Abstract
SummaryBackgroundThe burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016.MethodsWe analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsThe number of people with diabetes in India increased from 26·0 million (95% UI 23·4–28·6) in 1990 to 65·0 million (58·7–71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9–6·1) in 1990 to 7·7% (6·9–8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1–46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6–49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7–9·3) in 1990 to 20·4% (19·9–20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34–42) with diabetes, compared with the global average of 19 adults (17–21) in 2016.InterpretationThe increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation.FundingBill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Highlights
Development Goals (SDGs) include a target to reduce the proportion of prem ature deaths due to non-communicable diseases (NCDs), including diabetes, by one third by 2030.7,8 The National Health Policy 2017 of India aims to increase screening and treatment of 80% of people with diabetes and reduce premature deaths from diabetes by 25% by 2025.9
We have previously reported that epidemiological transition ratios of the states of India have a significant inverse relation with the Socio-demographic Index calculated by GBD on the basis of income, education, and fertility levels, which indicates broad correspondence of the epidemiological transition level (ETL) groups with sociodemographic development levels.[17]
We present the proportion of diabetes disability-adjusted life-years (DALYs) that could be attributed to various risk factors in 2016
Summary
Development Goals (SDGs) include a target to reduce the proportion of prem ature deaths due to NCDs, including diabetes, by one third by 2030.7,8 The National Health Policy 2017 of India aims to increase screening and treatment of 80% of people with diabetes and reduce premature deaths from diabetes by 25% by 2025.9. Overall diabetes burden estimates for the 1·3 billion population of India mask wide variations across the states of the country, many of which are comparable to large countries in terms of population. Attempts have been made previously to compile the trends of diabetes from studies done over several decades in different parts of India.[10,11,12,13,14] no comprehensive analysis is available www.thelancet.com/lancetgh Vol 6 December 2018
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