‘Sugar is the new tobacco.” In India, unsurprisingly, people’s first thought when they hear the term sugar is diabetes. According to the International Diabetes Federation (IDF), around half a billion people in the world are living with diabetes. This means that roughly every tenth person on the planet has diabetes. The number is projected to grow to a whopping 643 million by 2030 and 783 million by 2045. The terror does not end here. Diabetes was responsible for 6.7 million deaths in 2021, which roughly translates to 1 death every 5 seconds. The report’s findings highlight the elephant in the room: that diabetes is one of the fastest-growing health emergencies of the 21st century. 1
In response to growing concerns over the health and economic impact of diabetes, the IDF established World Diabetes Day (WDD) in 1991 with the support of the WHO. It became an official UN day in 2006. It is observed each year on November 14, which happens to be Sir Frederick Banting’s birthday. He, along with Charles Best, is famously responsible for the discovery of insulin in 1922. WDD is the world’s largest diabetes awareness campaign. It puts diabetes firmly in the public and political spotlight while bringing attention to topics of cardinal concern to the diabetes community. 2
Diabetes awareness is represented by a blue circle, which is the logo of WDD. This logo represents the unity of the global diabetes community in response to diabetes. Each year, WDD focuses on a specific theme that sometimes lasts for more than a year. This blog will revisit and review the themes of the last decade and evaluate our progress in battling diabetes. 3,4
WDD 2013: Protect Our Future: Diabetes Education and Prevention
WDD 2013 focused on the prevention of diabetes for the protection of one’s future. This was a call for countries to adopt and implement affordable and effective solutions to minimise diabetes-related health and financial burdens. Many countries, including India, have national-level programs for the prevention and detection of diabetes. The campaign was an invitation to the countries to optimise their efforts and yield the best results.
WDD 2014: Go Blue for Breakfast
The theme of WWD 2014 focused on the significance of healthy eating in the prevention of diabetes. The campaign promoted healthy lifestyle choices to avoid the development of the disease. This includes choosing a healthy, balanced meal over fatty and sweet junk food, exercising regularly, and cutting down on smoking and alcohol. 5
WDD 2015: Healthy Eating
The theme for WDD 2015 was similar to the one in 2014. It focused on healthy eating in order to maintain a healthy weight and lower the risk of diabetes. Healthy food was treated as a human right, a necessity that needed to be prioritized to save lives, reduce the global burden of diabetes, and bring down healthcare costs by billions of dollars. In addition to highlighting the significance of healthy eating as a preventive strategy, it also emphasised its role as a cornerstone for successful diabetes management, along with comprehensive healthcare strategies and medicine such as insulin. 6
WDD 2016: Eyes on Diabetes
The campaign of 2016 focused on two key messages: i) screening for type II diabetes is essential for managing the condition and reducing the risk of complications ii) screening for diabetes complications, including retinopathy and other eye diseases, is vital for managing all types of diabetes.7 Considering the high number of people living with undiagnosed diabetes, this call to ‘act today to change tomorrow’ was very significant and impactful. According to the IDF, diabetes remains undiagnosed in 50% of individuals around the world.1 By the time a person is actually diagnosed, complications may already be present. Thus, aggressive screening, early detection, and effective interventions in managing the condition are becoming more important than ever. 8
WDD 2017: Women and Diabetes – Our Right to a Healthy Future
The idea behind the 2017 WDD was to promote the significance of affordable and equitable access to essential diabetes medications and technologies for all women at risk of or living with diabetes. It highlighted the importance of access to education and information on the self-management of diabetes for women. This helps in ensuring optimal diabetes outcomes and in preventing type 2 diabetes. A WHO press release highlighted that “Women and girls are key agents in the adoption of healthy lifestyles to improve their health and the health and well-being of future generations. They have important roles to play to avoid diabetes or alleviate its effects, including practising physical activity and proper healthy diets to improve their health outcomes.”9 The campaign recognised the fact that gender roles and power dynamics influence vulnerability to diabetes and impact access to care. It worked towards creating awareness about the additional risks that women experience, including cardiovascular diseases, gestational diabetes, and chances for miscarriage due to diabetes. 10
