The Cost of Untreated Diabetes in India

Diabetes mellitus (DM) is one of the most common noncommunicable diseases and the seventh leading cause of death globally.

India is estimated to be the World Diabetes Capital by the year 2030. In a developing nation like India, a majority of people experience hospitalization cost burden from out-of-pocket (OOP) expenses. And lack of insurance schemes and policies further escalate the cost of diabetes care.

Diabetes is often called a silent killer as the disease progresses without too many external signs and symptoms. Unfortunately, the typical signs which are indicative of blood sugar problems like extreme daytime sleepiness, difficulty waking up in the morning, excessive sweet cravings (especially after major meals), unexplained hunger, thirst, urination are often passed of as random events that people blame on their lifestyle or lack of willpower while ironically, these are the precise symptoms that can help in early diagnosis of the disease.

If prediabetes is suspected, it becomes necessary to dig deeper and go one step further by analyzing your Insulin levels which are a more accurate indicator of diabetes risk than just fasting blood sugar levels. Majority of the population with the diagnosis of diabetes are busy bringing their high blood glucose levels in control, while totally ignoring the actual problem- Insulin resistance! It is insulin resistance that needs to be absolutely prioritized while treating diabetes. 

Growing evidence also suggests that insulin resistance (IR) is an important metabolic driver behind numerous other diseases and health risks with diabetes on the top of the list. Insulin, a hormone that the pancreas makes, allows cells to absorb and use glucose. In people with insulin resistance, the cells are unable to use insulin effectively.

IR is when cells in your muscles, body fat and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. So it is of utmost importance that IR is diagnosed at the primary stage of diabetes treatment in order to save cost.

Studies and data from across the globe is now proving that those with underlying insulin resistance had a higher incidence of fatal outcomes with Covid-19. Insulin resistance and the inflammation it triggers is the real pandemic of our times. 

As per WHO estimates, diabetes drains a significant percent of the health budget by cost toward diabetic care. The complications (short and long term) of both type I and II DM occurring during the most productive years pose an economic and social burden for the patient. The cost of diabetes can be categorised into three groups:

• Direct cost- includes health care costs (diagnosis, treatment, care and prevention), large number of drugs (OHA) and type of Insulin prescribed.
• Indirect cost- includes cost for absenteeism, loss of productivity and disability
• Intangible cost- includes cost for social isolation and dependence, low socio-economic status, mental health and behavioral disorder and loss of quality of life.

The average direct cost of diabetes is estimated to be ₹18,890 per annum (which means if you live with diabetes for 20 years, it’s  going to cost you around 4 lakhs) while the spending ranges anywhere between ₹999 to ₹1,09,344 (1).

Medicines, diagnostics, transportation cost and hospitalisation take up the majority of the expenditure.

As high as ₹1000 is spent on hospital visits on a daily basis. And these are just the costs of monitoring your blood sugar levels and keeping them in control.

Diabetes is a disease that comes with associated comorbidities and complications. Fluctuating blood sugar levels over a long period of time can lead to increased inflammation and damaged organs (especially brain, heart, liver and kidneys).

Diabetes results in both short and long term complications, mostly manifested as Cardiovascular diseases, nerve damage (neuropathy), kidney damage (nephropathy), eye damage (retinopathy), foot damage, skin changes, hearing impairment and also PCOD. Each of these add to the costs of living with diabetes especially as some of these health complications require surgical interventions.

Research suggests that cost on diabetic drugs and exogenous insulin (insulin injections) constitutes 50% of the total direct costs. Most of these costs can be totally eliminated by just reversing insulin resistance. This is a condition that is literally triggered by faulty eating patterns and disturbed lifestyle practices.

Diabetes can be completely prevented and also reversed once the root causes are identified. While prevention would lead to substantial long-term cost savings from treating the disease, it may also extend the life expectancy of you and your loved ones.

Reach out to us if you want to learn more about Diabetes. 

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299136/ 
2. https://care.diabetesjournals.org/content/37/12/3137#:~:text=Given%20a%20cost%20of%20undiagnosed,earlier%20in%20the%20disease%20process.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299136/#:~:text=Results,p.a.%20for%20the%20west%20zone.
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279984/
5. https://www.ijcm.org.in/article.asp?issn=0970-0218;year=2019;volume=44;issue=2;spage=113;epage=117;aulast=Mathew
6. https://www.jpbsonline.org/article.asp?issn=0975-7406;year=2016;volume=8;issue=4;spage=314;epage=320;aulast=Acharya
7. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30556-4/fulltext#articleInformation
8. https://catalyst.phrma.org/costs-and-consequences-of-not-treating-diabetes
9. https://care.diabetesjournals.org/content/37/9/2557