Prevalence of glucose intolerance in Asian Indians. Urban-rural difference and significance of upper body adiposity

Beyond the assembly line: An assessment of diabetes risks among Indian male industrial workers

Background

Diabetes mellitus is a chronic non-communicable disease that imposes a significant burden on affected individuals and the community. Considerable attention has been given to industrial accidents and ergonomics, however, lifestyle-related diseases among industrial workers have often been neglected. Therefore, the present study was conducted with the aim to assess the prevalence of obesity/overweight and ascertain the risk of diabetes mellitus among male employees of an industrial unit in South Mumbai.

Methods

The cross-sectional study was conducted among male employees of an industrial unit in South Mumbai. Family history, exercise patterns, anthropometric measurements and physical vital parameters were recorded. Body composition was assessed using bioelectrical impedance analysis (BIA). The Indian Diabetes Risk Score (IDRS) was employed to evaluate the risk of diabetes mellitus.

Results

In total, 3791 industrial workers participated in the study and 44.5% of participants were above 40 years. Mean height, weight, body mass index (BMI), Waist Circumference (WC) and waist to hip ratio (WHR) were 1.67 m, 71.33 kg, 25.99, 90.81 cm and 0.91 respectively. 56.1% individuals had WC more than 90 cm and 79.1% had WHR more than 0.90. 1846 (53%) and 927 (26.6%) participants had moderate and high diabetes risk respectively. The relationship between age, weight, BMI, WC, WHR, body fat mass and fat percentage, and IDRS was statistically significant.

Conclusion

A substantial proportion of industrial workers were identified as overweight and at high risk of diabetes mellitus. Consequently, it becomes imperative to offer health education and implement interventions to encourage regular exercise, adopt an active lifestyle, and promote healthy dietary habits among industrial workers.

Risk of diabetes and expected years in life without diabetes among adults from an urban community in India: findings from a retrospective cohort

BACKGROUND

Diabetes prevalence has increased over the past few decades, and the shift of the burden of diabetes from the older population to the younger population has increased the exposure of longer durations in a morbid state. The study aimed at ascertaining the likelihood of progression to diabetes and to estimate the onset of diabetes within the urban community of Mumbai.

METHODS

This study utilized an observational retrospective non-diabetic cohort comprising 1629 individuals enrolled in a health security scheme. Ten years of data were extracted from electronic medical records, and the life table approach was employed to assess the probability of advancing to diabetes and estimate the expected number of years lived without a diabetes diagnosis.

RESULTS

The study revealed a 42% overall probability of diabetes progression, with age and gender variations. Males (44%) show higher probabilities than females (40%) of developing diabetes. Diabetes likelihood rises with age, peaking in males aged 55-59 and females aged 65-69. Males aged 30-34 exhibit a faster progression (10.6 years to diagnosis) compared to females (12.3 years).

CONCLUSION

The study's outcomes have significant implications for the importance of early diabetes detection. Progression patterns suggest that younger cohorts exhibit a comparatively slower rate of progression compared to older cohorts.

The lifetime risk of developing type II diabetes in an urban community in Mumbai: findings from a ten-year retrospective cohort study

BACKGROUND

Incidence and prevalence do not capture the risk of developing diabetes during a defined period and only limited evidence exists on the lifetime risk of diabetes based on longer and continuous follow-up studies in India. Lacunae in evidence on lifetime risk can be attributed primarily to the absence of comprehensive and reliable information on diabetes incidence, mortality rates and lack of longitudinal studies in India. In light of the scarcity of evidence in India, the objective of this study was to estimate the incidence of diabetes and its lifetime risk in an urban community of Mumbai.

METHODS

The research study utilized data which is extracted from the electronic medical records of beneficiaries covered under the Contributory Health Service Scheme in Mumbai. The dataset included information on 1652 beneficiaries aged 40 years and above who were non-diabetic in 2011-2012, capturing their visit dates to medical center and corresponding laboratory test results over a span ten years from January, 2012- December, 2021. Survival analysis techniques are applied to estimate the incidence of diabetes. Subsequently, the remaining life years from the life table were utilized to estimate the lifetime risk of diabetes for each gender, stratified by age group.

RESULTS

A total of 546 beneficiaries developed diabetes in ten years, yielding an unadjusted incidence rate of 5.3 cases per 1000 person-years (95% CI: 4.9- 5.8 cases/ 1000 person years). The age-adjusted lifetime risk of developing type II diabetes in this urban community is estimated to be 40.3%. Notably, males aged 40 years and above had 41.5% chances of developing diabetes in their lifetime as compared to females with a risk of 39.4%. Moreover, the remaining lifetime risk of diabetes decreased with advancing age, ranging from 26.4% among 40-44 years old to 4.2% among those age 70 years and above.

CONCLUSION

The findings stress the significance of recognizing age specific lifetime risk and implementing early interventions to prevent or delay diabetes onset and to focus on diabetes management programs in India.

Distinct opposing associations of upper and lower body fat depots with metabolic and cardiovascular disease risk markers

BACKGROUND

To examine the associations of total and regional adiposity with metabolic and cardiovascular disease (CVD) risk markers.

METHODS

This cross-sectional study included 1080 (53.8% men, aged 39-44 years) individuals from South India. Anthropometry (height, weight, waist and hip circumference), body composition assessment using dual-energy X-ray absorptiometry (DXA), blood pressure (BP), and plasma glucose, insulin and lipids were measured. Regression analysis was used to examine associations of standardized fat measurements with type 2 diabetes (T2D), insulin resistance (IR), hypertension and hypertriglyceridemia and continuous measurements of BP, glucose, insulin, HOMA-IR and lipids. Contour plots were constructed to visualize the differential effect of upper and lower fat depots.

RESULTS

DXA-measured fat depots were positively associated with metabolic and CVD risk markers. After adjusting for fat mass index, upper body fat remained positively, while lower body fat was negatively associated with risk markers. A one standard deviation (SD) increase in android fat showed higher odds ratios (ORs) for T2D (6.59; 95% CI 3.17, 13.70), IR (4.68; 95% CI 2.31, 9.50), hypertension (2.57; 95% CI 1.56, 4.25) and hypertriglyceridemia (6.39; 95% CI 3.46, 11.90) in men. A 1 SD increase in leg fat showed a protective effect with ORs for T2D (0.42; 95% CI 0.24, 0.74), IR (0.31; 95% CI 0.17, 0.57) and hypertriglyceridemia (0.61; 95% CI 0.38, 0.98). The magnitude of the effect was greater with DXA-measured fat compared with anthropometry.

CONCLUSION

At any level of total body fat, upper and lower body fat depots demonstrate opposite risk associations with metabolic and CVD risk markers in Asian Indians.

Identification of risk factors for targeted diabetic retinopathy screening to urgently decrease the rate of blindness in people with diabetes in India

PURPOSE

There is an exponential rise in the prevalence of diabetes mellitus (DM) in India. Ideally all people with DM should be periodically screening for diabetic retinopathy (DR) but is not practical with current infrastructure. An alternate strategy is to identify high-risk individuals with vision-threatening diabetic retinopathy (VTDR) for priority screening and treatment.