WDD 2018–2019: The Family and Diabetes: Diabetes Concerns Every Family
IDF planned a biannual theme spanning 2018 and 2019 focusing on the role of family in the prevention, detection, and management of diabetes. Families are essential to support systems for patients with diabetes. The activities and materials of the campaign were aimed at creating awareness about the impact diabetes has on the family and patient support network and promoting the family’s role in diabetes management, treatment, prevention, and education.11
WDD 2020: The Nurse and Diabetes
The theme for 2020 aimed to create awareness about the crucial role of nurses in supporting people living with diabetes. It highlighted the global shortage of nurses to cater to healthcare demand. In 2018, this shortage was 5.9 million. The campaign urged that the number of trained and employed nurses needed to grow by 8% a year until 2030 in order to overcome this alarming shortfall. It highlighted the need for further investment in the health workforce.12
WDD 2021–2023: Access to Diabetes Care
The theme for 2021 runs until 2023. At the heart of the campaign is the compelling necessity to ensure access to diabetes education, resources, and care for everyone. It calls for government action to increase government investment in diabetes care and prevention. The focus area for this year’s campaign was ‘education to protect tomorrow.’ It reiterated the need for better access to quality diabetes education for healthcare professionals and people living with diabetes. 13
Where do we stand? The Indian Diabetes Story
After China, India has the second-largest number of diabetics between the ages of 20 and 79, a trend anticipated to continue until the year 2045. As per the data from 2021, there are around 74.2 million diabetes patients in India. This number is projected to increase to nearly 125 million people by 2045. The statistics also show that nearly half of these patients have undiagnosed diabetes. India also has the highest estimated number of prevalent type 1 diabetes cases in people under the age of 20 years and the third highest number of diabetes-related deaths in the world (around 0.6 million deaths).14 Diabetes is already a huge healthcare burden in India, which is only going to worsen over the coming years. The big question remains: Where do we stand in terms of education, detection, and treatment of this silent killer?
Education
Although diabetes is highly prevalent in India, the extent of awareness about the condition among the Indian population, especially among those living in rural areas, is woefully inadequate. A survey by the Indian Council of Medical Research (ICMR) found that only 36.8% of the rural Indian population is aware of this condition called diabetes. There is relatively greater awareness among the urban population (58.4%), but even then, nearly half of the population lacks knowledge.15 There is a great need for combined efforts by the community as well as the government to ensure awareness about diabetes and its complications.
Accessibility to care: doctors, health care providers, medications
Research conducted by different bodies, including ICMR, has shown that more than 50% of Indian diabetic patients are living with poor glycemic control (HbA1c >8%).16 A nationwide cross-sectional survey showed that only 45.8% of the people with diabetes knew that they had the disease. Despite knowing they had diabetes, only 36.1% were receiving treatment, and barely 15.7% had their sugar levels under control.17 This poor outcome with regard to the diagnosis and management of diabetes is an indicator of highly substandard care and monitoring in the country.16
Affordability of treatment
Diabetes mellitus is considered an economic menace by many experts in India. A systematic review that analysed the economic burden posed by diabetes found that, depending on the geographic zone, there is an estimated median direct cost between ₹8822 to ₹18,890 and a median indirect cost between ₹3949 to ₹18,146 per annum.18 This is a huge economic burden for a country with nearly 229 billion people living in poverty. Even if the best care is available, unless it’s affordable, it will be beyond the accessibility of commoners.
The future ahead
The problem of diabetes requires that it be addressed at two different levels.
Level 1: At the individual level
Diabetes mellitus type II can be prevented, postponed, and managed if people follow a good, healthy lifestyle with well-balanced nutrition, physical activities, and adequate sleep. In addition, periodic testing helps in the early detection of the condition. Those suffering from the disease should undergo regular monitoring and appropriate care to ensure that their sugar levels are under control and lessen the risk of complications.
