One in every five Indian adults living in urban cities suffers not only from hypertension but also diabetes. In Maharashtra, more disturbingly, one in three persons is struck by the twin epidemic. These are some of the highlights of India’s largest clinic–based survey to assess the prevalence of diabetes and hypertension. The findings of the study, called Screening India’s Twin Epidemic (SITE), were announced on Monday in Mumbai.

The overall health picture, the study suggests, is grim: 60%, or three out of every five Indians, have either diabetes or hypertension or both. The corresponding figure in Maharashtra, at 67%, is worse. In particular, almost 40% of those tested in the state had diabetes. And every second person had hypertension.

The only parameter where Maharashtra performed better than the all–India average was in the level of awareness: if 7% of those tested in the eight states put together didn’t know they had these diseases, in Maharashtra it was 5%.

The SITE study, sponsored by a multinational pharmaceutical company, Sanofi, tested almost 16,000 people living in urban cities across eight states over the last three years. Patients walking into general practitioners’ clinics for complaints other than diabetes and hypertension were tested.

“It is shocking that 60% of those we studied suffered from hypertension or diabetes or both,,” said Dr Shashank Joshi, the principal investigator for the SITE study. He further said that the total number of people suffering from either of the two diseases was almost as much as the number of people having both the diseases. “This only shows how uncontrolled the diseases are. People don’t monitor their sugar or blood pressure regularly.,”

The study assessed people on three parameters: if their levels of glycated haemoglobin were under 7, if their blood pressure was less than 130/80 and their levels of bad cholesterol less than 100 mg/dl.

The study found that only 1.9% of those tested could achieve these standards,,” said Dr Joshi, with only 20% having controlled blood pressure levels.

The study was conducted in 800 clinics in urban hubs such as Mumbai, Pune and Nagpur in Maharashtra; New Delhi–NCR; Chennai, Coimbatore and Madurai in Tamil Nadu; Bangalore, Mangalore, and Mysore in Karnataka; Hyderabad, Vizag and Vijaywada in Andhra Pradesh; Bhopal and Indore in Madhya Pradesh; Ahmedabad, Surat and Vadodara in Gujarat; and Kolkata, Hoogly and Howrah in West Bengal.

The reason for the surging numbers is not hard to find: obesity. Almost 80% of the people studied had abdominal obesity or a waist circumference of over 90 cm. The study also found that one of the driving forces was the rising trend of non–vegetarianism along with the old cause of excess salt in diet. “We found that 61.5% of those interviewed were nonvegetarians,” added Dr Joshi.

While the average American consumes 4 to 6 grams of salt a day, Dr Joshi said that Indians had almost 6 to 8 grams a day.

Dr Hemant Thacker, a consultant at Jaslok Hospital, blamed this on lifestyle changes. “There is a change in lifestyle, especially among the young. Instead of climbing stairs, we use elevators. We have become couch potatoes and like our drinks. We, however, don’t exercise enough,,” he said.

The biggest challenge, said doctors, was the silent epidemic. The SITE study, for instance, found that 7.2% of those tested didn’t know they had diabetes or hypertension. “Worse, 18.4% of those tested had a condition called pre–diabetes,,” said Dr Joshi.

Extrapolations from the recent ICMR study say that India has approximately 75 million people suffering from diabetes. But it is estimated that double that number have pre–diabetes. “For every person with diabetes, there are two who have elevated blood sugar levels that could result in diabetes a few years later,,” said Dr Joshi.

It is the inability of the human body to produce insulin. It is believed that 7% of the general population suffers from diabetes