© Kamla-Raj 2009 Ethno-Med, 3(2): 127-131 (2009)

Some Salient Points in Type 2 Diabetes Prevalence in

Rural Bengal
Rangadhar Pradhan, B. Dinesh Kumar and Analava Mitra*

School of Medical Science and Technology, Indian Institute of Technology Kharagpur,

Kharagpur 721 302, West Bengal, India
Telephone: 091-03222 282220; Fax : 091-03222 282221,
E-mail: *<amitra@smst.iitkgp.ernet.in>
KEYWORDS Type 2 diabetes. Prevalence. Rural Bengal.

ABSTRACT Diabetes mellitus is a complex metabolic disorder characterized by failure to properly utilize glucose and
other metabolites in the body causing spillover of these substances in the urine, mainly due to relative or absolute
deficiencies of insulin secretions by the β- cells of the pancreas. Our observations indicates that prevalence of diabetes
in rural Bengal is in between 3.5% - 5.7%. Religion wise prevalence in rural Bengal shows Muslims have lowest
prevalence (4.8%) and it is highest in Hindus (5.4%) while Christians (5.1%) in between. Analysis of Food intake
patterns show the prevalence of diabetes is more in meat eaters (7.2%). It is most in pork eaters (7.6%), intermediate
in chicken eaters (6.4%) and lowest in those who take goat/sheep (6.1%). In vegetarians it is 5.8% and in fish eaters
it is 5.2%. Other factors, such as migration from one place to another, food intake habit, exercises have a great role
in type 2 diabetes management.

