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Diabetes burden in India shifts to poor, urban areas in developed states
A new estimate of the national prevalence of diabetes and prediabetes in India reveals an epidemiologic transition in disease burden, with the disease disproportionately affecting poorer residents living in economically developed states, according to findings published in The Lancet Diabetes & Endocrinology.
“Our study suggests that cities in the country’s more affluent states have transitioned further along the diabetes epidemic,” Viswanathan Mohan, MD, PhD, DSc, president of the Madras Diabetes Research Foundation in Chennai, India, said in a press release. “As the overall prosperity of individual states and the country as a whole increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of society, a transition that has already been seen in high-income countries.”
Mohan and colleagues analyzed data from 57,117 adults participating in the Indian Council of Medical Research – India Diabetes study, an ongoing cross-sectional, community-based survey to establish the national and state-specific prevalence of diabetes and prediabetes in India (mean age, 41 years; 45% men; mean BMI, 22.1 kg/m²; 16,909 urban; 40,209 rural). States were sampled in a phased manner: phase 1 included Tamil Nadu, Chandigarh, Jharkhand and Maharashtra, sampled between Nov. 17, 2008, and April 16, 2010; phase 2 included Andhra Pradesh, Bihar, Gujarat, Karnataka and Punjab, sampled between Sept. 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur and Meghalaya, with sampling done between Jan. 5, 2012, and July 3, 2015. Participants completed questionnaires and underwent an oral glucose tolerance test and anthropometric measurements.
Among the 15 states studied, overall diabetes prevalence was 7.3%, with the prevalence twice as high in urban vs. rural areas (11.2% vs. 5.2). Men in urban areas had an OR of 1.84 for developing diabetes (95% CI, 1.66-2.04) when compared with men living in rural areas; women in urban areas had an OR of 1.58 for developing diabetes (95% CI, 1.42-1.75) when compared with women living in rural areas. Results persisted after adjusting for age, BMI, systolic blood pressure, socioeconomic status and smoking status.
In rural areas, researchers noted, diabetes was more prevalent among residents in higher socioeconomic categories in both the mainland and northeast states. However, in urban areas, the prevalence of the disease was higher among individuals of low socioeconomic status. The researchers observed that diabetes prevalence appeared to be higher in states with greater per-capita income, although this was not assessed statistically. Chandigarh, which has the highest per-capita income of the 15 studied states ($3,433), had the highest diabetes prevalence, whereas Bihar, the state with the lowest per-capita income ($682), had the lowest diabetes prevalence.
In multiple logistic regression analysis, age, male sex, obesity, hypertension and family history of diabetes were independent risk factors for diabetes in both urban and rural areas, according to researchers. – by Regina Schaffer
Disclosure s : The researchers report no relevant financial disclosures.