Newly reported rates of diabetes, hypertension ‘a call to action’ for India

The prevalence of diabetes and hypertension in India is rising, with high numbers across the country and climbing rates among younger demographics, researchers reported in JAMA Internal Medicine this week.

Despite India’s status as the second most populous country in the world, it’s often neglected in large-scale research on cardiovascular disease (CVD) and metabolic illnesses, first author Pascal Geldsetzer, MBChB, and colleagues wrote. Still, they said, understanding diabetes and hypertension prevalence in India, as well as how the conditions are distributed across the population, is key to preventing, screening and treating the diseases.

Under 2011’s Global Action Plan for the Prevention and Control of Noncommunicable Diseases, World Health Organization member states vowed to devote time to reducing the prevalence of hypertension by 25 percent between 2010 and 2025, as well as halting the rise of diabetes by 2025.

“Given India’s huge population, its achievements are critical to reaching these global targets,” Geldsetzer et al. wrote.

But India’s rates of hypertension and diabetes are still on their way up. According to the study, the age-standardized rate of diabetes in Indian men alone grew from 3.7 percent in 1980 to 9.1 percent in 2014. Those trends aren’t likely to slow down, either, the authors said—India’s rapidly aging and urbanizing population is enjoying higher standards of living, which are often accompanied by obesity and, as a result, cardiovascular disease.

“The latter (obesity) is particularly concerning given that adults of Asian-Indian ethnicity are thought to be predisposed to developing CVD when exposed to obesogenic environments and lifestyles,” Geldsetzer and co-authors wrote.

The researchers drew a nationally representative sample of 1,320,555 adults—a fraction of the country’s nearly 1.3 billion-strong population—for the study and analyzed the presence of diabetes and hypertension in the face of varying factors, including age, sex, wealth, state, location, education and marital status.

Each patient’s plasma glucose (PG) and blood pressure (BP) were recorded during the course of the two-year study, which stretched from 2012 to 2014. For the purposes of the trial, diabetes was defined as a PG level of greater than 126 mg/dL, while hypertension was defined as a systolic BP of greater than 140 mm Hg.

Geldsetzer and colleagues found that hypertension was much more widespread in the country than diabetes, with a 25.3 percent prevalence compared to diabetes’ 7.5 percent. Prevalence varied widely between Indian states, but overall, prevalence of hypertension was 20 percent in women and 24.5 percent in men. For diabetes, those figures were 6.1 percent and 6.5 percent, respectively.

Household wealth and education were both associated with modest, but favorable, outcomes, the authors wrote. Urban locations were linked to better outcomes than rural ones, but, as commentator Alka M. Kanaya, MD, wrote, “in middle-age to older adults across all geographic settings and socioeconomic groups in the country, the prevalence of both diabetes and hypertension were disturbingly high.”

Kanaya said in a related JAMA editorial that India’s population could benefit from a more cohesive national health system. With nearly 70 percent of the country’s population living in rural areas, she wrote, the majority of people have little to no access to hospitals and clinics.

“A major challenge in chronic disease prevention and treatment is India’s fragmented healthcare system, which is a patchwork of poorly resourced public healthcare and a booming urban private sector,” Kanaya wrote. “There is a wide gap in the quality of care among states and between rural and urban populations. The report by Geldsetzer and colleagues is not only a stark warning of the looming crisis of cardiovascular diseases in India, but can also serve as a call to action for the country.”