METHODS

We reanalyzed four population-based studies, conducted in South India between 2001 and 2010, and reclassified individuals above 40 years into known and newly diagnosed diabetes. Multiple regression analysis was done to identify risk factors in people with known and new DM.

RESULTS

The prevalence of DR in 44,599 subjects aged ≥40 years was 14.8% (18.4 and 4.7% in known and new DM, respectively), and the prevalence of VTDR was 5.1%. Higher risk factors of VTDR were older age >50 years, diabetes duration >5 years, and systolic blood pressure >140 mm Hg. Targeted screening of people with diabetes using high-risk criteria obtained from this study was able to detect 93.5% of all individuals with VTDR.

CONCLUSION

In a limited resource country like India, a high-risk group-based targeted screening of individuals with DM could be prioritized while continuing the current opportunistic screening till India adopts universal screening of all people with DM.

A Cross-Sectional Study on Ultrasonographic Measurements of Parotid Glands in Type 2 Diabetes Mellitus

Background

Diabetes mellitus is a metabolic disease which is seen increasing globally and is diagnosed and monitored on basis of invasive blood investigations. Salivary glands are affected in diabetes mellitus. The objective of this study was to assess ultrasonographic measurements of parotid glands and correlate with the glycosylated hemoglobin levels in type 2 diabetic mellitus and duration of type 2 diabetic mellitus and treatment regimens.

Materials and Methods

This study was conducted on 50 subjects of type 2 diabetes mellitus and on 50 healthy controls. After HbA_1C analysis of selected individuals, 100 individuals were grouped into group I (above 5.7) and group II (below 5.7). Ultrasonographic measurements (length (L), transverse dimension (TD), depth lateral to the mandible (DLM), and depth dorsal to the mandible (DDM)) of bilateral parotid glands were calculated. Statistical analysis was done using the chi-square test of significance and Spearman correlation coefficients.

Results

On correlation with measurement of right (L, DLM, DDM) and left (TD, DLM, DDM) of parotid glands with duration of type 2 diabetes mellitus, we found a moderate positive relationship, whereas as for right (TD) and left (L), we found a low-positive relationship. Similarly, for right (L, TD, DLM, DDM) and left (TD, DDM) parotid glands with HbA_1C, we found a low-positive relationship, whereas for left parotid gland (L, DLM) with HbA_1C, we found a moderate positive relationship. The mean DLM of right and left parotids in the insulin group was found to be slightly more than that in the combined group which was statistically insignificant.

Conclusion

Ultrasonographic measurements of parotid glands were found to be higher in study subjects as compared to control subjects, and they increased with increased HbA_1C levels; also, there was no difference in treatment regimen. Ultrasonography could be a prospective diagnostic test for detection and monitoring of diabetes mellitus, and still further studies are required for this.

Prevalence and trends of the diabetes epidemic in urban and rural India: A pooled systematic review and meta-analysis of 1.7 million adults

PURPOSE

India has experienced a recent sharp increase in diabetes/pre-diabetes. We conducted a systematic-review and meta-analyses to describe the most recent prevalence and trends of pre-diabetes/diabetes in urban and rural India.

METHODS

MethodsA literature search was conducted in PubMed and Scopus databases for population-based studies describing prevalence of diabetes/pre-diabetes in urban/rural populations. Trends were analysed in rural and urban settings overall, genderwise and statewise.

RESULTS

The study reports data from 1,778,706 adults in India (69-studies), from surveys conducted from 1972-2017. Prevalence of diabetes increased in both rural and urban India from 2.4% and 3.3% in 1972 to 15.0% and 19.0% respectively in year 2015-2019. This was independently observed in both genders. Similar increasing prevalence was observed for pre-diabetes, overall and in both genders. In the latest decade (2010-2019) rural and urban prevalence was highest in states of Goa (17.4%) and Tamil Nadu (24.0%) respectively. Statewise analysis observed a wide disparity in prevalence between the North and the South of India.

CONCLUSION

Pooled estimates show a relatively high burden of diabetes and pre-diabetes in rural and urban India, with narrowed urban-rural gap. Hence, it is important to plan urgent primary and secondary prevention strategies to minimize further increase in areas with high prevalence.

Prevalence of overweight/obesity and its associated factors among a sample of Moroccan type 2 diabetes patients

Background

Obesity constitutes a major risk factor for the development of diabetes, and has been linked with poor glycaemic control among type 2 diabetic patients.

Aims

This study examines the prevalence of overweight/obesity and associated factors in type 2 diabetic patients in the Beni-Mellal Khenifra region in Morocco.

Methods

A questionnaire-based cross-sectional study was conducted in 2017 among 975 diabetes patients attending primary health centres. Demographic and clinical data were collected through face-to-face interviews. Anthropometric measurements, including body weight, height and waist circumference, were taken using standardized techniques and calibrated equipment.

Results

The prevalence of overweight was 40.4%, the general obesity was 28.8% and the abdominal obesity was 73.7%. Using multivariate analysis, we noted that the general obesity was associated with female sex (AOR= 3,004, 95% CI: 1.761–5.104, P<0.001), increased age (AOR=2.192, 95% CI: 1.116–4.307, P<0.023) and good glycaemic control (AOR=1.594, 95% CI: 1.056–2.407, P=0.027), whereas abdominal obesity was associated wih female sex (AOR=2.654, 95% CI: 1.507–4.671, P<0.001) and insulin treatment (AOR=2.927, 95% CI: 1.031–8.757, P=0.048).

Conclusion

Overweight, general obesity and abdominal obesity were high among participants, especially among women. Taken together, these findings urge the implementation of a roadmap for this diabetic subpopulation to have a new lifestyle.

Epidemiology of Ischemic Heart Disease and Diabetes in South Asia: An Overview of the Twin Epidemic

BACKGROUND & OBJECTIVES

Ischemic heart disease (IHD) is one of the most important causes of death and disability in the world and diabetes is an important risk factor. This review was performed to describe the mortality and morbidity burden from this twin epidemic in South Asian countries.

METHODS

Country-level data on the epidemiology of IHD and diabetes were obtained from the Global Burden of Disease (GBD) study. Sub-national data were available only for India. We also retrieved epidemiological studies from published reviews on IHD and diabetes in India. These were supplemented with MEDLINE search.

RESULTS

GBD study and regional epidemiological studies have reported that there are significant regional variations in IHD mortality and disease burden within South Asian countries. IHD burden has increased significantly from 2000 to 2017. Prospective Urban Rural Epidemiology study has reported that diabetes is an important IHD risk factor in the South Asian region. GBD Study and International Diabetes Federation have reported increasing diabetes-related mortality and disease burden in South Asian countries, especially India. There are regional variations in diabetes-related mortality, disease burden, and prevalence in South Asia. At the macrolevel, rapid food and nutrition transition along with increasing physical inactivity is responsible for this twin epidemic.

CONCLUSION

Increasing trends in IHD and diabetes-related mortality and disease burden with regional variations are observed in South Asian countries.

