Prevalence and risk factors for diabetes and impaired glucose tolerance in Asian Indians: A community survey from urban Eastern India

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Abstract

Objectives

To determine the prevalence of diabetes and impaired glucose tolerance (IGT) and to identify risk factors for the same specific to an underdeveloped urban locale of Eastern India.

Methods

Study design. Population based cross-sectional study, with multistage random sampling technique.

Setting. Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India.

Participants. 1178 adults of 20–80 years age randomly selected from 37 electoral wards of urban populace.

Definition and diagnosis of diabetes mellitus and IGT. These were based on a Report of a World Health Organiztion/International Diabetes Federation Consultation of 2006.

Main outcome measure. Prevalence and significant risk factors for Diabetes and IGT.

Statistical analysis. Both descriptive and multivariable logistic regression analyses.

Results

The crude rates of diabetes and IGT in the study population were 15.7% and 8.8%, respectively. Similarly age-standardized rates of diabetes and IGT were 11.1% and 6.7%, respectively. Both diabetes and IGT had shown a male preponderance.

Conclusion

Diabetes and IGT were very highly prevalent in this urban populace. Cardiometabolic risk factors like older age, central obesity, inadequate fruit intake, hypertension, hypertriglyceridemia and socio economic status were found to be significant predictors of diabetes in this study.

Introduction

The Diabetes Atlas of the International Diabetes Federation shows that India has the dubious distinction of leading the world in diabetes prevalence and is home to over 51 million diabetics [1]. Recent surveys indicate that the prevalence of Diabetes in urban Indian adults has increased from 1.2% in 1971 [2] to about 20% at present [3], [4]. With its chronic course; we can expect diabetes to have a serious adverse impact on the life expectancy as well as the quality of life [5]. South Asians have an increased prevalence of coronary heart disease (CHD) and diabetes mellitus amongst all the ethnic groups irrespective of their religious affiliations, life style, diet or the country of residence [6], [7], [8]. This South Asian Paradox refers to the fact that high prevalence rates of diabetes are seen in people originating from South Asian nations of Bangladesh, India, Nepal, Pakistan and Sri Lanka despite low rates of obesity as defined by conventional body mass index criteria [9], [10]. South Asians also seem to have a peculiar body phenotype known as South Asian phenotype, characterized by increased waist circumference, waist hip ratio, excessive body fat, increased plasma insulin levels, insulin resistance and an atherogenic dyslipidemias with low levels of HDL cholesterol and increased triglyceride levels [9], [10]. All these predispose them not only to diabetes but also to premature CHD. There could also be unique genetic markers which make South Asians more susceptible to diabetes [9], [10], [11].

Unfortunately, accurate recent nationwide data are lacking in India [12], [13], let alone data from specific states within India. Earlier we reported that the state of Orissa, one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India, showed interesting variations in classical coronary risk factors among an urban population [14]. Such a unique geographic location opens up to cultural and socio-economic interactions. Diabetes is a lifestyle disease and factors contributing to changing patterns in Diabetes prevalence in recent years in this geographic region may provide interesting insights into tackling the ever-rising burden of Diabetes in South Asians in general. Interesting to note, one of the earliest studies for prevalence of diabetes in India was conducted from Orissa state [2], [15]. The present study aims at updating on changing patterns of Diabetes in a unique urban Eastern Indian population and quantifying factors significantly contributing to any observed underlying pattern.

Section snippets

Study design and setting

The current study was a population-based survey of cohort under Berhampur Municipal Corporation with an estimated population of 307,724 in 2001, in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. So the inhabitants here are heterogeneous mix of language, religion, varied socioeconomic statuses and culture.

Sampling design and sample size

The study population of 1178 adults of 20–80 years of age was selected using a multi-stage random sampling technique. The

Results

This was one of the large community based surveys done from Eastern India for ascertaining the prevalence of cardiovascular risk factors with the aim of providing the baseline information on prevalence rates for intervention programmes to the policy planners. A total of eleven hundred seventy eight subjects participated in the study (185 had diabetes; 104 were having IGT and the remaining 889 individuals were considered normal).

Discussion

This cross-sectional study of adequate statistical power and representativeness (n = 1178) was conducted among an apparently urban healthy population in Eastern India, a region with unique lifestyles and culture. A very high age standardized prevalence of diabetes at 11.1% and 6.7% for IGT was reported in this study population. Older age, increased central obesity, inadequate fruit intake, being hypertensive, hypertriglyceridemia and middle socio economic status significantly contributed to

Funding sources

No funding received.

Conflicts of interest

None declared.

Acknowledgments

We thank Dr. K. Revathi Devi, Medical Officer, Sudhir Heart Centre, Berhampur, Orissa, India; Lt. Col (Retd.) Dr. M.S. Panda, Senior Medical Officer, Veterans Health Clinic, Berhampur, Orissa, India; Dr. U.S. Panigrahi, Professor of Psychiatry, Dr. Ram Manohar Lohiya Hospital, New Delhi; Mrs. Pearline Suganthy, Statistician, Christian Medical College Hospital, Vellore, India; and Mrs. Mohini Sahu, Child Development Project Officer, Berhampur, Orissa, India.

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