INTRODUCTION of CVD mortality in men with or without diabetes

The word “diabetes” is derived from the Greek
word “diabainein” which means “to pass through”.
It is characterized by an excess of sugar in the
blood and urine associated with hunger, thirst and
gradual loss of weight due to inadequate insulin
action. Insulin is a hormone, which regulates
carbohydrate and triglyceride metabolism, through
its action at several sites (Rahman and Zaman 1989).
As per Wild et al. (2004) incidence of diabetes
in India will increase by 195% in 2025 and the
sufferers will be young age individuals. Type 2
diabetes along with its forerunner Impaired
Glucose Tolerance (IGT) is a result of Insulin
Resistance (IR) and is commonly associated with
Obesity, hypertension, Coronary Artery Disease
(CAD) and Dyslipidaemia. The disease is
affecting at an alarming rate to both rural and
urban populations in India (Mohan et al. 1996
and 2001; Ramachandran et al. 1990 and 2003).
The most common cause of mortality in these
patients is CVD, accounting for at least 50% of
deaths according to the World Health Organiza-
tion Multinational Study of Vascular Diseases in
Diabetes (Morrish et al. 2001). Hypertension is
estimated to contribute from 35% to 75% of
diabetic complications (Kirpichnikov and Sowers
2001). Findings from the MRFIT indicated that
systolic blood pressure along with serum
cholesterol and smoking are significant predictors
(Stamler et al. 1993).
Incidence of diabetes is more on the Southern
parts of the country and least in the eastern parts.
Nearly 12 per cent of the adult population in Delhi,
nearly 10 per cent in Mumbai, 12.5% in Bangalore,
13.5% in Chennai and near 16% in Hyderabad are
patients of diabetes. The incidence of diabetes
has increased in Hyderabad with an average of
16 % above the age of 25, as compared to 5% in
other cities and world average of 3%. However,
in rural areas the incidence is 5% less
(Ramachandran et al. 2001).
PREVALENCE OF DIABETES IN BENGAL
Our observations indicates that prevalence
in rural Bengal is in between 3.5% - 5.7%. Three
districts of West Bengal have high prevalence of
diabetes-Howrah (13.2%), Kolkata (12%) and
Burdwan (8.7%). Prevalence is comparatively low
in Purulia (2.7%), Bankura (3.0%), Dinajpur East
(3.6%) and West (3.5%). The prevalence can be
described as with the following sub-heads.
Religion
Religion wise prevalence in rural Bengal
shows Muslims have lowest prevalence (4.8%)
and it is highest in Hindus (5.4%) while Christians
(5.1%) in between. In the Muslims-those who
128 RANGADHAR PRADHAN, B. DINESH KUMAR AND ANALAVA MITRA
pray 5 times prevalence is least (4.5%), in four
times it is intermediate (4.7%) and in those who
pray three times or less it is highest (4.9%). The
ratio in non-prayers, those who prays once a day,
twice a day, thrice a day and five times a day are
9: 7: 5.5: 3: 2 respectively It is being observed by
analyzing the data of 7600 volunteers (obtained
from different hospitals and health centers of West
Midnapur District) of which 1560 was Muslim,
5200 being Hindu and the rest Christian, the
prevalence of diabetes is less in Muslim and the
ratio in Hindu, Muslim and Christian being 13:8:
10. The exact cause of this is unknown. The
particular posture of Muslim worship may have
some role. It has been observed that while estimat-
ing serum insulin values (radio-immunoassay) of
several Muslim volunteers maintaining identical
conditions repeated stooping exercises increase
serum insulin values by 18-22% (Mitra 2008).
Diet and Food Intake Pattern
Analysis of Food intake patterns show the
prevalence of diabetes is more in meat eaters
(7.2%). It is most in pork eaters (7.6%),
intermediate in chicken eaters (6.4%) and lowest
in those who take goat/sheep (6.1%). In
vegetarians it is 5.8% and in fish eaters it is 5.2%.
In the vegetarians those who consume ghee it is
least (3.8%) while it is highest in those who take
coconut oil or groundnut oil (6.8%), in mustard
oil consumers it is 5.6%. Rural Bengal diet is
chiefly composed of carbohydrates about 80-90%
(Mitra and Bhattacharya 2005). Fat intake is about
10% while protein intake is 10-15%. Ghafoarunissa
(1996) indicates that fat intake depends on income
while our studies in rural Bengalee population
show no such relationship. Consumption of more
of carbohydrates lead to diabetes and our study
shows 80% or more of carbohydrates lead to more
of diabetes. Intake of carbohydrates lower than
80% show not much increase in diabetes
prevalence. A diet composed of 60-65% carbo-
Table 1: Food constituents as consumed by semi urban and rural people
Total Income per SemiUrban Protein
family per month or Rural (%)
<1000 Semi Urban 10-12
Rural 10-15
1000-5000 Semi Urban 15-20
Rural 10-15
>5000 Semi Urban 25
Rural 10-15
hydrate, 25- 35% fat, and 10-20% protein, with
limited or no alcohol consumption is ideal to
reduce diabetic prevalence (Mitra and Bhatta-
charya 2006a). Complex carbohydrate shall be
used in diet, which takes longer duration for
digestion and absorption and reduces the
prevalence of diabetes. Animal and vegetal
proteins shall be in a 1:1 ratio. 60% of lipids must
be of vegetal origin with a monounsaturated/
polyunsaturated ratio of 1:1 (Iafusco 2006).
Ontogenetic models by Dilman (1989) show that
with aging, hypothalamus fails like a failing
rheostat. Supplementing the diet with fresh fruits
that supply potassium and other minerals improve
insulin resistance and those whose diet are
supplemented with seasonal fruits show
reduction in diabetic prevalence (3.2%).
The data obtained from 500 rural volunteers
and analyzed by the method suggested by
Rangana (1986) presented in Table 1 (Food
Constituents as Consumed by Semi Urban and
Rural People), however, showed that the diet did
not have a strong relationship compared to the
level of income in the rural population. This might
be due to selection of low cost food materials
capable of supplying necessary food components
and energy required for normal activities (Mitra
2008). The above data for further analysis revealed
saturated fat intake was about 6-8% except in higher
income semi-urban population where it was about
15-18%, polyunsaturated fat intake was about 4-
6% and monounsaturated fat intake was about 6-
9%. Fiber intake was about 30-40%. Our
observation show eating in squatting position
reduces the prevalence (3.8%) while eating in chairs
and tables show increase in the prevalence (9.4%)
of diabetes.
Diabetes in Tribal and Non tribal Population
Studies with diabetic population in tribal and
non-tribal show an overall ratio of tribal: non-
tribal 7:18. Of the tribes in Midnapur West
Fat Carbohydrate Approximate
(%) (%) calorie
10 80 1600
10-15 65-75 1800
15-20 70-80 2000
10-15 65-75 2000
20-25 50-65 2250
10-15 65-75 2250
SOME SALIENT POINTS IN TYPE 2 DIABETES PREVALENCE IN RURAL BENGAL 129