Whole exome sequencing identifies the novel putative gene variants related with type 2 diabetes in Mizo population, northeast India

The contribution of genes towards T2D development varies among different population groups across the world. It has been reported that a number of loci involved in T2D susceptibility are common across certain population groups, but ethnicity specific variants are also observed. The population of Mizoram has an independent ethnic identity and there are no scientific records about the history of the Mizo people; which makes this ethnic group unique and interesting to study. The aim of the study focuses on the identification of the gene variants which may contribute to T2D susceptibility in Mizo-Mongloid ethnic tribe of North east India through whole exome sequencing. The variants like 328G > C (KRT18), 997G > T (CYP4A11), 2368 T > C (SLC4A3), 508G > A (SLC26A5), 1659C > T (KCNS1), 650C > A (ABCD1) 821A > T (YTHDC2), 931G > T (PINX1), 3280C > A (TNRC6A), 48C > A(TACO1), 6035A > T(LAMA1), 805C > A(ACP7) and 806A > G(ACP7) variants were not reported for any disease in the database and were found to be pathogenic in different insilico analysis softwares. The changes in protein stability upon mutation has been predicted where 35.71% increases the stability of the protein, while 64.28% of the variants decrease the stability of the protein. These findings present the population specific variants which might involve in the susceptibility to T2D in Mizo population. Further, in this study some gene variants have contribution as a possible diagnostic or prognostic marker for other diseases as well, which suggests the need for performing association analysis for different disease manifestations in Mizo population in the near future.

Ethnicity and Type 2 diabetes in the UK

Type 2 diabetes is a major UK public health priority. Among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10-12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years. This review focuses on the UK context and Type 2 diabetes in adult populations, exploring the available evidence regarding the complex interplay of biological, lifestyle, social, clinical and healthcare system factors that are known to drive these disparities.

Impact of Early Life or Intrauterine Factors and Socio-Economic Interaction on Diabetes - An Evidence on Thrifty Hypothesis

Diabetes mellitus is one of the most concerning non-communicable diseases worldwide. The prevalence of diabetes increased rapidly by the influence of socioeconomic interactions. The thrifty hypothesis postulates that certain genes that are involved in positive selection promote efficient fat deposition and storage. This is beneficial for the survival of mankind in adverse conditions. However, in this modern society, these genes have become disadvantageous as people are significantly less likely to experience famines and nutrition shortages. The socioeconomic development that has occurred during the 20th century induced abundance of food supplies in almost all regions of the world. This has led to a rapid rise in the prevalence of obesity, and type 2 diabetes as a consequence. Boom of diabetic pandemic in newly developed countries compare with others those who developed gradually can be explain by thrifty hypothesis, as a result of the difference in the exposure to environmental factors and famine by the ancestors leads. The globalization, urbanization, lack of physical activity, intake of high calorie food and migration is major cause of pandemic emergence of diabetes in high as well as middle and low-income countries.

"DIABETIC TAX" - Cost of Care among Persons with Type 2 Diabetes Mellitus in an Urban Underprivileged Area of Bengaluru

Background:

Diabetes mellitus drains a significant percent of the health budget by cost toward direct diabetes care and diabetes-related disabilities.

Objectives:

The aim of the study is to assess the annual costs incurred by patients with type 2 diabetes mellitus.

Methodology:

This cross-sectional study was undertaken among 153 diabetic people in an urban underprivileged area of Bengaluru from January 2013 to January 2014. This was a cost of illness study done from the patient's perspective using a structured interview schedule.

Results:

A diabetic person in an urban underprivileged community in Bengaluru spends 11,489.38 ± 28,341.77 annually for diabetic care. Direct and indirect costs accounted for 95% and 5% of costs. Majority were spent on admission (45.1%), followed by drugs (21.8%), investigations (5.6%), and consultations (4.5%). Nonmedical costs such as food and transport accounted for 18% of the costs. About 50% of them had delayed treatment due to financial constraints. Nearly 25% of patient's income and 10.7% of the family income were spent for diabetic care. Higher education, income, duration of disease, hospital admission, type of treatment, and place of treatment were found to be associated with costs.

Conclusion:

Estimates of cost will help conceptualize strategies to deal with the situation at local, regional, and national level.

Insights on Medical Nutrition Therapy for Type 2 Diabetes Mellitus: An Indian Perspective

It is critical to integrate medical nutrition therapy (MNT) provided by a registered dietician (RD) into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DM in India, based on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60-70%), proteins (~ 20%) and fats (10%) that will be acceptable and beneficial in an Indian T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care. It outlines a step-wise approach to MNT involving a careful interplay of nutrition assessment, diagnosis, individualization and patient counseling. Overall, the success of MNT relies on providing accurate, acceptable and appropriate dietary choices for continued patient adherence. Collaborative efforts from diabetologists, endocrinologists, internists and RDs are required to prioritize and implement MNT in diabetes practice in India.Funding: Signutra Inc.

Prediabetes Risk Evaluation Scoring System [PRESS]: A simplified scoring system for detecting undiagnosed Prediabetes

OBJECTIVE

To develop a simplified scoring system for detecting undiagnosed prediabetes among healthy adult population of Haryana, India.

MATERIAL & METHODS

This cross-sectional study was a household survey which involved 892 healthy adults >18year of age who were subjected to an oral glucose tolerance test. Sensitivity, specificity, positive and negative predictive value and area under the receiver operating characteristic (ROC) curve and the optimal cut off points for identifying undiagnosed prediabetes were calculated.

RESULTS

Out of 892 subjects studied, 459 were males and 433 were females and 160 were found to be prediabetic (17.93%). At an optimal score of >45 the area under the ROC curve is 0.785 with sensitivity, specificity, positive and negative predictive value of 84.37%, 58.47%, 30.75 and 94.48% respectively.

CONCLUSIONS

Prediabetes Risk Evaluation Scoring System (PRESS) a simple and non-invasive screening tool to identify adult individuals having undiagnosed prediabetes.

High prevalence of diabetes, prediabetes and obesity among residents of East Delhi - The Delhi urban diabetes survey (DUDS)

AIM

The burden of diabetes is very high in our country particularly in the urban metros. The present survey was planned to ascertain the current prevalence of diabetes and prediabetes in Delhi since the available prevalence estimates are over a decade old.

METHODS

The present study was conducted in urban area of east Delhi and followed a multistage random sampling design. The prevalence of known diabetes was ascertained based on self reporting and prevalence of newly detected diabetes and prediabetes was based on oral glucose tolerance test (OGTT).

RESULTS

We surveyed 470 households and included 1317 individuals. Prevalence of diabetes was 18.3% (known 10.8% and newly detected 7.5%). Prevalence of prediabetes was 21% as per WHO criteria and 39.5% as per ADA criteria. The ratio of known to unknown diabetes was 1.44:1. Every third household (35.77%) had at least one known case of diabetes. High rates of obesity and central obesity were also observed in the study population.

CONCLUSION

The present study found a strikingly high prevalence of diabetes, prediabetes and obesity in Delhi. This calls for urgent and effective preventive measures to prevent diabetes.

Overview of trends in cardiovascular and diabetes risk factors in Fiji

CONTEXT

Fiji has undergone an epidemiological transition, characterised by declining infectious disease and childhood mortality, that has been offset by rising cardiovascular disease mortality. Other Pacific Island states are in a comparable situation.

