Last Updated on September 6, 2023 by Neelam Singh
Described as a lifestyle disease, Type 2 diabetes, attributed to physical inactivity, unhealthy diets, and obesity, was once largely restricted to urban India. Not anymore. The medical condition has now expanded its reach to include rural areas as well.
In recent years, rural India has been grappling with a worrisome surge in Type 2 diabetes cases, signaling a significant shift in lifestyles and dietary habits among its population. This trend underscores the complex interplay between modernisation, traditional values, and health outcomes in these areas. The rise of Type 2 diabetes reflects the transition from traditional, physically active lifestyles to more sedentary ones, often accompanied by diets high in processed foods, unhealthy fats, and refined sugars.
The data reveals all
A study “Prevalence and trends of the diabetes epidemic in urban and rural India: A pooled systematic review and meta-analysis of 1.7 million adults”, reporting data from 1,778,706 adults in India from surveys conducted from 1972-2017 revealed that the prevalence of diabetes increased in both rural and urban India from 2.4% and 3.3% in 1972 to 15.0% and 19.0%, respectively, in 2015-2019.
Limited access to healthcare services and a lack of awareness further compound the challenges of addressing this escalating health concern. In many rural areas, healthcare facilities are sparse and medical resources are scarce, leaving a significant portion of the population without adequate access to diabetes screening, treatment, and education. Moreover, cultural and linguistic barriers may hinder effective communication about diabetes prevention and management.
According to Dr. Haleema Yezdani, a diabetologist who has participated in several telemedicine camps in rural India, shares that resistance towards routine checkups and other practical obstacles also play a role. “Many people work on daily wages, and getting tests done means spending money, time, and loss of pay going to the nearest PHC. Unless they have a gross problem, people in rural India don’t go in for tests,” says Dr. Yezdani.
As per a government study conducted earlier this year, 11% of Indians have diabetes. According to the report, India has far higher rates of diabetes, hypertension, and obesity than previously thought. In addition, the survey of over 113,000 people discovered that 35% of Indians had hypertension and that 15% of them were pre-diabetic. It was carried out in 31 Indian states and territories between October 2008 and December 2020.
Changing scenario
One of the main causes of diabetes tightening its grip on rural areas is a lack of awareness. “They don’t know the disease, its symptoms. Follow-ups are rare. There have been several instances when I have caught diabetes through a random blood sugar reading. Now I find that the onset of diabetes is also happening in the early 20s as compared to the 40s earlier,” adds Dr.Yezdani.
One striking issue is the underestimation of diabetes prevalence in rural communities. As urban areas tend to receive more attention in terms of healthcare research and initiatives, rural regions often remain off the radar, resulting in inadequate data collection and analysis. This leads to a skewed perception of the actual extent of the problem and subsequently delays targeted interventions.
Renowned diabetologist Dr. V. Mohan opines that appropriate epidemiological research must be conducted in order to determine the true prevalence of diabetes in rural areas. “The ICMR INDIAB study published in the Lancet Diabetes Endocrinology did just that. We found that the prevalence rates of diabetes in rural areas are much higher than reported in the past. In some states, like Kerala, the rural prevalence is as high as the urban one. But in many states, there are still huge urban rural differences,” states the President and Director of the Madras Diabetes Research Foundation in Chennai, which is an ICMR Center for Advanced Research on Diabetes.
Dr. Mohan underlines the reduction in physical activity and change in food patterns due to the urbanisation of rural areas as the reasons behind increasing diabetes.
“In rural areas in the past, there was a lot of physical activity as they were mostly agriculturists who did manual work in the fields. With improvements in their socioeconomic status, they are now able to eat foods that are high in calories, fat, and sugar. Their physical activity has declined thanks to the advancement in technology and availability of tractors and motorised equipment. Their sleep patterns have changed thanks to TV, cell phones, etc. Rural areas are rapidly getting urbanised. The price they pay is rising rates of obesity, diabetes, hypertension, and heart disease. Hence, the same preventive measures we advise for urban people must now be applied to rural people as well.”
Due to the higher population density in rural areas, even a slight increase in diabetes rates can result in several million extra diabetics in India. Finally, the ICMR INDIAB study revealed that pre-diabetes is widely prevalent in practically all states. “This means that the diabetes epidemic is about to explode in rural areas of India as well,” adds the seasoned medical practitioner.
Awareness is the key
Addressing the growing burden of Type 2 diabetes in rural India requires a multi-faceted approach. Public health campaigns should prioritise raising awareness about the risks of an unhealthy lifestyle and the importance of regular screenings. Mobile health clinics and telemedicine platforms could be utilised to bridge the gap in healthcare access. Collaborations between local healthcare workers, non-governmental organisations, and governmental agencies can help disseminate information and provide essential resources.
“I believe a phygital model that enables physical assistance to digitally connect with the doctor can be very effective. It can especially work for follow ups for patients suffering from Type 2 diabetes,” says Chandramouli Samatham, Founder and CEO of Caare Telehealth, a telemedicine company.
Efforts to counter the rising tide of Type 2 diabetes in rural India must consider the unique socio-cultural dynamics at play. Empowering individuals with knowledge, promoting physical activity, and advocating for healthier dietary practices are essential steps toward curbing the prevalence of diabetes in these underserved areas. By acknowledging the problem, dedicating resources, and fostering community engagement, a concerted effort can be made to reverse the alarming trend and improve the overall health and well-being of rural populations.
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