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Prevalence and determinants of diabetes mellitus in the Indian industrial population.
No full textAIM: To highlight the regional difference in the prevalence of diabetes mellitus (DM) and to explore determinants in variability in the Indian industrial population. METHODS: A cross-sectional survey was carried out among the employees and their family members (10 930 individuals, mean age 39.6 years, 6764 male) of eleven medium-to-large industries from diverse sites in India, using a stratified random sampling technique. Information on behavioural, clinical and biochemical risk factors of DM was obtained, through standardized instruments. DM was diagnosed when fasting blood glucose was > or = 7.0 mmol/l and/or individuals took drug treatment for DM. Multiple logistic regression analysis was carried out to identify the potential predictors of DM. RESULT: In the 20 to 69-year-old age group, the crude prevalence of DM and impaired fasting glucose was 10.1 and 5.3%, respectively. Urban sites had a higher prevalence and awareness of DM status. Individuals in the lower education group had a high prevalence of DM (11.6%). In diabetic subjects, 38.4% were unaware that they had diabetes. Waist-circumference-to-height ratio had a higher DM predictive power than waist circumference and body mass index. The risk factors associated with overall prevalence of DM were: age, sex, low-education level, family history of DM, hypertension and overweight/obesity. Interaction of risk factors was observed only in urban high-prevalence sites. CONCLUSION: There are wide regional variations in the prevalence of DM in India. The high burden of undetected diabetes, even in settings with universal access to on-site health care, highlights the need for innovative prevention and control strategies
Association of high sensitivity C-reactive protein [hsCRP] and Tumour Necrosis Factor- α [TNF-α] with carotid Intimal Medial Thickness in subjects with different grades of glucose intolerance- The Chennai Urban Rural Epidemiology Study (CURES- 63)
No full textObjective: To assess the association of high sensitivity C-Reactive Protein [hsCRP] and Tumour Necrosis Factor-α [TNF-α] with IMT in Asian
Indians with different grades of glucose intolerance.
Design and methods: Subjects with normal glucose tolerance [NGT](n=150), impaired glucose tolerance [IGT] (n=150) and type 2 diabetes
(DM) (n=150) were recruited from the Chennai Urban Rural Epidemiology Study [CURES], in south India. hsCRP was estimated by
nephelometry and TNF-α by enzyme linked immunosorbent assay. Carotid IMT was assessed by high resolution B-mode ultrasonography.
Results: hsCRP and TNF-α levels were higher in those with DM [pb0.001] and IGT [pb0.001] compared to NGT. In linear regression
analysis, both hsCRP [p=0.003] and TNF-α [p=0.001] showed an association with IMT among NGT subjects even after adjusting for age and
gender. Among IGT subjects, TNF-α was associated with IMT [pb0.001], while no association was observed either with hsCRP or TNF-α in
diabetic subjects. In NGT subjects, mean IMT was highest in those with high values [III tertile] of both TNF-α and hsCRP [0.83±0.1 mm;
pb0.001] followed by those with high TNF-α+low hsCRP [0.74±0.09 mm; pb0.001], high hsCRP low TNF-α [0.67±0.09 mm; pb0.001], and
lowest in those with both low TNF-α and hsCRP [I tertile] [0.63±0.05 mm.
Conclusion: We conclude that in Asian Indians 1. Levels of hsCRP and TNF-α increase with increasing severity of glucose intolerance 2. Both
hsCRP and TNF-α are associated with IMT in NGT subjects while TNF-α alone is associated with IMT in IGT subjects 3. hsCRP and TNF-α have
a cumulative effect on mean IMT values in NGT subjects.
© 2008 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved
Prevalence of Fibrocalculous Pancreatic Diabetes in Chennai in South India
Get PDFFibrocalculous pancreatic diabetes is a form of diabetes secondary to chronic pancreatitis found in tropical, developing countries. There is no population based data
on prevalence of fibrocalculous pancreatic diabetes. This paper reports on prevalence of fibrocalculous pancreatic diabetes in Chennai in South India based on the Chennai Urban
Rural Epidemiology Study
Challenges in Diabetes Care in India : Sheer Numbers, Lack of Awareness and Inadequate Control
Get PDFAbstract
With an estimated 40 million people suffering from the condition, the largest in any country in the world,
diabetes has become a major health care problem in India. Recent epidemiological studies from India point to
the great burden due to diabetes and its micro and macrovascular complications. This is primarily because the
status of diabetes control in India is far from ideal. Based on the available data, the mean glycated hemoglobin
levels are around 9% which is at least 2% higher than the goal currently suggested by international bodies.