OBJECTIVE

With a focus on Fiji, this study reviews and contextualises research performed by the authors and others that examines cardiovascular disease (CVD) and type 2 diabetes (T2DM) and their risk factors in Pacific Island states.

METHODS

This overview covers evidence for the causes and consequences of CVD risk factors and the epidemiological transition and reflects on biological and evolutionary hypotheses. It is based on studies the authors carried out that synthesised disparate population-based CVD risk factor surveys conducted in Fiji over 1980-2012.

RESULTS

Prevalences of obesity, T2DM and hypertension continue to increase in the Fiji population. Tobacco smoking prevalence has decreased, but remains relatively high in men compared to many developed countries. T2DM and hypertension trends, and CVD consequences related to diet, exercise and tobacco smoking, have placed the Fiji population in a variant of the epidemiological transition manifesting as a plateau in life expectancy similar to that of numerous developed countries during the mid-20th century.

CONCLUSION

There is evidence that risk factors and consequent CVD mortality can be reduced in populations. Obesity and T2DM reductions have been observed only in populations surviving in dire circumstances. Interventions to lower the prevalence of CVD and T2DM risk factors in the Fiji population require multi-faceted approaches, with continual monitoring and evaluation for their impact on these risk factors and morbidity and mortality outcomes.

Validation of simplified Indian Diabetes Risk Score for screening undiagnosed diabetes in an urban setting of Haryana

BACKGROUND AND OBJECTIVES

Identification of at risk individuals using simple screening tools like Indian Diabetes Risk Score (IDRS) and appropriate life style interventions could greatly help in preventing or delaying the onset of diabetes and thus reducing the burden of disease.

MATERIAL AND METHOD

450 individuals >20years who consented to participate were selected randomly from three anganwadis of urban area of Rohtak city. Demographic characteristics and anthropometric measurements such as weight, height and waist circumference were taken. BMI was calculated. IDRS developed by Mohan et al. was applied for categorizing the individuals as high risk, moderate risk and low risk. World Health Organization (WHO) criterion of fasting blood glucose ≥126mg/dl was used for diagnosing diabetes.

RESULTS

54% of individuals were categorized as high risk followed by 37.6% as moderate risk as per IDRS risk score. Prevalence of diabetes was more in ≥50years age group (28.6%) as compared to 35-49 years (14.2%) and 20-35 years age group (6.0%). Individuals with no physical activity had significantly high prevalence of diabetes as compared to mild or moderate physical activity (P 0.004). Similarly, males with waist circumference ≥100cm and females with ≥90cm had significantly high prevalence of diabetes (P 0.000 and P 0.005). On multiple logistic regression analysis age, family history of diabetes and BMI were independent predictors of diabetes.

CONCLUSION

Diabetes is a rising epidemic. Early screening and appropriate interventions at the start are needed for control of disease and risk factor modifications.

Delayed follow-up in patients with diabetic retinopathy in South India: Social factors and impact on disease progression

Purpose:

To identify social factors associated with delayed follow-up in South Indian patients with diabetic retinopathy (DR) and to study DR progression during the delayed follow-up period.

Materials and Methods:

In this cross-sectional study, 500 consecutive patients with DR returning after greater than twice the advised follow-up period were identified from a tertiary referral center in South India. A previously validated 19-item questionnaire was administered to study patients to assess causes for the follow-up delay. Patient demographics, DR status, and treatment plan were recorded at the study visit and the visit immediately before the delay. The eye with the most severe disease was included in the analysis.

Results:

Complete data were available for 491 (98.2%) patients. Among these, 248 (50.5%) cited “my eyes were okay at the time,” 201 (41.0%) cited “no attender to accompany me,” and 190 (38.6%) cited “financial cost” as causes of the follow-up delay. Those with vision-threatening DR (VTDR, n = 233) predominantly reported “financial cost” (47% vs. 32%, P = 0.001), whereas those with non-VTDR more frequently reported “my eyes were okay at the time” (58% vs. 42%, P = 0.001). Evidence of disease progression from non-VTDR to VTDR was seen in 67 (26%) patients. Almost 1/3^rd (29%) of patients who were previously advised regular examination required additional intervention.

Conclusion:

Many patient-level factors affect poor compliance with follow-up in DR, and these factors vary by disease severity. Targeting these barriers to care through patient education and clinic procedures may promote timely follow-up and better outcomes in these patients.

Prevalence of glaucoma in Eastern India: The Hooghly River Glaucoma Study

Context:

Glaucoma is the leading cause of global irreversible blindness. No recent study with adequate sample size has been carried out to estimate glaucoma prevalence in Eastern India.

Aims:

The aim of this study was to assess and compare the prevalence and types of glaucoma in a rural and urban East Indian population.

Settings and Design:

The Hooghly River Glaucoma Study (HRGS) is a population-based cross-sectional study from West Bengal. A tertiary hospital in Kolkata was our urban study center. Our rural study area included 28 contiguous villages from the district of Hooghly surrounding the rural base hospital located at Dhobapara in village Bakulia. Individuals aged 40 years and above were included in this study.

Subjects and Methods:

All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. Glaucoma was defined using modified International Society of Geographical and Epidemiological Ophthalmology criteria.

Statistical Analysis Used:

Analysis was performed using Chi-square test and multiple logistic regression using SPSS.

Results:

Totally, 14,092 individuals participated; 2.7% were detected to have glaucoma in rural arm and 3.23% in urban arm (P < 0.001). In urban population, 2.10% had primary open angle glaucoma (POAG), 0.97% had primary angle closure glaucoma (PACG), and 0.15% had secondary glaucoma. In rural population, 1.45% had POAG, 1.15% had ACG, and 0.10% had secondary glaucoma.

Conclusions:

HRGS is the largest population-based glaucoma study in India to date with glaucoma prevalence comparable to other landmark Indian studies. POAG was the most common form of glaucoma in our study population as well. PACG was more common in this region than previously thought.

Cardiometabolic disease in South Asians: A global health concern in an expanding population

Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.

Genetic components in diabetic retinopathy

Diabetic retinopathy (DR) is a serious complication of diabetes, which is fast reaching epidemic proportions worldwide. While tight glycemic control remains the standard of care for preventing the progression of DR, better insights into DR etiology require understanding its genetic basis, which in turn may assist in the design of novel treatments. During the last decade, genomic medicine is increasingly being applied to common multifactorial diseases such as diabetes and age-related macular degeneration. The contribution of genetics to the initiation and progression of DR has been recognized for some time, but the involvement of specific genes and genetic variants remains elusive. Several investigations are currently underway for identifying DR susceptibility loci through linkage studies, candidate gene approaches, and genome-wide association studies. Advent of next generation sequencing and high throughput genomic technologies, development of novel bioinformatics tools and collaborations among research teams should facilitate such investigations. Here, we review the current state of genetic studies in DR and discuss reported findings in the context of biochemical, cell biological and therapeutic advances. We propose the development of a consortium in India for genetic studies with large cohorts of patients and controls from limited geographical areas to stratify the impact of the environment. Uniform guidelines should be established for clinical phenotyping and data collection. These studies would permit identification of genetic loci for DR susceptibility in the Indian population and should be valuable for better diagnosis and prognosis, and for clinical management of this blinding disease.

