Editorial: Diabetes control—lifestyle changes hold the key

India’s rising diabetes burden demands early diagnosis, lifestyle changes and stronger preventive healthcare interventions

India, home to the second-largest diabetes population in the world after China, is virtually sitting on a ticking time bomb. World Diabetes Day, observed on November 14, provides an occasion for the country to introspect about the reasons for the high incidence of the disease and the strategies needed to check it. As per the latest data released by the International Diabetes Federation (IDF), over 89.8 million Indian adults are living with diabetes. This number is projected to rise to 156.7 million by 2050 if current trends continue. What is alarming is that about 43% of people with diabetes are undiagnosed, representing roughly 38.6 million Indians who may have the disease without knowing it. This year’s World Diabetes Day theme, “Early action on diabetes,” carries particular urgency for India. Type 2 diabetes accounts for around 90–95% of all diabetes cases, both globally and in India. This means more than 80 million Indians with diabetes belong to this category. Type 2 diabetes is asymptomatic in its early stages, which makes it difficult to diagnose. Indians are genetically more vulnerable to the disease than the Western population. Experts say that multiple genes associated with insulin resistance and impaired insulin secretion appear to be more common in South Asian populations. Higher abdominal fat and lower muscle mass are other key factors responsible for the high incidence, along with carbohydrate-rich food. Sedentary lifestyles and unhealthy diets, including refined rice and wheat products, sugary beverages and ultra-processed foods, are the other culprits.

Obesity and being overweight are the most important risk factors responsible for diabetes. The disease burden can be reduced significantly by lifestyle changes, including adopting a healthy diet and doing regular physical activity. Lack of insulin, or the inability of cells to respond to it, leads to high levels of blood glucose (hyperglycaemia), which is the clinical indicator of diabetes. Insulin deficit, if left unchecked over the long term, can damage many of the body’s organs, leading to life-threatening health complications. The countries with the largest numbers of adults with diabetes in the 20–79 age bracket are China, India and the United States, and they are anticipated to remain so in 2030. Worryingly, in India, a large number of children are also affected by diabetes. Children are developing obesity and metabolic syndrome early because of the shift in diets towards more processed and fast foods. It is vital to keep diabetes in check, as it can prove to be debilitating or even fatal if not treated or controlled with medicine and lifestyle changes. The World Health Organisation (WHO) says that diabetes is a major cause of blindness, kidney failure, heart attack and stroke. However, diabetes can be reversed through a healthy diet and physical activity in 60% of cases. With the rising trajectory of diabetes in India, there is a need for more effective health policy interventions.

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