santhals are affected most (4.2%), Lodhas least prevalence of diabetes in those who perform
(2.9%). Economic condition in tribes has a direct regular exercises is very low (1.6%). Those who
relationship with diabetic prevalence, highest in perform walking for 1 hour at a speed of 3 km/
high-income group (5.2%). While in non-tribes it hour show a prevalence of 2.2%, at a speed of 4
is most in middle-income group (3.7%) and km/hour 2.0%, at a speed of 5 km/hour 1.7% and
occupation wise it is highest in clerical grades at a speed of 6km/hour 1.6% respectively.
(3.8%). Those engaged in professional trades it Beneficial changes in blood biochemistry of Type
is highest in drivers (4.3%). Table 2 shows the 2 diabetes patients due to walking are also being
respective prevalence in different districts of West observed (Mitra and Bhattacharya 2006b).
Bengal.
Herbal Remedies
Table 2: Diabetic prevalence of tribes and non-tribes
in different districts of West Bengal Our study with a tribal group that is taking 21
Name of district Tribe Non-tribe tulsi leaves a day shows that the group is free of
Midnapur East 2.3 5.4
diabetes and atherosclerotic disorders. The non-
Midnapur West 5.2 8.6 tribal persons in the same area show a diabetic
24 parganas North 4.3 7.4 prevalence of 4.6%. The polyphenols and other
24 parganas South 3.8 6.6 anti-oxidants in tulsi are having anti-diabetic
Burdwan 5.1 9.6 effects (Mitra and Bhattacharya 2007). Similarly
Jalpaiguri 4.8 5.6
Dinagpur East 2.9 4.2 our study with an ethnic group taking 10-12
Dinagpur West 3.6 4.4 banyan leaves/day shows reduction in diabetes
Kolkata 9.7 12.4 prevalence (3.2%) in comparison with other
Malda 3.6 6.2 groups in the area (4.7%) (Mitra 2007). In a
Durjeeling 4.4 4.6
Coochbehar 2.6 2.9 selective group in West Midnapur some people,
Bankura 2.7 3.1 particularly young ladies take young buds of
Purulia 2.5 3.0 china-rose (Hibiscus) 3-4/day and it is a religious
Murshidabad 3.9 4.6 practice daily before worship. China-rose contains
Birbhum 4.2 7.6
Hoogli 4.4 8.6
Cyanidin diglucoside, carotene, thiamin,
Nadia 5.6 7.8 riboflavin, niacin and ascorbic acid. Fasting blood
Howrah 8.2 14.5 sugar and serum insulin values (Boehinger
Manheim 1983) of these ladies are low with
increase in insulin sensitivity.
Migration In a selective group in West Midnapur some
people use Putranjibi leaves (Putranjiva
A study is being conducted by us, in a roxburghii). 14-15 leaves are boiled with 500 cc
selective pocket of Midnapur West where a group of water till it is being reduced to half and filtered
of residents from Vidarbha migrated. They are to remove the residue, cooled and taken four times
closely followed. In Vidarbha the edible oil a day as a vitalizer. It is being observed that both
consumed by them is flax oil while after migration fasting blood sugar and serum insulin values
the oil medium is changed to coconut oil/ mustard (Boehinger Manheim 1983) are reduced with
oil. The study conducted by us shows that flax increased insulin sensitivity. It is also being
oil consumption protects against insulin observed that some Santhals residing in
resistance syndrome (Mitra et al. 2005) and Midnapur West are using Gurmur leaves daily (5-
change over to coconut oil/ mustard oil shows 6/day) as anti-diabetic measures. The prevalence
that beneficial effect is retained for 5-7 years and of diabetes is less in them (2.6%) comparing with
then declines (Mitra and Bhattacharya 2006c). other santhal groups (4.9%).