Level 2: Government initiatives
The government of India, having understood the seriousness of the condition, has taken initiatives to facilitate greater access to diabetes education and care for everyone. Some of these include:
- The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) was launched in 2010 under the National Health Mission (NHM). Under this initiative, population-based screening for non-communicable diseases, including diabetes, is being expanded to more than 400 districts. Trained frontline workers, including ASHA and ANM workers, are involved in screening, and those suspected of having the disease are referred to medical officers at public health centers
- The Free Drugs Service Initiative of NHM offers financial support to people from poor economic backgrounds and provides free essential medicines, including insulin
- Through the ‘Jan Aushadhi Scheme’ quality generic medicines including insulin are made available at affordable prices to all people
- Government hospitals provide free-of-cost treatment for diabetes
- As per the Socio-Economic Caste Census (SECC) database 2011, under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), support for in-patient care is offered to 10.74 crore, eligible families
In addition to these, each state government body has its own initiatives and schemes to ensure access to care.
Conclusion
In spite of government and community efforts, diabetes continues to rise in India. Although our high population burden may be contributing to this, we can leverage the benefit of vast manpower availability to solve many of the country’s problems, especially the shortage of healthcare providers. While the government’s current efforts are commendable, they need to be reinforced and intensified in order to create awareness, facilitate early detection, and ensure proper management. In addition, people should be sensitised from a young age to the complications of diabetes and the ways to prevent the disease. Regardless of government and community efforts, there is a great individual responsibility to ensure personal health. A salubrious lifestyle that encompasses a healthy diet and exercise should be preferred to keep chronic diseases like diabetes at bay.
References
1. https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf. Accessed on 16th November 2022.
2. https://www.who.int/campaigns/world-diabetes-day. Accessed on 16th November 2022.
3. https://worlddiabetesday.org/about/. Accessed on 16th November 2022
4. https://worlddiabetesday.org/resources/wdd2021-23/logo/. Accessed on 16th November 2022
5. https://www.emro.who.int/jor/jordan-news/world-diabetes-day-ncd.html . Accessed on 16th November 2022
6. https://www.idf.org/component/attachments/attachments.html?id=571&task=download. Accessed on 17th November 2022
7. https://blogs.bmj.com/bmjopen/2016/11/14/world-diabetes-day-2016/
8. https://www.idf.org/component/attachments/attachments.html?id=597&task=download. Accessed on 17th November 2022
9. https://www.emro.who.int/media/news/world-diabetes-day-2017-supports-womens-rights-to-a-healthy-future.html. Accessed on 18th November 2022
10. https://www.idf.org/news/2:world-diabetes-day-2017-to-focus-on-women-and-diabetes.html#:~:text=To%20mark%20International%20Women’s%20Day,right%20to%20a%20healthy%20future. Accessed on 18th November 2022
11. https://www.paho.org/en/news/14-11-2019-family-and-diabetes-theme-world-diabetes-day-2019#:~:text=The%20theme%20of%20the%20World,health%20threat%20posed%20by%20Diabetes. Accessed on 18th November 2022
12. https://worlddiabetesday.org/wddbrk/wp-content/uploads/2019/09/2020-Toolkit-EN.pdf. Accessed on 21st November 2022
13. https://worlddiabetesday.org/about/theme/. Accessed on 19th November 2022
14. https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf. Accessed on 19th November 2022
15. Deepa M, Bhansali A, Anjana RM, Pradeepa R, Joshi SR, Joshi PP, Dhandhania VK, Rao PV, Subashini R, Unnikrishnan R, Shukla DK. Knowledge and awareness of diabetes in urban and rural India: the Indian Council of Medical Research India diabetes study (phase I): Indian Council of Medical Research India diabetes 4. Indian journal of endocrinology and metabolism. 2014 May;18(3):379
16. Das AK, Saboo B, Maheswari A, Banerjee S, Jayakumar C, Mohan AR, Potty VS, Kesavadev J. Health care delivery model in India with relevance to diabetes care. Heliyon. 2022 Oct 4:e10904.
17. Mathur P, Leburu S, Kulothungan V. Prevalence, awareness, treatment and control of diabetes in India from the countrywide National NCD Monitoring Survey (NNMS). Frontiers in public health. 2022 Mar 14:205.
18. Oberoi S, Kansra P. Economic menace of diabetes in India: a systematic review. International Journal of Diabetes in Developing Countries. 2020 Oct;40(4):464-75.