The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes in India study (PODIS)

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Abstract

This random multistage cross-sectional population survey was undertaken to determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in subjects aged 25 years and above in India. The study was carried out in 77 centers (40 urban and 37 rural). 18363 (9008 males and 9355 females) subjects were studied. 10617 (5379 males and 5238 females) were from urban areas and 7746 (3629 males and 4117 females) from rural areas. Blood samples were taken after a fast of 10–12 h and 2 h after 75 g of oral glucose. Subjects were categorized as having IGT or DM using the World Health Organisation (WHO) (1999) criteria. The standardized prevalence rate for DM in the total Indian, urban and rural populations was 4.3, 5.9 and 2.7%, respectively. The corresponding IGT rates in the three populations was 5.2, 6.3 and 3.7%, respectively. The urban prevalence of DM and IGT was significantly greater than in the rural population (P < 0.001 in both instances). The prevalence of DM was significantly, more than that of IGT (P < 0.001) within both the rural and urban populations.

Type 2 diabetes is a major health problem is India.

Introduction

The estimated number of people with diabetes is predicted to rise in the coming decade and the major burden will be borne by Asian countries which will see a 2.7–3.6-fold increase in the prevalence rates [1], [2], [3].

Many countries are in the process of setting up diabetes prevention programs in order to stem this growth and epidemiological studies can be of significant help in delineating high risk sectors of the population so that the prevention programs can be properly targeted [4]. However, any epidemiological study must give a correct and faithful representation of the population. The second most populous country in the world, India is home to a significantly diverse groups of people when ethnicity, caste and religion, habitat, socioeconomic status, education levels, lifestyles and food habits are taken into account. In the absence of a systematic, scientific and truly nationwide survey of the prevalence of diabetes in India which takes into account this diversity, the true burden of diabetes can never be correctly estimated and no worthwhile national diabetes care policy be framed.

A majority of the studies on the prevalence of diabetes carried out in India [5], [6], [7], [8], [9], [10], [11], [12], [13], have been mostly confined to pockets within urban areas especially the city of Chennai (Madras). The only study which studied rural prevalence was confined to a small area very close to a major city [13]. Moreover, this study as well as one other study in a major city [12] only looked at people with known Type 2 diabetes rather than examine the total prevalence. In the most recently reported study, the megacity bias was again inherent as it was mostly confined to the four large metropolitents and two other cities [9]. Another recent study looked at both urban as well as rural populations but was confined to a small part of one state in north India [5].

To the best of our knowledge, the prevalence of diabetes in India study (PODIS) is the only diabetes prevalence study which overcomes these constraints to provide an estimate of the prevalence of diabetes, both known as well as undiagnosed, in rural as well as urban areas giving it a truly all India perspective.

This paper reports, the results from more than 18,000 subjects who received an oral glucose tolerance test (OGTT), thereby allowing calculation of DM prevalence using both the WHO (1999) and the ADA (1997) criteria. This allows an estimate of the DM and IGT prevalence, a comparison in the same subjects of the prevalence of DM using the two criteria [14] and should be read alongside the full results of the PODIS study published in this issue [15] which reports DM prevalence using the ADA criteria only in more than 41,000 patients.

Section snippets

Material and methods

The prevalence survey was undertaken over a period of three years between 1999 and 2002.

We used a multi-step sampling method. Seventy-seven centers were chosen from all over India by an independent polling agency well versed in doing electoral surveys to represent a composite picture taking into account the vast, diverse and heavily populous country. Forty of the centers were from urban areas and 37 from rural areas. These 77 centers were a part of the 108 centers chosen for the full PODIS

Result

A total of 18,363 (9008 males and 9335 females) subjects were studied. The responder rate was 85.4% (81.6–89.3%). It was 91.2% in rural areas and 79.6% in urban areas.

Table 1 shows the characteristics of the subjects. Of the total study population, 10,617 and 7746 were from urban and rural areas, respectively. In the urban group, of the 10,617 respondents, the number of males was 5379 and the number of females was 5238. In the rural group, of the 7746 respondents, the number of males was 3629

Discussion

The World Health Organisation (WHO) estimates India to be home to the largest number of diabetes patients in any given country and this trend will continue into the future [18], [19].

In the full report of the PODIS study we have discussed in detail that a majority of the prevalence studies carried out in India [5], [6], [7], [8], [9], [10], [11], [12], [13] have been mostly confined to pockets within urban areas, especially the city of Chennai (Madras). One study has looked at rural prevalence

Acknowledgements

We would like to thank Prof. G. Kaliaperumal, Head of Biostatistics, NIMHANS, Bangalore for his help with the statistical analysis. We would also like to thank Lifescan, India, for their support and help in carrying out this survey.

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