Temporal trends in the prevalence of diabetes mellitus in a rural community in Sri Lanka

In developing countries the prevalence of diabetes mellitus is reported to be lower in rural areas compared to urban areas. This difference has been attributed to lifestyle factors associated with the higher socio-economic status of those living in urban areas. However, recent clinical observations indicate that the prevalence of diabetes is on the increase even in the rural sector. The aims of the present study were to objectively assess whether the prevalence of diabetes has increased in a named rural community in Sri Lanka during a period of ten years and whether there has been a change in the socio-economic status of the community during this period. The study was conducted on a sample of 220 subjects randomly selected from an adult population of 25,605 residents in a rural area in central Sri Lanka. Each of these subjects had the fasting blood sugar estimated and the height, weight, resting blood pressure and socio-economic parameters, such as the level of education, occupation and monthly income, recorded. These data were compared with those of a similar study conducted by the main author in the same community ten years ago.

The results revealed that the age-standardised prevalence of diabetes had increased from 2.5% in 1990 to 8.5% in 2000 (p=0.008) and that this was accompanied by an increase in the monthly income, level of education and body mass indices. Since nearly 70% of all Sri Lankans live in villages, continuation of the present trend would result in a dramatic increase in the number of patients with diabetes in the future. Suitable strategies should be implemented to arrest this trend and manage a large number of patients with diabetes in the future.

Review: Type 2 diabetes in India: regional disparities

Type 2 diabetes mellitus epidemic in India is a result of societal influences and changing lifestyles. Diabetes has been known in India for centuries as a disease of the affluent class. Epidemiological studies in the 1960's and 1970's using random and post-load blood glucose estimations reported diabetes prevalence varying from 1—4% in urban populations and 1—2% in rural populations. More standardised epidemiological studies since the 1990's reported prevalence rates that vary from 5—15% among urban populations, 4—6% in semi-urban populations and 2—5% in rural populations with large location-based disparities within urban and rural populations. There is a significantly increasing trend in urban populations (exponential trend R2=0.744) while among rural populations the prevalence is increasing at a slower rate (R2=0.289). At the turn of this century diabetes in adult urban Indian populations varies from a low of 5.4% in a northern state to a high of 12.3—15.5% in Chennai, South India, and 12.3—16.8% in Jaipur, Central India. This scenario is similar to other South Asian countries and evolving populations in East Asia, Middle-East, Americas, Australasia and Pacific Islands. Gene-environment interactions appear to be responsible for this rapid increase. The insulin-resistant state that was meant to be protective mechanism for regulation of calorie and fat metabolism at times of famine has turned deleterious as affluence has increased among these populations leading to diabetes epidemic. Population based measures to prevent the control of a diabetes epidemic include avoidance of adiposity by enhanced physical activity and regulated calorie intake.

Prevalence of generalized & abdominal obesity in urban & rural India--the ICMR-INDIAB Study (Phase-I) [ICMR- NDIAB-3]

BACKGROUND & OBJECTIVES

Overweight and obesity are rapidly increasing in countries like India. This study was aimed at determining the prevalence of generalized, abdominal and combined obesity in urban and rural India.

METHODS

Phase I of the ICMR-INDIAB study was conducted in a representative population of three States [Tamil Nadu (TN), Maharashtra (MH) and Jharkhand (JH)] and one Union Territory (UT)[Chandigarh (CH)] of India. A stratified multi-stage sampling design was adopted and individuals ≥ 20 yr of age were included. WHO Asia Pacific guidelines were used to define overweight [body mass index (BMI) ≥ 23 kg/m [2] but < 25 kg/m [2]], generalized obesity (GO, BMI ≥ 25 kg/m [2], abdominal obesity (AO, waist circumference ≥ 90 cm for men and ≥ 80 cm for women) and combined obesity (CO, GO plus AO). Of the 14,277 participants, 13,800 subjects (response rate, 96.7%) were included for the analysis (urban: n = 4,063; rural: n = 9737).

RESULTS

The prevalence of GO was 24.6, 16.6, 11.8 and 31.3 per cent among residents of TN, MH, JH and CH, while the prevalence of AO was 26.6, 18.7, 16.9 and 36.1 per cent, respectively. CO was present in 19.3, 13.0, 9.8 and 26.6 per cent of the TN, MH, JH and CH population. The prevalence of GO, AO and CO were significantly higher among urban residents compared to rural residents in all the four regions studied. The prevalence of overweight was 15.2, 11.3, 7.8 and 15.9 per cent among residents of TN, MH, JH and CH, respectively. Multiple logistic regression analysis showed that female gender, hypertension, diabetes, higher socio-economic status, physical inactivity and urban residence were significantly associated with GO, AO and CO in all the four regions studied. Age was significantly associated with AO and CO, but not with GO.

INTERPRETATION & CONCLUSIONS

Prevalence of AO as well as of GO were high in India. Extrapolated to the whole country, 135, 153 and 107 million individuals will have GO, AO and CO, respectively. However, these figures have been estimated from three States and one UT of India and the results may be viewed in this light.

Impact of classical risk factors of type 2 diabetes among Asian Indian, Chinese and Japanese populations

AIMS

This review investigated the population impact of major modifiable type 2 diabetes (T2D) risk factors, with special focus on native Asian Indians, to estimate population attributable risks (PARs) and compare them with estimates from Chinese and Japanese populations.

METHODS

Information was obtained on risk factors in 21,041 Asian Indian, 17,774 Chinese and 17,986 Japanese populations from multiple, large, cross-sectional studies (the DECODA project) of T2D. Crude and adjusted PARs were estimated for the major T2D risk factors.

RESULTS

Age had the highest crude and adjusted PARs among Asian Indians and Chinese in contrast to waist-hip ratio among Japanese. After adjusting for age, the PAR for body mass index (BMI) in Asian Indians (41.4% [95% CI: 37.2%; 45.4%]) was second only to triglycerides (46.4% [95% CI: 39.5%; 52.8%]) compared with 35.8% [95% CI: 29.9%; 41.4%] in Japanese and 38.4% [95% CI: 33.5%; 43.2%] in Chinese people. The PAR for BMI adjusted for age, LDL and triglycerides (39.7% [95% CI: 31.6%; 47.2%]) was higher than for any other factor in Asian Indians, and was much higher than in the Chinese (16.8% [95% CI: 3.0%; 30.9%]) and Japanese (30.4% [95% CI: 17.5%; 42.2%]) populations.

CONCLUSION

This review provides estimates of the association between major risk factors and prevalences of T2D among Asian populations by examining their PARs from large population-based samples. From a public-health point of view, the importance of BMI in Asian Indians is especially highlighted in comparison to the other Asian populations. Given these results and other recent findings on the causality link between BMI and T2D, it can be postulated that obesity may be involved in the aetiology of T2D through interaction with ethnic-specific genetic factors, although ethnicity itself is not a direct risk factor for T2D as people of all ethnic backgrounds develop diabetes.