Walking Some Interesting Observed Data

Walking benefits in the insulin resistance The pandas at a famous Lord Shiva temple
syndrome and our study shows walking for 1 hour place take about 1 kg/day of sweets yet the
at a speed of 6 kilometers/hour produces maximum prevalence of diabetes is very low in them (0.85%).
benefit (Mitra and Bhattacharya 2006b). The They also take a large amount of Bhang. The
130 RANGADHAR PRADHAN, B. DINESH KUMAR AND ANALAVA MITRA

dietary patterns and life style are otherwise similar Table 3: Effect on lipid profile of NIDDM patients
in them and nearby villagers. The only (rural) fed with less fat and more carbohydrate in
the diet (Normal rural Indian diet).
incorporation of bhang in the daily intake may
have an anti-diabetic role and is to be explored Time TLC HDLC LDLC VLDLC TG FBS
by further studies. Dec 0 252 56 178 18 94 162
The prevalence of diabetes is high in those Jan 1 254 56 180 18 94 164
Feb 2 258 56 184 18 94 167
who look after horses in villages (7.5%) and low Mar 3 255 58 179 18 94 163
in those who look after cows (3.4%), it is Apr 4 254 57 179 18 94 165
intermediate in goat caregivers (5.3%) and highest May 5 254 57 178 19 98 163
in them looking after pigs (8.4%). This is in line June 6 252 56 176 20 102 163
with Maldharis (who take care of camels) in July 7 252 56 176 20 102 163
Aug 8 250 56 174 20 102 163
Rajasthan in whom diabetes prevalence is nil. The Sep 9 250 56 176 18 94 163
exact causes are yet to be explored. Oct 10 250 56 176 18 94 162
Nov 11 253 56 179 18 94 162
Obesity and Diabetes
from November to February and reduces from
The most powerful risk factor for Type 2 March to august. Very Low density Lipoprotein
diabetes or NIDDM is obesity. Previous studies (VLDL) increases from May to August and
have shown both a strong and a weak relationship reduces from September to November.
between obesity and Type 2 diabetes. The two Triglycerides (TG) increase from May to August
most important aspects are extent and duration. and reduce from September to November. Fasting
In the western world, two-thirds or more of Blood Sugar (FBS) increases rednees from
patients with diabetes are obese as compared with January to April and reduces from May to October.
Type 2 diabetes subjects in India where obesity
is not common. A possible reason is the CONCLUSION
confounding influence of weight loss with onset
of disease or with therapy. Comparison between Diabetes is a chronic disease increasing in
Indians in Malaysia and South Africa show that explosive pattern in India and rural Bengal is not
the differences in diabetes prevalence in Indians an exception to it. Changes in socio-economic
abroad cannot be explained on the basis of pattern and life styles may be important in
adiposity. The high prevalence of diabetes in the addition to susceptible genes for the causation.
Fiji Indian population cannot be explained on the Our studies are intended to find out the changes
basis of BMI. Inter-ethnic differences have to be in prevalence in different areas of rural Bengal in
accounted for (Mitra et al. 2007). relation to different factors-economic, religious,
eating patterns, physical activities, seasonal
Lipid Biochemistry changes etc.
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