These future rates are based on current figures, historical trends in other countries that have experienced similar risk factors and the changes in risk, including alteration in sugary diets and physical activity. Also, there are changes in so-called competing factors — with people growing older as other diseases reduce, the rate of their developing diabetes could also rise. Sugar is a major factor underpinning this situation. Many cuisines the world over have had a sweet tooth through history. But what is different about our relationship with sugar today is the concentration and formulation of what we are eating now compared to prior years. Also, the density and quantity of consumption per day differs from the past in a very profound way. Changes in the forms and weight of sugar consumed are now driving these health implications.
Worryingly, in India, a large number of children are also impacted by diabetes. Children are developing obesity and metabolic syndrome early because of the change in diets to more processed and fast foods. As medics, we need to prepare for this situation. One of the biggest transitions taking place in our health systems now is understanding how to move from the classical ways in which we addressed the interactions between medical care and public health.
Often, this has been very acute and short-term — if people had a common infectious disease, for instance, they were given a course of antibiotics and they were soon cured. Their relationship with a primary care physician would thus be brief. But now, we need to develop an understanding of a progressive, longterm relationship with a primary care provider. This will be necessary to understand how to control these chronic lifestyle-related diseases, negotiate the need for medicines, the availability of healthier foods and so on. With the prevalence of less healthy diets and lifestyles, health systems will not be about one-off discussions but will need a longer frame of time.
Alongside, as diabetes rises, access to insulin will also become a big challenge. Insulin was invented decades ago but remarkably, there is no generic insulin yet. Its price and requirement of refrigeration makes it hard for people in rural and less developed areas to access this. The optimist in me suggests we will be able to provide insulin to more people driven by demand. Despite the complexities involved in an injected medication, Covid-19 vaccines have been able to reach rural and remote regions in India. But the same levels of innovativeness for insulin will require understanding how the infrastructure can be improved for deliverability and affordability.
This will also require exploring a range of options for people with diabetes, including those with Type 1 diabetes who truly need insulin as well as Type 2 folks who could also use other alternative therapies. We need to rethink our relationship with sugar as well. India has been quite progressive in its approach to sugar via its taxation structure. In Mexico, which had an even more worrying situation with obesity and diabetes, taxation on sweetened beverages has shown encouraging results, with the poorest classes proportionately benefitting health-wise from this policy. Alongside, I also hope that a broader perspective is taken in India about how to balance the growing desire for a more Western diet with more caution about the fall-outs of such a diet. This will involve thinking about multiple factors from trade policy to rediscovering more traditional and healthier diverse diets. Given the medical implications, such mitigations in time will be really beneficial.