The Indian government is funding an ongoing research project by the Indian Council of Medical Research, the results of which were recently published in the international medical journal The Lancet. The study was commissioned after the government found that 11.2% of Indians who were diagnosed with diabetes are impoverished and living in urban areas. The study aims to identify the relationship between economic status, place of residence and diabetes. So far, the researchers have found that the disease is disproportionately catching up with the urban poor in the country’s developed states.

India is home to over 60 million adults with diabetes, comprising 7.8% of the population. And this is where this study is important: “This trend is worrying because it suggests that the diabetes epidemic is spreading to those individuals who can least afford to pay for its management,” the research reads. Also, according to the paper’s background, previous studies did not carefully dissect the heterogeneous nature of the disease in India. The aim of the ongoing research is to estimate the prevalence of diabetes and pre-diabetes across the country by estimating the prevalence by state.

To reach that conclusion, the researchers used a stratified multistage design to obtain a community-based sample of 57,117 individuals above 20 years old. The sample population represents 14 out of 28 states in India and one union territory. They found that the urban areas of more wealthy states have transitioned further along the diabetes epidemic. However, impoverished citizens living in wealthy states were more likely to be diabetic than their wealthier counterparts.

Chandigarh, the region with the highest per capita GDP among Indian states and union territories (the region has a GDP of $3,433), was found to have 13.6% prevalence of diabetes among urban poor – which is also the highest in India. The same trend was observed in Maharashtra and Tamil Nadu too. Surprisingly, the reverse trend was observed in rural areas of states across India, where wealthier people are more likely to be diabetic than their poorer counterparts.

As the overall prosperity of India increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of the society – a trend that has already been observed in high-income countries. “The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measure,” the researchers conclude.

Today, around 66% of the 415 million people with diabetes around the world live in cities. “Urban diabetes is an emergency in slow motion, but its growth is not inevitable,” reads the website of Cities Changing Diabetes, an initiative that engages cities around the world to map the problem, share solutions and drive concrete action to fight the diabetes epidemic in big cities. Cities Changing Diabetes currently works with Copenhagen, Houston, Johannesburg, Mexico City, Shanghai, Tianjin, Vancouver, and Rome.