India has several challenges with respect to management of diabetes starting with the large numbers of people with diabetes, the younger age at onset, the lack of awareness and the lack of affordability of care. A joint effort by diabetologists, physicians, NGOs and the Government will help to improve the quality of life for people with diabetes. India has the potential to become the diabetes care capital of the world, if we all work together,” said, Dr. V Mohan, Director & Chief of Diabetes Research, Madras Diabetes Research Foundation, ICMR Advanced Centre for Genomics of Diabetes, Chairman & Chief Diabetologist, Dr. Mohan’s Diabetes Specialities Centre.

Elaborating on the need of creating awareness, Dr J Kumar, Group Medical Director, Paras Group of Hospitals, said,“The WHO in its effort to draw universal attention from all governments has chosen ‘Blue Colour’ of Sky to symbolise a global effort to fight diabetes and reverse the global trends that will impede economic development and increase the cause of so much sufferings and premature deaths. We all should take a pledge to do our best in creating awareness to control diabetes through Blue campaign, blue lights to decorate during Diwali in India. Let’s celebrate Blue Diwali on the occasion of World Diabetes Day 2020 as both falling on the same day.”

Elaborating on the impact of COVID-19 and the onslaught of diabetes as a part of Diabetes Awareness Campaign, Dr Ashutosh Goyal, Senior Consultant Endocrinologist, Paras Hospital, said, “Of course, COVID-19 has created a lot of problems, broadly impacting the immune system. When your immune system is compromised, you are unable to fight infection. And the persons with diabetes are more prone to get into COVID-19 infection.

Speaking on the Diabetes Awareness Campaign of HEAL Foundation, Dr Abhijeet Bhograj, Co-Founder & Medical Director, 7 Sugar (Bengaluru), said, “The Blue Diwali campaign initiated by the HEAL Foundation is a unique and powerful in the direction of uniting the nation in spreading awareness about diabetes, it is an initiatives, which makes a difference in reducing the long-term economic burden on the nation. The fight against diabetes is a long battle and this is a step forward on the occasion of World Diabetes Day 2020. Technological innovations are also there in place to deal with the disease. By using AI technology to collect the data would be of great help. We need to cut down on carbohydrate content from our diet. In the year 2020, we need to encourage to celebrate ‘Blue Diwali’ to spread awareness amongst the masses.”

On the relationship between intermittent fasting and diabetes management, Ms Manjari Chandra,Clinical Nutritionist & Founder Manjari Wellness, said, “Although, the concept of intermittent fasting has come from foreign counties, yet, it is a cultural part of India because Indian people usually have an interval of 14-15 hours between their dinner and the first meal the next morning, which is intermittent fasting. Intermittent fasting is beneficial in diabetes if it is done scientifically following the balanced dietary regimen. Fasting and feasting can’t go together.”

“The colour blue has always been the symbol of health and life and abundance of the sky and sea. In the Hindu mythology the most powerful of human incarnation if lord Vishnu, Krishna and lord Ram have been depicted blue. We all know that Diwali is celebrated to symbolise lord Rama’s winning good over evil. Diabetes also has a symbol. The blue circle, which has been adapted by the International Diabetes Federation (IDF)to spread the awareness of this dreaded disease. On this rare occasion that Diwali and World Diabetes Day fall on the same day, let’s join hands and spread the message across to light the Diwali blue in colour. I congratulations for the HEALFoundation for this unique initiative,” Dr. Rahul Agarwal, Senior Consultant General Physician, Diabetologist, Medicover Hospital.

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• The average HbA1C level – the best indicator of a patient’s long-term blood sugar control, stood at 8.48% , registering a marginal improvement over the last year
• Hyderabad, Kolkata, and Jaipur have shown a dip in HbA1c levels in the last two years
• People with diabetes are at up to 50% higher risk of a fatal outcome and severe health complications due to COVID-19

06 November 2020, New Delhi: In the run-up to World Diabetes Day, the Novo Nordisk Education Foundation today unveiled the second-year report of its Impact India: 1000-Day Challenge’ programme. The program was launched two years ago with an ambition of reducing the HbA1c levels of people with diabetes in India by 1% over the next 1000 days, thereby reducing the risk of complications and the economic burden associated with diabetes. Encouraged by the government’s ground-breaking health care initiatives like Ayushman Bharat and the availability of real-time data from digital platforms, this programme further strengthens Novo Nordisk’s belief that it is now possible to fight the battle against diabetes.

According to the report, the average HbA1c level of the country was recorded at 8.48% from October 2019 to September 2020. Though the average HbA1C level has decreased marginally compared to last year’s figures, the prevailing high HbA1c levels is a matter of deep concern especially in the light of the COVID-19 pandemic which puts people with uncontrolled diabetes at a higher risk of a fatal outcome and serious health complications. The data collection exercise for the iDCI was conducted across 30 Indian cities. The average respondent age was 55 years, of which 57% were males and 43% female.

At present, more than 77 million people are living with diabetes in India and country’s annual spend is approximately INR 64,500 crores on diabetes related healthcare which is further expected to increase if diabetes is not controlled. HbA1c is the best recommended indicator of long-term blood sugar control and gives average blood sugar control for 3 months.

The second-year report was launched in the presence of  Mr Vikrant Shrotriya, Trustee, Novo Nordisk Education Foundation, Prof. Dr A.K. Das, Professor of Medicine, Pondicherry Institute of Medical Sciences, Puducherry and Patron of the Impact India programme, Shri Sachin Kumar Singh, CEO, Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP), Department of Pharmaceuticals, Govt. of India and H.E. Freddy Svane, the Danish Ambassador in India.

