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48 undiagnosed diabetics among every 100 adults examined in Maharashtra

Sabitri Shinde, 43, a Palghar resident, injured her foot while working in the fields and over a month, the injury turned into a severe infection. When she eventually sought medical advice, the doctor strongly recommended an immediate Hemoglobin A1c test, which she disregarded. Later, during a door-to-door survey by the state health department, her alarmingly high blood sugar level, exceeding 410 mg/dL, was discovered.

Shinde said, “I constantly felt hungry but despite eating excessively, I kept losing weight. Some villagers even speculated it was black magic. However, due to the survey, it was diagnosed. The health officer warned that otherwise diabetes would have led to necrosis in my infected foot.”

Shinde is one of 11 lakh Maharashtra residents diagnosed with diabetes during a health survey, who were unaware of their condition.

In the battle against diabetes, underdiagnosis is a major challenge due to slow symptoms. The state public health department recently discovered that out of 100 people screened for diabetes, 48 had undiagnosed diabetes.

ASHA worker Pallavi Tambe who diagnosed Shinde’s condition shared how people ignore diabetes symptoms until they developed associated complications such as blindness, chronic kidney disease or others.

Of the 22 lakh adults above 30 years of age examined by the public health department across the state as of August, 10.9lakh were diagnosed with diabetes. Of the 32.47 lakh people who were examined for hypertension, 23 lakh or 70.8 per cent were diagnosed with the condition, with 5.49 lakh of them having comorbidities.

Dr Charudatta Shinde, district civil surgeon, Nandurbar, explained that diabetes can take time to show symptoms, particularly in Type 2 diabetes. People often remain undiagnosed because early symptoms may be subtle or go unnoticed. “Additionally, some individuals may attribute the symptoms to other factors or dismiss them,” he said.

The National Program for Prevention and Control of Cancer Diabetes Cardiovascular Diseases and Strokes (NPCDCS) was implemented in 2010 and Maharashtra launched it in 2011. It was gradually expanded to all districts in 2018-19. “The programme started in 2010-11 in Wardha and Washim. Later, we started expanding it across the state. In 2021, we also included Mumbai and suburban Mumbai district. This is the first pan-Maharashtra data compiled by the health department,” said a senior health officer from the public health department.

Due to the delay in diagnosis, especially Type 2 diabetes, chronic metabolic disorder characterised by insulin resistance and high blood sugar levels, often related to lifestyle factors, many of the patients reach hospitals at a late stage of prognosis. “We get patients across the state where almost seven out of 10 patients develop diabetic foot. Most of them have to undergo amputations,” said Dr Tushar Bandgar, head of endocrinology, at Mumbai’s KEM hospital.

He explained how lifestyle factors such as poor diet, lack of physical activity, obesity and stress can lead to diabetes by contributing to insulin resistance and impaired glucose metabolism, increasing the risk of Type-II diabetes. “We are seeing a rise in Type 2 diabetes even among children where they recover with proper medication but this trend is concerning,” he added.

Another main challenge is compliance of the medication and nutrition. The consumption of rice in Maharashtra, like in many Indian states, is significant. Rice is commonly consumed in various forms, including steamed rice, biryani, pulao, and in dishes like poha and vada pav, which are popular street foods in the state. Doctors believe this dietary eating habit along with sedentary lifestyle are the main reason for such high incidences of diabetes and hypertension in the state.

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“Unhealthy eating, marked by excessive consumption of sugary, processed, carbohydrate-rich foods, can trigger diabetes. Such food items cause rapid spike in blood sugar levels, straining the body’s insulin response. Over time, this can lead to insulin resistance and impaired glucose regulation, increasing the risk of Type 2 diabetes,” said Dr Rajiv Kovil, founder of the United Diabetes Forum (UDF), a non-profit organisation of diabetologists in India.

A significant obstacle is medication and non-adherence to diet. The district health department intends to assign ASHA workers for patient monitoring. Dr Balasaheb Solanke of Women’s Hospital Lokhandi Sawargaon, Beed, said, “Patients often need counseling to follow their medication regimen. Neglecting medication can lead to uncontrolled blood sugar, causing complications like heart disease, kidney problems, vision issues, and potentially life-threatening emergencies.”

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An ICMR study in 2016 study revealed that 15.2 per cent of urban residents in Maharashtra were prediabetic, with fasting sugar levels between 110 and 125 units. India’s population with diabetes has grown to over 101 million, from 70 million in 2019, as per an ICMR study published in the UK medical journal Lancet.

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