Lifetime risk of diabetes in metropolitan cities in India

Shammi Luhar,Sanjay Kinra,Lynda Clarke,M Masood Kadir,Mohammed K Ali,Dorairaj Prabhakaran,Nikhil Tandon,Viswanathan Mohan,Dimple Kondal,Ranjit M Anjana,Shivani A Patel,K M Venkat Narayan,Rebecca Jones

doi:10.1007/s00125-020-05330-1

Abstract

Aims/hypothesisWe aimed to estimate the lifetime risk of diabetes and diabetes-free life expectancy in metropolitan cities in India among the population aged 20 years or more, and their variation by sex, age and BMI.MethodsA Markov simulation model was adopted to estimate age-, sex- and BMI-specific lifetime risk of developing diabetes and diabetes-free life expectancy. The main data inputs used were as follows: 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).ResultsLifetime risk (95% CI) of diabetes in 20-year-old men and women was 55.5 (51.6, 59.7)% and 64.6 (60.0, 69.5)%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk (95% CI) declined with age to 37.7 (30.1, 46.7)% at age 60 years among women and 27.5 (23.1, 32.4)% in men. Lifetime risk (95% CI) was highest among obese Indians: 86.0 (76.6, 91.5)% among 20-year-old women and 86.9 (75.4, 93.8)% among men. We identified considerably higher diabetes-free life expectancy at lower levels of BMI.Conclusions/interpretationLifetime risk of diabetes in metropolitan cities in India is alarming across the spectrum of weight and rises dramatically with higher BMI. Prevention of diabetes among metropolitan Indians of all ages is an urgent national priority, particularly given the rapid increase in urban obesogenic environments across the country.Graphical abstract

Highlights

Diabetes is a major global public health problem currently affecting 463 million individuals and projected to affect 700 million by 2045 [1]
Main findings Overall, the lifetime risk of developing diabetes among Indian metropolitans at age 20 years was 64.6% among women and 55.5 (51.6, 59.7)% among men
We found a higher age-specific lifetime risk of developing diabetes in higher BMI groups compared with lower ones

Summary

Introduction

Diabetes is a major global public health problem currently affecting 463 million individuals and projected to affect 700 million by 2045 [1]. Lifetime risk provides an estimate of the cumulative probability of eventually developing diabetes over the course of life. It is a valuable estimate for effectively communicating diabetes risk to individuals, even at young ages, and is a powerful tool with which to galvanise public health and policy responses. The population of India, while at the epicentre of the global diabetes epidemic, has a lower BMI distribution and lower overall life expectancy; Indian people show a comparatively higher propensity to develop diabetes, both at younger ages and lower BMI levels [5], suggesting a substantially different epidemiology

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