Prevalence of diabetes and pre-diabetes and assessments of their risk factors in urban slums of Bangalore

BACKGROUND

To determine the prevalence of diabetes and pre-diabetes and to assess the risk factors associated with diabetes and pre-diabetes in the urban slums of Bangalore.

MATERIALS AND METHODS

A cross-sectional study was conducted in four slums of Bangalore in the age group of 35 years and above comprising of total 2013 subjects. Risk factors like age, sex, family history, behavior, physical activity, BMI, waist hip ration, diet habits were assessed to find their association with diabetes.

RESULTS

Prevalence of diabetes was 12.33% and of pre-diabetes was 11.57%. Prevalence was more among the females compared to males. Increasing age, over weight and obesity, sedentary life style, tobacco consumption, diet habits showed statistically significant association with prevalence of diabetes and pre-diabetes.

CONCLUSION

Physical activity like regular exercises both at the office and at home, fibers-rich diet, blood sugar estimation after 35 years are some of the recommendations which can control diabetes.

The health system and population health implications of large-scale diabetes screening in India: a microsimulation model of alternative approaches

BACKGROUND

Like a growing number of rapidly developing countries, India has begun to develop a system for large-scale community-based screening for diabetes. We sought to identify the implications of using alternative screening instruments to detect people with undiagnosed type 2 diabetes among diverse populations across India.

METHODS AND FINDINGS

We developed and validated a microsimulation model that incorporated data from 58 studies from across the country into a nationally representative sample of Indians aged 25-65 y old. We estimated the diagnostic and health system implications of three major survey-based screening instruments and random glucometer-based screening. Of the 567 million Indians eligible for screening, depending on which of four screening approaches is utilized, between 158 and 306 million would be expected to screen as "high risk" for type 2 diabetes, and be referred for confirmatory testing. Between 26 million and 37 million of these people would be expected to meet international diagnostic criteria for diabetes, but between 126 million and 273 million would be "false positives." The ratio of false positives to true positives varied from 3.9 (when using random glucose screening) to 8.2 (when using a survey-based screening instrument) in our model. The cost per case found would be expected to be from US$5.28 (when using random glucose screening) to US$17.06 (when using a survey-based screening instrument), presenting a total cost of between US$169 and US$567 million. The major limitation of our analysis is its dependence on published cohort studies that are unlikely fully to capture the poorest and most rural areas of the country. Because these areas are thought to have the lowest diabetes prevalence, this may result in overestimation of the efficacy and health benefits of screening.

CONCLUSIONS

Large-scale community-based screening is anticipated to produce a large number of false-positive results, particularly if using currently available survey-based screening instruments. Resource allocators should consider the health system burden of screening and confirmatory testing when instituting large-scale community-based screening for diabetes.

Relationship of serum bisphenol A with diabetes in the Thai population, National Health Examination Survey IV, 2009

BACKGROUND

Epidemiological studies of the association between bisphenol A (BPA) exposure and diabetes have been inconsistent. The present study determined serum BPA concentrations in the Thai population and their association with hyperglycemia and diabetes.

METHODS

In all, 2581 serum samples from the Thai National Health Examination Survey (2009) were used to determine BPA levels. Impaired fasting glucose (IFG) was defined as fasting plasma glucose ≥100 and <126 mg/dL. Diabetes was defined as a history of a physician's diagnosis or fasting plasma glucose ≥126 mg/dL. Multinomial logistic regression was used to examine the association of serum BPA with IFG and diabetes.

RESULTS

Of 2581 samples tested, BPA was detected in 2135 samples (weighted percentage 78.1%), with a geometric mean concentration of 0.34 ng/mL BPA. Serum BPA levels were significantly higher among those with diabetes or IFG compared with normoglycemic individuals (0.52 and 0.38 vs 0.33 ng/mL, respectively; P < 0.001). After adjusting for potential confounders, compared with the first quartile (≤0.071 ng/mL), the overall adjusted odds ratios (OR) of serum BPA concentration in the third and fourth quartiles (0.319-0.745 and ≥0.746 ng/mL, respectively) for IFG were 1.72 (95% confidence interval [CI] 1.19, 2.49) and 1.23 (95% CI 0.80, 1.89), respectively; for diabetes, the adjusted OR were 1.88 (95% CI 1.18, 2.99) and 1.83 (95% CI 1.12, 2.95), respectively, with a slightly stronger association among men than in women.

CONCLUSIONS

Serum BPA concentrations were not associated with IFG, but were positively associated with diabetes in the Thai population. Further prospective studies are needed to confirm the relationship.

Urbanization and prevalence of type 2 diabetes in Southern Asia: A systematic analysis

BACKGROUND

Diabetes mellitus is one of the diseases considered to be the main constituents of the global non-communicable disease (NCD) pandemic. Despite the large impact that NCDs are predicted to have, particularly in developing countries, estimates of disease burden are sparse and inconsistent. This systematic review transparently estimates prevalence of type 2 diabetes mellitus in Southern Asia, its association with urbanization and provides insight into the policy challenges facing the region.

METHODS

The databases Medline and PubMed were searched for population-based studies providing estimates of diabetes prevalence in the Southern Asia region. Studies using WHO diagnostic criteria of fasting plasma glucose (FPG) ≥7.0mmol/L and/or 2h-plasma glucose (2hPG) ≥11.1mmol/L were included. Data from eligible studies was extracted into bubble graphs, and trend lines were applied to UNPD figures to estimate age-specific prevalence in the regional population. Estimates specific to sex, area of residency, and diagnostic method were compared and trends analysed.

RESULTS

A total of 151 age-specific prevalence estimates were extracted from 39 studies. Diabetes prevalence was estimated to be 7.47% for 2005 and 7.60% for 2010. Prevalence was strongly associated with increased age, male gender and urban residency (P < 0.001).

CONCLUSION

Diabetes prevalence in Southern Asia is high and predicted to increase in the future as life expectancy rises and the region continues to urbanise. Countries in this region need to improve NCD surveillance and monitoring so policies can be informed with the best evidence. Programs for prevention need to be put in place, and health system capacity and access needs to be assessed and increased to deal with the predicted rise in NCD prevalence.

Justification of anthropometric empirical indicator (AEI) by digital chest and pelvic X-rays: a comparative scenario with DXA on obesity grounds

BACKGROUND

Obesity is an abnormal accumulation of body fat directly proportional to reduced life expectancy. Treatment of this ailment should be preceded by proper and accurate assessment of the degree of obesity.

OBJECTIVES

The main objective is the justification of anthropometric empirical indicator (AEI) by the utilization of chest and pelvic radiographs, so that precise measurement of obesity on economical grounds can be manifested. Also, the subsequent objective is to establish a comparative scenario between dual energy X-ray absorptiometry (DXA) and novel, portable, bioelectric impedance analysis (BIA)-based body composition analyzer, MI-105 (Meditech International Inc. India).

MATERIALS AND METHODS

The cross-sectional design was adopted in the present study, in which 20 female participants from urban south India were involved. The measurements of body composition, anthropometry and chest (covering the region from neck to abdomen) as well as hip radiography of the studied population were acquired.