The IMPROVE study has helped identify the barriers to good control of diabetes both among patients as well
as physicians in today’s practice. However the recent ACCORD study points to the dangers of overaggressive
treatment, especially in high risk in elderly patients. A balanced approach to improve awareness about
diabetes and its control both among patients and the medical fraternity is urgent need of the hour in India.
The associated risks of tight control in high risk groups should also be kept in mind
Incidence of Diabetes and Pre-diabetes in a Selected Urban South Indian Population (Cups - 19)
Get PDFAbstract
Objectives: Several cross-sectional studies have reported on the prevalence of diabetes in India. However,
there are virtually no longitudinal population-based studies on the incidence of diabetes from India. The
aim of the study was to determine the incidence of diabetes and prediabetes in an urban south Indian
population.
Methods: The Chennai Urban Population Study [CUPS], an ongoing epidemiological study in two residential
colonies in Chennai [the largest city in southern India, formerly called Madras] was launched in 1996; the
baseline study was completed in 1997. Follow-up examination was performed after a mean period of 8
years. At follow-up, 501 [47.0%] subjects had moved out of this colonies and were lost to follow-up. Of the
remaining 564 individuals, 513 [90.9%] provided blood samples for biochemical analysis. Regression analysis
was done using incident diabetes as dependant variable to identify factors associated with development of
diabetes or pre-diabetes.
Results: Among subjects with normal glucose tolerance (NGT) at baseline [n=476], 64 (13.4%) developed
diabetes and 48 (10.1%) developed pre-diabetes (IGT or IFG). The incidence rate of diabetes was 20.2 per 1000
person years and that of pre-diabetes was 13.1 per 1000 person years among subjects with NGT. Of the 37
individuals who were pre-diabetic at baseline, 15 (40.5%) developed diabetes [incidence rate: 64.8 per 1000
person years], 16 (43.2%) remained as pre-diabetic and 6 (16.2%) reverted to normal during the follow-up
period. Regression analysis revealed obesity [Odds Ratio (OR): 2.1, p=0.001], abdominal obesity [OR: 2.23,
p<0.001] and hypertension [OR: 2.57, p<0.001] to be significantly associated with incident diabetes. The Indian
Diabetes Risk Score (IDRS) showed the strongest association with incident diabetes [OR: 5.14, p<0.001].
Conclusion: The study shows that the incidence of diabetes is very high among urban south Indians.
While obesity, abdominal obesity and hypertension were associated with incident diabetes, IDRS was th
BMI Compared With Central Obesity Indicators in Relation to Diabetes and Hypertension in Asians
No full textObjective: To compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio
(WSR) in association with diabetes or hypertension.
Methods and Procedures: Cross-sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology:
Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged
35–74 years, of different ethnicities were included in this meta-analysis.
Results: Age-adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR
were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension
were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three)
adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P = 0.001) in men
but with WC and WSR than BMI (both P < 0.05) in women. Hypertension had stronger association with BMI than
WHR in men (P < 0.001) and had the strongest with BMI than the others (WHR P < 0.001; WSR P < 0.01; and WC
P < 0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were
slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742)
while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped.
Discussion: WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly
associated with hypertension in Asians
Pervalence pregablin as premedication Agent: A study on Efficacy and safety in type 2 diabetic patients Undergoning Foot Surgeries
No full textN
Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension
No full textRecent estimates indicate that two billion people are overweight or obese and
hence are at increased risk of cardiovascular disease and its comorbidities.
However, this may be an underestimate of the true extent of the problem, as the
current method used to define overweight may lack sensitivity, particularly in
some ethnic groups where there may be an underestimate of risk. Measures of
central obesity may be more strongly associated with cardiovascular risk, but
there has been no systematic attempt to compare the strength and nature of the
associations between different measures of overweight with cardiovascular risk
across ethnic groups. Data from the Obesity in Asia Collaboration, comprising 21
cross-sectional studies in the Asia-Pacific region with information on more than
263 000 individuals, indicate that measures of central obesity, in particular, waist
circumference (WC), are better discriminators of prevalent diabetes and hypertension
in Asians and Caucasians, and are more strongly associated with prevalent
diabetes (but not hypertension), compared with body mass index (BMI).
