India’s diabetes crisis: Even higher number of young Indians getting it since COVID-19 pandemic

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For India, often referred to as the diabetes capital of the world, COVID-19 may have triggered a silent explosion of sorts with a higher, than before, number of Indians joining the pool of diabetics since the pandemic began.

As per estimates by the International Diabetes Foundation, nearly 80 million adults live with diabetes in the country and this number is set to reach over 130 million by 2045.

India ranks second after China in the global diabetes epidemic and contributes over 18 percent of the global diabetes case burden.

The latest survey by integrated healthcare company Practo, ahead of World Diabetes Day which falls on November 14, has confirmed what experts have been fearing: the platform witnessed an overall 44 per cent increase in in-person diabetes consultations year on year (October 2020 - September 2021 versus October 2021 - September 2022).

Also, young Indians in the age group of 25-34 years recorded the highest spike in consultations as their share of consultations increased by 46 percent since last year, the survey also found.

The findings are alarming and sadly, not the only ones. Retrospective data analysis by digital healthcare platform Tata 1mg showed that one-third of the people who tested for HbA1c at its labs between March and October this year, were found to have diabetes, with the highest incidence reported among the 40-60 years age group.

The findings were based on results from the HbA1c test (or glycosylated haemoglobin test), which tells about the average level of blood sugar over the past 2 to 3 months.

Specialists point out that while those who were hospitalised or admitted to critical care due to COVID-19 had almost three times the risk of those who did not have the disease, even those with moderate illnesses and no prior diabetes risk factors had a higher likelihood of getting the chronic condition.

According to Dr Ashu Goyal, senior diabetologist with Shalby hospital in Surat, high Body Mass Index (BMI), a measure of obesity and a risk factor for type 2 diabetes, doubled the risk of diabetes following the SARS-CoV-2 infection, even though empirical data is required to elucidate population-level long-term patterns in new-onset diabetes and to determine their critical areas.

India’s diabetes story

The cases of diabetes, a group of metabolic disorders that is characterised by a high blood sugar level over a prolonged period, in India doubled between 2007 to 2017 as per International Diabetes Foundation.

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Most of this increase is in cases of type 2 diabetes, which is caused by insulin resistance and the pancreas slowly losing the ability to make insulin, leading to multiple complications if not managed properly. A complex set of factors can contribute to the development of type 2 diabetes that includes genes, environment and lifestyle.

But cases of type 1 diabetes, an autoimmune condition that results from the body attacking beta cells in the pancreas that makes insulin, are also coming up at worrying proportions.

Global non-profit organisation Arogya World, which works towards the elimination of non-communicable diseases, says that as per a 2021 review, people who live in cities and metropolitan areas in India are more likely to develop diabetes than ever before. This is due, in part, to cities promoting a lifestyle that can increase a person’s BMI.

Pandemic and diabetes

Dr V Mohan, chairman and chief diabetologist with Chennai-based Dr Mohan’s Diabetes Specialities Centre said that while COVID-19 outcome was comparatively poorer for people with diabetes, the pandemic also exacerbated the problem for those with no prior history of the disease.

Many people got diabetes due to an increase in obesity rates, stress, depression, lack of healthy eating and regular exercise during the lockdown, he said, adding that many moderate and severe patients also got the disease due to the steroids used to fight the inflammation.

According to Dr Ashu Goyal, senior endocrinologist & diabetologist with Shalby Multispecialty Hospitals in Surat, a large number of hospitalised COVID-19 patients caught diabetes or excessive blood sugar following recovery.

Scientific reports convey that Coronavirus spike proteins have harmed pancreatic beta cells, which are essential for insulin secretion and the organ is unable to maintain appropriate blood sugar levels and regulate glucose into cells.

“Findings demonstrate that a majority of COVID-19 patients with diabetes exhibit complications of newly onset elevated blood sugar and severe metabolic decompensation,” Goyal said.

Dr Anil Bhoraskar, senior diabetologist with S L Raheja Hospital in Mumbai who is also secretary, Diabetic Association of India (scientific section) said that many diabetics had long-term complications lingering for months.

Side effects of the drug treatment of COVID-19 also created multiple problems but were successfully managed by various hospitals.

New hope on the horizon

While the pandemic has made things gloomier for the diabetes scenario in India, there is some good news too.

There are several classes of drugs which have come to the Indian market over the last couple of years. The first group is called the SGLT2 (sodium-glucose cotransporter-2) group of drugs.

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“These drugs are not only antidiabetic drugs but they also help in weight loss. They are also cardio and kidney protective and hence they have become very popular in the treatment of type 2 diabetes,” said Mohan.

The other class of drugs to have hit the market are GLP1 (glucagon-like peptide) receptor analogs or GLP1 RA-available both in injectable as well as oral forms. Apart from diabetes control, these drugs, too, help in reducing body weight and have protective effects.

In addition, for those needing insulin, the availability of insulin pumps, particularly the artificial pancreas (hybrid closed loop insulin pumps) has been useful as they help to determine the blood glucose levels and then decide the correct dose of insulin which is to be injected using artificial intelligence.

“This is a total revolution in the treatment of diabetes,” said Mohan, adding that the continuous glucose monitoring systems, for which a small coin-shaped sensor is placed on the upper arm helps to continuously detect glucose levels is also another useful innovation.

“Very soon we may also have once-a-week insulins available in the market,” he added. “These are indeed exciting times for diabetes research”.