A large-scale survey conducted by the Indian Council of Medical Research finds a considerably high prevalence of non-communicable metabolic diseases in many Indian states.
A detailed report is published in The Lancet Diabetes & Endocrinology.
Study: Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Image Credit: WESTOCK PRODUCTIONS / Shutterstock
Background
The prevalence of non-communicable metabolic diseases, including diabetes, hypertension, obesity, and dyslipidemia, is gradually increasing in India and other South Asian countries. Several studies analyzing self-reported disease prevalence have found a high total burden of diabetes, hypertension, and dyslipidemia in India.
However, the major drawbacks of these studies are the absence of robust diagnostic methodologies and a truly representative population of the country. Furthermore, there are wide variations in ethnic compositions, dietary habits, and socioeconomic status between Indian states and regions. Thus, estimating the prevalence of non-communicable diseases will likely mask vast inter-regional and intra-regional differences.
The Indian Council of Medical Research-India Diabetes study was initiated to estimate the prevalence of metabolic non-communicable diseases, including diabetes, prediabetes, dysglycemia, hypertension, obesity (generalized and abdominal), and dyslipidemia in 28 Indian states, two union territories, and the National Capital Territory of Delhi.
Study design
This cross-sectional population-based survey involved a representative population of individuals aged 20 years and above residing in urban and rural Indian regions. A total of 113,043 individuals participated in the survey between October 2008 and December 2020.
The analysis considered a three-level stratification based on each state's geography, population size, and socioeconomic status.
Diabetes and prediabetes were diagnosed using the World Health Organization (WHO) criteria. Hypertension was diagnosed using the Eighth Joint National Committee guidelines. Obesity was diagnosed using the WHO Asia Pacific guidelines, and dyslipidemia was diagnosed using the National Cholesterol Education Program—Adult Treatment Panel III guidelines.
Overall prevalence of metabolic non-communicable diseases
The overall prevalence of diabetes was estimated to be 11.4% in India. The prevalence was significantly higher in urban areas compared to rural areas and among males compared to females.
The overall prevalence of prediabetes and dysglycemia was estimated to be 15.3% and 26.6%, respectively, in India.
The overall prevalence of hypertension was estimated to be 35.5% in India. Similar to diabetes, the prevalence of hypertension was higher in urban areas and among males. The estimation done using the American College of Cardiology/American Heart Association criteria showed almost two times higher prevalence of hypertension (66.3%).
The overall prevalence of generalized obesity, abdominal obesity, and dyslipidemia was estimated to be 28.6%, 39.5%, and 81.2%, respectively. The prevalence of these three diseases was significantly higher in urban areas than in rural areas. Moreover, females showed a significantly higher prevalence of generalized obesity than males.
State-level prevalence of metabolic non-communicable diseases
The state-level prevalence of diabetes and prediabetes ranged from 4.8% to 26.4% and from 6.8% to 31.3%, respectively. The highest prevalence of diabetes was observed in the southern and northern Indian regions. The prevalence was lower in the central and northeastern regions.
In contrast to diabetes prevalence, the central and northern regions showed the highest prevalence of prediabetes. The lowest prevalence was observed in Punjab, Jharkhand, and some parts of the northeastern region.
The state-level prevalence of hypertension, generalized obesity, and abdominal obesity ranged from 24.3% to 51.8%, from 11.6% to 53.3%, and from 18.4% to 61.2%, respectively. A high prevalence of hypertension was observed across the country except in the central region.
The prevalence of generalized obesity was higher in the southern region, followed by the northern and eastern regions. However, a high prevalence of abdominal obesity was observed throughout the country.
The prevalence of dyslipidemia showed a wide inter-state and inter-regional variability. Specifically, a high prevalence of hypertriglyceridemia and low high-density lipoprotein (HDL) cholesterol was observed throughout the country, and the highest prevalence of hypercholesterolemia and high low-density lipoprotein (LDL) cholesterol was observed in the northern region, Kerala, and Goa.
Study significance
The study finds a significantly higher prevalence of diabetes and other metabolic non-communicable diseases in India.
The variability in disease prevalence between states and regions highlights the need for state-specific policies and interventions to prevent serious public health consequences.
Global gap in diabetes prevalence and treatment has widened since 1990