For any given level of BMI, WC or waist : hip ratio, the absolute risk of diabetes
or hypertension tended to be higher among Asians compared with Caucasians,
supporting the use of lower anthropometric cut-points to indicate overweight
among Asians
Risk factors for diabetic retinopathy in a South Indian Type 2 diabetic population—the Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4
No full textAims
To determine risk factors for diabetic retinopathy (DR) in an urban South Indian Type 2 diabetic population.
Methods
The Chennai Urban Rural Epidemiology Study is a large cross-sectional study conducted in Chennai, South India.
A total of 1736 Type 2 diabetic subjects were recruited for this study, which included 1382 known diabetic subjects (90.4%
response rate) and 354 randomly selected, newly detected diabetic subjects diagnosed by oral glucose tolerance test. All subjects
underwent four-field stereo retinal colour photography, graded by the Early Treatment Diabetic Retinopathy Study protocol.
Results
Of the 1736 Type 2 diabetic subjects photographed, photographs could be graded in 1715 subjects. Stepwise
ordinal logistic regression analysis revealed that male gender (
P
= 0.041), duration of diabetes (
P
< 0.0001), glycated
haemoglobin (HbA
1c
;
P
< 0.0001), macroalbuminuria (
P
= 0.0002) and insulin therapy (
P
= 0.0001) were significantly
associated with severity of DR. The risk for developing DR was 7.7 times (95% confidence interval 4.71–12.48,
P
< 0.0001) for elevated postprandial plasma glucose levels compared with 4.2 times (95% confidence interval 2.78–
6.34,
P
< 0.0001) for elevated fasting plasma glucose when the fourth quartile values were compared with the first
quartile glucose values.
Conclusions
In South Indian Type 2 diabetic subjects, duration of diabetes, HbA
1c
, male gender, macroalbuminuria and
insulin therapy were independent risk factors for severity of DR. Postprandial hyperglycaemia indicated a higher risk for
DR compared with elevated fasting plasma glucose levels.
Diabet. Med. 25, 536–542 (2008)
Keywords
Chennai Urban Rural Epidemiology Study Eye Study, diabetic retinopathy, postprandial hyperglycaemia, risk
factors, South Indians
Abbreviations
BP, blood pressure; CURES, Chennai Urban Rural Epidemiology Study; DME, diabetic macular oedema;
DR, diabetic retinopathy; ETDRS, Early Treatment Diabetic Retinopathy Study; FPG, fasting plasma glucose; HbA
1c
,
glycated haemoglobin; IFG, impaired fasting glucose; KD, known diabetic subjects; LDL, low-density lipoprotein; NDD,
newly detected diabetic subjects; NPDR, non-proliferative diabetic retinopathy; OGLA, oral glucose-lowering agent;
PPPG, postprandial plasma glucose; PDR, proliferative diabetic retinopathy; WHR, waist–hip rati
Glycaemic index of common foods tested in the UK and India
No full textThe aim of this study was to ascertain whether international glycaemic index (GI) values, predominantly developed using peoples living in Europe,
North America or Australia, are applicable to Asian Indians resident in their own country. Thirty-four Caucasian subjects were recruited in Oxford,
UK and thirteen Asian Indian subjects in Chennai, India. Two types of sweet biscuits and three breakfast cereals were tested for glycaemic
response in each group. Subjects were served equivalent available carbohydrate amounts (50 g) of test foods and a reference food (glucose),
on separate occasions. Capillary blood glucose was measured from finger-prick samples in fasted subjects (25 and 0 min) and at 15, 30, 45,
60, 90 and 120 min after starting to eat. For each test food, the incremental area under the curve (IAUC) and GI values were determined. Although
the glycaemic response to the reference food was higher in Asian Indian subjects compared with UK Caucasian subjects (IAUC 219 mmol/min per
litre v. 157 mmol/min per litre, respectively; P,0·01), there was no significant difference in GI values of the five test foods between the two
groups. This is the first study known to the authors to examine the role of ethnicity on GI when the subjects are resident in their own countries.
The findings from this study have important implications for the use of the GI concept worldwide and support the application of international
values to different ethnic groups. The higher glycaemic response to all foods in Asian Indians may represent another mechanism for increased
diabetes susceptibility among Asian Indians