Diabetes in India
Table 11.1 summarizes for comparison some prevalences of diabetes around the world. It’s obvious that there are big differences among countries in their national average prevalences, ranging from low values of 1.6% in Mongolia and Rwanda up to high values of 19% in the United Arab Emirates and 31% in Nauru. But Table 11.1 also illustrates that these national averages conceal equally big differences within any given country related to differences in lifestyle: at least in developing countries, wealthy or Westernized or urban populations tend to have much higher prevalences than do poor or traditional or rural populations.
India provides excellent examples of those subnational differences. (For this information I am grateful to Professor V. Mohan, of the Madras Diabetes Research Foundation.) The average prevalence in India as of the year 2010 was 8%. But there was little diabetes in India until just a few decades ago. Surveys in 1938 and 1959, in large cities (Calcutta and Mumbai) that are today strongholds of diabetes, yielded prevalences of only 1% or less. Only in the 1980s did those numbers start to rise, first slowly and now explosively, to the point where India today harbors more diabetics (over 40,000,000) than any other nation. The reasons are essentially the same as those behind the diabetes epidemic around the world: urbanization, rise in standard of living, the spread of calorie-rich sweet and fatty fast foods cheaply available in cities to rich and poor people alike, and increased sedentariness associated with replacement of manual labor by service jobs, and with video games and television and computers that keep children (and adults) seated lethargically watching screens for hours every day. Although the specific role of TV has not been quantified in India, a study in Australia found that each hour per day spent watching TV is associated with an 18% increase in cardiovascular mortality (much of it related to diabetes), even after controlling for other risk factors such as waist circumference, smoking, alcohol intake, and diet. But those factors notoriously increase with TV watching time, so the true figure must be even larger than that 18% estimate.
Table 11.1. Prevalences of Type-2 diabetes around the world
| POPULATION | PERCENTAGE PREVALENCES |
|---|---|
| European and Middle Eastern “Whites” | |
| 41 Western European countries | 6 (range, 2–10) |
| 4 overseas Western European countries (Australia, Canada, New Zealand, U.S.) | 8 (range, 5–10) |
| 1 very poor Arab country (Yemen) | 3 |
| 2 poor Arab countries (Jordan, Syria) | 10 |
| 6 wealthy Arab countries | 16 (range, 13–19) |
| Yemenite Jews, traditional | ~0 |
| Yemenite Jews, Westernized | 13 |
| Africans | |
| rural Tanzania | 1 |
| Rwanda | 2 |
| urban South Africa | 8 |
| U.S. African-Americans | 13 |
| Asian Indians | |
| urban India, 1938–1959 | ~1 |
| rural India today | 0.7 |
| urban Singapore | 17 |
| urban Mauritius | 17 |
| urban Kerala | 20 |
| urban Fiji | 22 |
| Chinese | |
| rural China | ~0 |
| urban Hong Kong | 9 |
| urban Singapore | 10 |
| urban Taiwan | 12 |
| urban Mauritius | 13 |
| Pacific Islanders | |
| Nauru, 1952 | 0 |
| Nauru, 2002 | 41 |
| Nauru, 2010 | 31 |
| Papua New Guinea, traditional | ~0 |
| Papua New Guinea, urban Wanigela | 37 |
| Aboriginal Australians | |
| traditional | ~0 |
| Westernized | 25–35 |
| Native Americans | |
| Chile Mapuche | 1 |
| U.S. Pima | 50 |