Diabetes is one of the largest global health challenges of this century. The number of people living with both type 1 and type 2 diabetes is increasing day by day causing severe economic burden to the patients and to the society at large. Among the two types, Type 2 diabetes, being common and more prevalent contributes significantly to the increasing trend. The International Diabetes Federation has estimated that globally there are 415 million people with diabetes in 2015 and is predicted to increase to 642 million by 2040.1 It is alarming to note that more than 47% of the world’s population is still undiagnosed for diabetes with the prevalence still bound to increase further. Furthermore, 318 million people are estimated to have impaired glucose tolerance and 20.9 million live births are affected by some form of hyperglycaemia in pregnancy, of which 85.1% are due to gestational diabetes. People with type 2 diabetes are increasing in every country, but more than 80% live in low and middle –income countries such as India, Bangladesh, Bhutan, Pakistan, Sri Lanka, Philippines and Indonesia. Among the top 10 countries in the world, India stands second with 69.2 million people with diabetes and another 36.5 million with prediabetes which is a high-risk condition for diabetes and cardio-vascular disease.1 This increasing incidence is mainly attributed to lifestyle changes; eating unhealthy food and being physically inactive.
The South Asian and Pacific region is facing a high risk with prevalence of diabetes. There are reported differences in the characteristics of diabetes in Asian populations2.
A recently reported Indian Council of Medical Research - INdia DIABetes (ICMR-INDIAB) study conducted in four different zones of rural and urban India showed that the prevalence of diabetes and prediabetes are higher compared to previous studies. The inter-state variations in prevalence, ranging from 4.3% in Bihar, 10.4% in Tamil Nadu and 13.6% in Chandigarh.3
In 2012, the survey carried out by the National Nutrition Monitoring Bureau among the rural population showed 8.2% and 6.8% among adult men and women for diabetes, respectively. The prevalence was reported to be high in the states of Kerala, Tamil Nadu and Gujarat (8.2 – 16.4%) among both genders. Analysis of secular trends revealed an increase in diabetes prevalence in the rural population at a rate of 2.02 per 1000 population per year.4
A series of epidemiological studies carried out by India Diabetes Research Foundation in Southern Indian population to show the increase in prevalence in diabetes and prediabtes in city and rural population. The diabetes prevalence was 5% in 1985, 8.2% in 1989, 11.6% in 1995, 13.9% in 2000 and 18.6% in 2006 in City. The prevalence of diabetes in rural population was 2.2% in 1989, 5.9% in 2000, 6.4% in 2003 and 9.2% in 2006.5-11
Diabetes affects children and adolescents alike. Type 1 diabetes though uncommon is increasing at a rate of 3% every year particularly among children. In 2015 the number of children worldwide with type 1 diabetes exceeded half a million for the first time. In India alone there are more than 70,000 children with this condition, second largest number in the world after the USA.1 Diabetes during pregnancy (gestational diabetes) poses higher risks of diabetes among women and long-term consequences for the offspring.
Long – term diabetes causes increased risk of complications and disability affecting the heart, eyes kidneys and nerves. Cardiovascular disease in particular is one of the leading causes of death among people with diabetes.
In India 85-95% of all health care costs are borne by individuals and their families from household income. Direct expenses consume 27–34% of household incomes of rural and urban poor people while the middle-to-high income groups in rural and urban areas consume 5.0–12.6% and 4.8–16.9% of income respectively on diabetes care.12,13
In the Grover et al. study, the total annual cost of care for 50 patients of the sample population was 14,508 rupees (263.78 euros). The largest proportion of the total cost was made up of direct costs (68%), followed by indirect costs (28.76%) and provider’s costs (2.8%). Drug costs were high. Total treatment cost was significantly higher in those who were more educated, those who visited the hospital more often, and those receiving a greater number of drugs.13,14
A study in Indian patients by Ramachandran et al analyzed the urban-rural expenditure on diabetes. The study indicated that the economic burden of diabetes care on families in developing countries is rising rapidly, even after accounting for the inflation. The annual family income was higher in urban subjects [rupees (Rs) 100,000 or $2,273] than in the rural subjects (Rs 36,000 or $818) (P < 0.001). Total median expenditure on health care was Rs 10,000 ($227) in urban and Rs 6,260 ($142) in rural (P0.001) subjects. Treatment costs increased with duration of diabetes, presence of complications, hospitalization, surgery, insulin therapy and urban setting. For example, expenditure proportionately increased with the number of complications. Expenditure on treatment of complications varied significantly between the populations.13,15
The Cost of Diabetes in India (CODI) study was a large community based survey of diabetes costs. According to the results of the CODI study, ambulatory care constitutes 65% cost whereas hospitalization cost is 35%. Therapy cost is 31% of which specific antidiabetic drug cost is only 17%. Ambulatory care including monitoring and doctor visits constitute 34% costs.13,16
The Delhi Diabetes Community (DEDICOM) study by Kumar et al. analyzed the direct cost of ambulatory diabetes care among the middle and high income group diabetics in the capital city of Delhi. The average estimate of direct annual expenditure on ambulatory care of diabetes was ~ Rs 6,000 (~US$ 150).13,17