Diabetes management in the time of urbanisation: An Indian perspective

Urbanisation, is a transformative shift for society, but not without its share of uncertainties. A country’s public health is often challenged during its transformation and development. That’s how rapid urbanisation and economic development in India took a toll on the increased prevalence of chronic diseases, including type 2 diabetes, hypertension, and metabolic syndrome.¹ Diabetes epidemics are evident in rural areas that are undergoing socioeconomic development and urbanisation.² National Family Health Survey (NFHS) reports state that diabetes poses a significant threat to households nationwide.³ With lifestyle factors and urbanisation fuelling the diabetes epidemic, a dynamic approach is essential.

Key issues emerging from urbanisation:

1. Increased disposable income is leading to growing fast food consumption:
   As per the latest World Bank report⁴ In India, 600 million people—or 40% of the country’s total population—will reside in urban areas by 2036, also according to demographic forecasts, India is expected to be 50% urbanised by 2050.⁵ With this rate of expansion already underway, the middle class in India is becoming increasingly affluent, and access to more disposable⁶ income is changing how people consume fast food and other services. With the advent of food delivery apps, the practice of ordering food from outside has grown in popularity during the past ten years, particularly among youth.⁷
2. Urbanisation may lead to a sedentary lifestyle:
   A study⁸ has highlighted how rapid industrialisation and urbanisation have led to sedentary lifestyles and consumption of calorie-intense processed and adulterated foods, which has significantly contributed to a surge in the issue of excess weight,⁹ a reason for doubling up the country’s prevalence of overweight and obesity around 2005–15. This is found to be the primary risk factor for the onset, development, and progression of type 2 diabetes mellitus (DM) in all age groups.¹⁰ Moreover,maintaining a healthy lifestyle becomes even more challenging with the flexibility of working hours brought about with the integration of offices into our homes and the pervasive access to 24×7 connectivity.

   

3. Urban set-up contributes to health issues:
   According to study findings,¹¹ among women and men in urban India who did not have diabetes at age 20, the lifetime chance of having it was 64.6% and 55.5%, respectively. Additionally, data indicates that metropolitan people with obesity can anticipate having diabetes for most of the years left in their lives (around 50% from the age of 20). Another study reveals a rising epidemic of type 2 diabetes among young Asians, primarily due to childhood obesity and high BMI, increasing the risk of developing the condition in early adulthood.¹² Additionally, social media and internet platforms are causing a concerning trend of unscientific health advice, promoting weight loss and slimmer appearance through unreliable research and data.

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What can bring about a healthy change?
Despite the abundance of information, credible, science-based solutions remain scarce, particularly in awareness, treatment, and control (ATC) among adults. As diabetes management is a journey, a consistent and balanced approach is essential to keeping it under control. The lack of accurate information exacerbates the situation. Regular screenings and preventive measures aid in early detection and prevention. Prioritising a balanced diet, ample sleep, and stress management is crucial for overall well-being. Not everyone can sustain intense workouts, and individual tolerance for calorie intake varies greatly. Consulting a physician is paramount to navigating health decisions such as these. Therefore, one cannot diminish the role of awareness and education in significantly improving health management for patients with diabetes and excess weight, reducing the risk of additional health complications and treatment options.¹³

Reference:

1. Cyril, S. et al. BMC Public Health 13, 513 (2013).
2. Ramachandran A, et al. Diabetes Care. 2008 May;31(5):893-8.
3. Maiti, S. et al. Evidence from NFHS, 2019–2021. Sci Rep 13, 2971 (2023).
4. India’s Urban Infrastructure Needs to Cross $840 Billion Over Next 15 Years: New World Bank Report. Accessed on July 2024.
5. Pandey B, et al. Sci Rep 10, 17241 (2020).
6. https://www.ice360.in/app/uploads/2021/06/ICE-360-Proposal.pdf. Accessed on July 2024.
7. Patgiri, R, et al. Changing Food Habits of Urban Middle-Class Youth in India: ‘Ordering In’. South Asia Research, 42(3), 327-342.
8. Vennu V, et al, Int J Environ Res Public Health. 2019 Oct 18;16(20):3987.
9. Gupta, Shivani, et al. Effect of Urbanization, Sedentary Lifestyle and Consumption Pattern on Obesity: An Evidence from India (December 2, 2020). Available at SSRN: https://ssrn.com/abstract=3741382
10. Chandrasekaran, P, et al. Int. J. Mol. Sci. 2024, 25, 1882
11. Luhar S, et al. Diabetologia. 2021 Mar;64(3):521-529.
12. Jha RP, et al. J Diabetes Metab Disord. 2021 Jul 5;20(2):1725-1740.
13. Nazar CM, et al. J Nephropharmacol. 2015 Sep 9;5(2):110-115.

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