RESULTS

The higher significant difference of ≤0.001 was evidenced in all female studied population in the main body composition parameters measured by DXA and low-cost BIA. The same framework of significance is applicable to AEI, AEI (image morphed) and AEI (image automatic).

CONCLUSION

The novel-derived parameters: AEI (image morphed) and AEI (image automatic) can precisely gauge obesity and can be the effective alternatives for high-cost DXA. In addition, low-cost BIA-based body composition analyzer can also be the better substitute for DXA.

Prevalence of Diabetes Mellitus and Its Risk Factors among Permanently Settled Tribal Individuals in Tribal and Urban Areas in Northern State of Sub-Himalayan Region of India

Background. Effect of urban environment on the development of DM and its risk factors is studied with an ecological fallacy due to their study designs that formulate the background for the present study. Objective. To study the prevalence of DM and associated lifestyle related risk factors in traditional tribal individuals residing in tribal area and migrating persons of the same tribe to urban area of sub-Himalayan northern state of India. Methodology. Population based cross-sectional study. Results. A total of 8000 individuals (tribal: 4000; urban: 4000) were recruited. Overall, among urban tribes the prevalence of central obesity (59.0%), overweight (29.3%), stage 1 (22.8%) and stage 2 (5.3%) hypertension, and DM (fasting: 7.8%; OGTT: 8.5%) (P = 0.00) was significantly higher than the tribes of tribal area. Based on OGTT, the prevalence of DM was found to be 9.2% among central obese tribes of urban area and 6.7% of tribal area (P = 0.00). DM showed a significant high prevalence among urban tribes with prehypertension (urban: 8.3%; tribal: 2.9%; P = 0.00), and stage 1 (urban: 14.1%; tribal: 8.7%; P = 0.00) and stage 2 (urban: 17.5%; tribal: 13.9%; P = 0.59) hypertension. Conclusion. Urban environment showed a changing lifestyle and high prevalence of DM among tribal migrating urban tribes as compared to traditional tribes.

Key role of dietary fats in coronary heart disease under progressive urbanization and nutritional transitionh

The increased vulnerability to non-communicable diseases (NCD) of developing populations experiencing a demographic and epidemiological transitions to increased risk of NCD at a time when the battle against infectious diseases, is ongoing. Apart from population growth, the major attributes of developmental transition are confined to changes in occupational pattern in family structure, lifestyle, dietary practices and progressive ageing of population. The emergence of the NCD is significantly associated with changes in dietary pattern, in most of the countries. Coronary heart disease (CHD) is the leading cause of death in developed countries and the incidence is increasing in developing countries, including India. The disease needs awareness of the risk factors responsible for prevention. The purpose of this review is to present an overview of the role of dietary fats in growth and development and in health and disease. Although the causation of CHD is multifaceted and the risk factors associated in general are several, there are specific and important elements, such as dietary fats and lifestyle. Dietary fats are an important component as they serve a number of functions in the body. The minimum desirable and upper limits of fat intake have been given, based on recommendations of expert groups. Sources of different fats are made available worldwide and the production, consumption, storage, oxidation and nomenclature are being discussed in the light of health and disease. The relative essentiality of the omega-6 and omega-3 fatty acids is recognized in terms of pharmacologically active eicosanoid metabolism. Nevertheless, epidemiological, physiological and clinical studies have demonstrated that long-chain omega-3 fatty acids present in fish oils have quite diverse health benefits. Appropriate guidelines need to be recommended at a national level consistent with dietary habits. The ratios of balanced fatty acids, namely omega-11, omega-9, omega-6 and omega-3, should be worked out appropriately in ameliorating nutrition-related disease states. Any simple dietary modification that can lead to a substantial reduction in morbidity and mortality from CHD would be of great medical, social and economic benefit.

Comparison of relative waist circumference between Asian Indian and US adults

BACKGROUND

Relative to Europeans, Asian Indians have higher rates of type 2 diabetes and cardiovascular disease. Whether differences in body composition may underlie these population differences remains unclear.

METHODS

We compared directly measured anthropometric data from the Chennai Urban Rural Epidemiology Study (CURES) survey of southern Indians (I) with those from three US ethnic groups (C: Caucasians, A: African Americans, and M: Mexican Americans) from NHANES III (Third National Health and Nutrition Examination Survey). A total of 15,733 subjects from CURES and 5,975 from NHANES III met inclusion criteria (age 20-39, no known diabetes).

RESULTS

Asian Indian men and women had substantially lower body mass index, waist circumference, hip circumference, waist-to-hip ratio, and body surface area relative to US groups (P values <0.0001). In contrast, the mean (±se) waist-weight ratio was significantly higher (P < 0.001) in I (men 1.35 ± 0.002 and women 1.45 ± 0.002) than in all the US groups (1.09, 1.21, and 1.14 in A, M, and C men; 1.23, 1.33, and 1.26 in A, M, and C women (se ranged from 0.005 to 0.006)).

CONCLUSIONS

Compared to the US, the waist-weight ratio is significantly higher in men and women from Chennai, India. These results support the hypothesis that Southeast Asian Indians are particularly predisposed toward central adiposity.

Prevalence of diabetes and hypertension and association with various risk factors among different Muslim populations of Manipur, India

BACKGROUND

Type 2 Diabetes mellitus (DM) and hypertension (HT) are among the most common non-communicable chronic diseases in developed and developing countries around the world. The study reports the prevalence of DM and HT and its influence from its possible risk factors.

METHODS

Individuals of both sexes (Male-1099, Female-669) belonging to six different populations were randomly selected and screened for diabetes and hypertension following from different districts of Manipur, which is a small hilly state, situated in the north eastern extreme corner of India sharing an international boundary with Myanmar (Burma). "Diabetes mellitus" and "hypertension" were defined by the American Diabetes Association and the Joint National Committee's 7th Report guidelines, respectively.

RESULTS

The overall prevalence of diabetes and hypertension in the entire study population was found to be 16.63% and 18.16% respectively. About 13.8% individuals had shown co-prevalence of Diabetes Mellitus and Hypertension. The association of Diabetes Mellitus with different risk factors such as consumption of alcohol and difference in physical activities were found to be statistically significant. The association of Diabetes Mellitus with different populations and age groups are also statistically significant. The association between Hypertension with different populations and different physical activities were also found to be statistically significant.

Current state of care for diabetic retinopathy in India

In this article we review the current state of care of diabetic retinopathy in India. We discuss the magnitude of the problem; diabetes, and diabetic retinopathy in India. We highlight the causes of vision loss in diabetic retinopathy. The current level of awareness among general population and physicians is a concern. Current screening strategies practiced in India and the situational analysis of ophthalmologists in India are also reviewed. We review the current management of diabetic macular edema and proliferative diabetic retinopathy. To know the current practice pattern among retinal surgeons in India, a survey was done and the results of the survey are presented. There are few studies in the Indian population which have found some genetic risk and protective factors and a summary of these studies are also presented in this article.

