Context: Diabetes is a chronic disease resulting from inadequate insulin production or ineffective use of insulin in the body. Main types include Type 1, Type 2, and gestational diabetes. A systematic review from north-east, central, and north-western Indian studies give a pooled prevalence of diabetes in tribal people to be 5.9% and that of impaired glucose tolerance to be ranging from 6.6% to 12.9%.

Types of Diabetes

• Type 1 Diabetes: Occurs when the immune system destroys pancreatic cells that produce insulin. Commonly diagnosed in children and young adults.
• Type 2 Diabetes: Linked to the body’s inability to effectively use or produce insulin, usually appearing in middle-aged and older individuals.
• Gestational Diabetes: Develops during pregnancy and often disappears after childbirth, but increases the risk of Type 2 diabetes later.
• Lean Diabetes: A condition associated with intermittent starvation and carbohydrate metabolism overload, seen in low and middle-income countries.

Situation in India

• 11.4% of India’s population or 101 million people are living with diabetes. Whereas 15.3% of the population or an additional 136 million people are pre-diabetic.
• India has a significant diabetes burden with approximately 77 million adults affected by Type 2 diabetes and 25 million at high risk of developing the disease.
• Projections suggest that by 2030, India may have 79.4 million individuals with diabetes.

In Tribal Population

• In Bilaspur district, a significant increase in diabetes cases was noted. There 922 new patients diagnosed in one community health center in less than a year.
• The proportion of deaths attributed to non-communicable diseases (NCDs) in India has risen significantly, and tribal populations are at risk.
• An estimated 104 million tribal people, about 8.6% of India’s population, could suffer from diabetes.
• The prevalence of diabetes in tribal areas is estimated to range from 1% to 10%.

Reasons for Diabetes in Tribal Population

• Overreliance on rice distributed through the Targeted Public Distribution System (TPDS) has contributed to the surge in diabetes cases among tribal populations.
• Traditionally, tribal communities practiced millet cultivation and consumed a variety of vegetables and fruits, which has declined over the years.
• Nutritional inadequacy is prevalent among tribal populations, leading to an increased risk of diabetes.
• Lack of awareness and resources for diabetes management are significant factors.
• The physical inactivity of tribal populations due to frailty is another concern.

Ways to Reduce the Diabetes Burden

Government investment in data management systems, healthcare worker training, and infrastructure for disease control is crucial. Decentralized care and the establishment of non-medical approaches like peer support groups can raise awareness and promote inclusivity. Improving the situation can be achieved through nutritional rehabilitation, including the distribution of diverse food types such as eggs, millets, and nuts through the TPDS.

Addressing diabetes in tribal populations requires a multi-faceted approach, combining health education, dietary diversity, and accessible healthcare services to mitigate the diabetes burden in these communities.