Amidst these COVID-19 pandemic times, a few cities have shown a drop in their HbA1c levels from Jan-June 2018 to July-Sep 2020. These include Hyderabad, Kolkata, and Jaipur but the majority of Indian cities have seen an upsurge in HbA1c levels.

• In South India, Hyderabad HbA1c levels have dropped from 8.64% to 8.02 % (down by 0.62%) in 24 months.
• In the East,Kolkata registered a drop from 8.24% to 7.96% (down by 0.28%) in the same period.
• Jaipur in North India has notched a dipfrom 8.30% to 8.01% (down by 0.29%) in the same period.

Speaking about the programme, Dr A.K. Das, Professor of Medicine, Pondicherry Institute of Medical Sciences and Patron of the IMPACT India programme, shared, “For the last two years, Impact India  has striven to create awareness on the ‘Indian Reality’ of diabetes management. We have created a scientific framework as a part of our train-the-trainer approach through which 3311 doctors have been reached via 180 Impact Workshops across 150+ cities so far. We are hopeful that the programme will continue to empower thousands of Indians on successful diabetes management.”

 Mr Vikrant Shrotriya, Trustee, Novo Nordisk Education Foundation, said, “We have worked towards managing diabetes for nearly 100 years at Novo Nordisk. The “Impact India: 1000-Day Challenge” Programme is a unique initiative focused at educating and improving the lives of people with diabetes  We believe that our real competition is with the uncontrolled growth in diabetes, lack of awareness, and restricted access to medicines. So, we will continue partnering with stakeholders including healthcare professionals, professional associations, and government bodies to overcome these obstacles. We are happy that cities like Hyderabad, Jaipur and Kolkata are showing a decline in their HbA1c levels over the last two years, and are hopeful that by next year, many more Indian cities will report similar dips.”

Mr Sachin Kumar Singh, IRS, CEO of BPPI, Department of Pharmaceuticals advised that “The Government of India has made adequate provisions for all known/ diagnosed people with diabetes to receive a regular supply of prescribed medicines. The data generated under the IMPACT India programme will be useful in identifying the trend in HbA1c levels across major cities in India.  We congratulate Novo Nordisk Education Foundation for developing a tool through which policymakers and doctors can analyze the trends and accordingly prepare the right medical approach and policies for people living with diabetes. “

H.E. Freddy Svane, Ambassador of Denmark to India, mentioned, “Novo Nordisk Education Foundation has been doing an admirable work in the field of diabetes awareness in India.  I congratulate everyone who has contributed towards the “Impact India: The 1000-Day Challenge” Programme, second year running. The positive difference that this programme has made in the lives of people living with diabetes in India is commendable.”

Former Indian Cricketer and Brand Ambassador, Novo Nordisk India, Anil Kumble said, “As a sportsperson, I have learned that a healthy exercise routine goes a long way in staying physically and mentally fit. This year, the COVID-19 pandemic has forced us to stay home for prolonged periods of time, barring us from performing outdoor sports or other exercises. However, indoor exercises are as beneficial as their outdoor counterparts. Practices like Yoga, Pilates and brisk walking are useful in keeping blood glucose levels down in people with diabetes. The iDCI findings concretely demonstrate that diabetes can be controlled even under a lockdown if people with diabetes are to follow a balanced exercise regimen.”

Dr. Banshi Saboo, President, Research Society for the Study of Diabetes in India (RSSDI) informed, “The high level of HbA1c in people with diabetes is deeply concerning. The COVID-19 pandemic has had a catastrophic influence on the physical and mental wellbeing of people. Under such a scenario, staying fit through physical exercises becomes critical for effective management of diabetes. In our pursuit to encourage people to stay healthy, we have partnered with Novo Nordisk to bring the second edition of Pedals Changing Diabetes. The 5K Virtual Run & Cyclothon urges people to take up running or cycling as a fun way to keep fit and manage their diabetes. We look forward to participation from people across the country in the Pedals Changing Diabetes programme as this will help in raising awareness around the disease and its management.”

iDCI (Indian Diabetes Care Index) was introduced in the year 2018 as part of the programme to improve diabetes care in the country. Based on big data analytics, iDCI has been providing a real-time view of the average HbA1c in India, a key indicator of the state of diabetes control across select cities.  Under the Impact India programme, digital platforms are also being leveraged to partner with practitioners (doctors and paramedics) to evolve and implement an approach to diabetes care appropriate to India. iDCI is a dynamic tool that not only tracks the status of diabetes care but also helps to increase awareness, motivate, and sensitize healthcare professionals (HCPs) and society towards better diabetes management.

The last two years of the programme has seen significant contributions from healthcare practitioners (HCPs), and people living with diabetes from across the country. There has been an improving trend in the iDCI results since its inception, and this will lead to a reduction in the future burden of diabetes-related complications in India.

 (HbA1C levels recorded Between July-September 2020)

About Novo Nordisk Education Foundation 

The Novo Nordisk Education Foundation (NNEF) was founded in 1997 with a mission to “enhance healthcare through awareness and education” NNEF drives several projects including the Changing Diabetes^® Barometer, Changing Diabetes^® in Children programmes and World Diabetes Day awareness activities in partnership with state governments and other key stakeholders. As a result of these efforts, more than 750,000 people have been reached; nearly 4000 doctors and paramedics have been trained and over 100 community diabetes centres have been established. Under the Changing Diabetes^® in Children programme, more than 4000 children have been receiving free treatment and care since 2011. Taking the commitment to care further, NNEF launched “IMPACT India”, an India specific solution-oriented programme on the eve of World Diabetes Day in 2018 with an ambition to reduce the average HbA1c of the country by 1% over a three-year period.

  For more information visit: nnef.in 

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