Anthropometry: a new approach to identify communal body fat status in an urban south Indian population

BACKGROUND AND OBJECTIVES

Deep penetration of obesity into geographical and ethnic communities based on profession is being highly evidenced by researchers. Impact of this penetration in the Indian urban population is addressed by the accepted factors of professional and cultural changes. High risk of Atherosclerosis, hyperinsulinaemia, impaired glucose tolerance; prothrombotic is not addressed by the relationship between BMI vs. body fat, while body fat plays major role in all risks. The present study attempts to prove an anthropometrical empirical formula which can be an indicator of body fat in a group, based on profession or life style.

METHODS

A total number of 159 (77 males of age 36.95 ± 14.795, 82 females of age 38.07 ± 13.16) subjects participated in the study. Body composition analysis and anthropometric measurements were performed after conducting careful clinical examination. Body fat was measured using body composition analyzer and used as a reference to justify indication of anthropometrical empirical indicator (AEI). Indicative accuracy of AEI was cross verified by male and female analysis individually.

RESULTS

Community specific mean body fat 23.15 ± 8.47 (kg) for the mean weight of 66.05 ± 13.46 (kg) indicated prevalence of excess 35% body fat. This much of body fat has not been addressed by mean BMI 25.56 ± 4.66 (kg/m(2)).

CONCLUSIONS AND INTERPRETATION

Statistical relation between AEI and body fat reflects original information of risk (where as BMI does not) in the selected community. AEI outperforms the identification of obesity affected profession or life style based communities over BMI analysis.

Increasing prevalence of type 2 diabetes in a rural bangladeshi population: a population based study for 10 years

BACKGROUND

To observe changes in the prevalence of type 2 diabetes mellitus (DM) and impaired fasting glucose (IFG) and its associated risk factors in a rural Bangladeshi population over a 10-year period.

METHODS

Three cross-sectional studies were undertaken in a rural community (aged ≥20 years) in 1999, 2004, and 2009. Structured questionnaires including sociodemographic parameters, anthropometric measurements, blood pressure, and blood glucose values were recorded. DM and IFG were diagnosed using 1999 World Health Organization criteria.

RESULTS

Age standardized prevalence of DM increased significantly (P<0.001) from 1999 to 2009 (2.3%, 6.8%, and 7.9% in 1999, 2004, and 2009, respectively). The prevalence of IFG increased significantly (P=0.011) from 4.6% to 5.8% between 1999 and 2004 but then decreased from 5.8% to 5.3% during 2004 to 2009. Significant linear trends were shown in both sexes for general and central obesity as indicated by body mass index, waist circumference, and waist hip ratio (WHR). Increasing age and systolic blood pressure were significant risk factors for DM in all three studies. WHR for males was also significantly associated with the risk of DM in all three studies. WHR for females was only significantly associated with DM in 2009.

CONCLUSION

A significant rise in the prevalence of DM was observed in this population over 10 years. This increase was seen in both sexes, and in all age groups. A significant increase in the prevalence of the associated risk factors of general and central obesity was observed in both sexes.

The association between vitamin D status and type 2 diabetes in a Thai population, a cross-sectional study

OBJECTIVE

To explore vitamin D status in relation to diabetes, based on data from a national health examination survey in Thailand.

DESIGN AND METHODS

A total of 2641 adults, aged 15-98 years, were randomly selected according to geographical region from the Thai 4th National Health Examination Survey sample. Logistic regressions were used to examine the cross-sectional association between diabetes status and level of 25(OH)D separately by age groups and areas of residence.

RESULTS

Fifty per cent of the subjects were men and 5·8% had diabetes. The mean level of 25(OH)D was 79·3 ± 0·8 nm. Based on cut-off values of 50 and 75 nm, six per cent and 45% had vitamin D insufficiency, respectively. In a regression model, it was found that 25(OH)D3 and total 25(OH)D were positively associated with diabetes. In addition, logistic regression analysis showed that low circulating 25(OH)D3, but not 25(OH)D2, levels was significantly associated with an increased odds of diabetes in older persons (aged ≥70 years) in urban areas. However, for subjects residing in rural areas, no association between serum 25(OH)D3 or total 25(OH)D and diabetes was found. Furthermore, vitamin D insufficiency was associated with a higher risk of diabetes (OR, 1·56; 95% CI, 1·10-1·12) only in the urban elderly.

CONCLUSION

Low vitamin D status is modestly associated with a small increase in the risk of diabetes in the urban Thai elderly. The observation that higher vitamin D status is associated with increased diabetic risk in young adults needs to be further explored and confirmed.

Prevalence and determinants of diabetes mellitus in Puducherry, South India

Background:

Diabetes mellitus is an emerging global health problem. It is a chronic, noncommunicable, and expensive public health disease.

Aims and Objectives:

To determine the prevalence and the risk factors of type 2 diabetes mellitus among the adult population of Puducherry, South India.

Materials and Methods:

This was a population-based cross-sectional study carried out during 1^st May 2007–30^th November 2007 in the rural and urban field practice area of Mahatma Gandhi Medical College and Research Institute, Puducherry. Simple random sampling technique was used for the selection of 1370 adult 20 years of age and above. Main outcome measures were the assessment of the prevalence of prevalence and correlates of diabetes among the adult population. Predesigned and pretested questionnaire was used to elicit the information on family and individual sociodemographic variables. Height, weight, waist, and hip circumference, blood pressure was measured and venous blood was also collected to measure fasting blood glucose, blood cholesterol.

Results:

Overall, 8.47% study subjects were diagnosed as diabetic. The univariate analysis and multivariate logistic regression analysis showed that the important correlates of diabetes mellitus were age, blood cholesterol, and family history of diabetes. The findings were found to be statistically significant.

Conclusions:

In our study we observed that adults having increased age, hypercholesterolemia, and family history of diabetes mellitus are more likely to develop diabetes mellitus.

Increased prevalence of metabolic syndrome in non-obese asian Indian-an urban-rural comparison

BACKGROUND

In the present study we evaluated the association of insulin resistance (IR) with different components of Metabolic Syndrome (MS) in an Asian Indian population, and performed a comparative study between urban and rural populations of India.

METHODS

A Total of 267 urban men and women aged 25-70 years participated in this study. RESULTS were compared with rural data from a previously published study. Fasting serum insulin, uric acid, and lipid profile were measured along with fasting and 2 hour plasma glucose. Association of MS and IR was studied by using univariate regression analysis.

RESULTS

Prevalence of MS was significantly higher in the urban population compared to that of the rural population (35.2% vs 20.6%, chi(2) = 23.2, p < 0.001). Calculated insulin resistence (HOMA-IR) was common in MS group of both populations. Percentage prevalence of IR was high and almost the same in both population (42%). Percentage prevalence of abdominal obesity and hypertriglyceridemia was significantly higher in the urban population compared to the rural population. Linear regression analysis of IR significantly correlated with different components of MS of both the population.

CONCLUSIONS

The significant finding of the present study was that the rural population exhibited a high prevalence of MS and IR, though nonobese. IR correlated with components of MS not only in the urban but also in the rural population. To reduce the incidence of Type 2 Diabetes (T2DM) and cardiovascular disease (CVD) in our populations, early identification of populations at risk based on prevalence of MS and IR will become of prime importance.