Rural prevalence of type 2 diabetes mellitus: A cross sectional study

Abstract

Background: Recent studies in India indicate rising trends of diabetes even in rural areas. Continuous monitoring of the diabetes situation is required by repeated cross sectional studies in different parts of the country both urban rural to plan control measures. Aim: To estimate the prevalence of Type 2 diabetes in a sample of rural population and explore associations between diabetes and known risk factors. Materials and Methods: A cross sectional study was carried out in 3 villages in the rural field practice area of a medical college in Pune, India. All eligible adults of both genders were included and screened for diabetes by house to house survey. A total of 1000 subjects were examined. Physical examination included measuring height, weight, and waist hip ratio. Blood glucose was estimated using glucometer. Family history of diabetes was also elicited. Data was analysed by descriptive statistics using proportions with 95% confidence intervals. Various associations were explored using using Odds Ratio with 95% confidence intervals as applicable. Results: The prevalence of diabetes mellitus was 9.1% (91/1000; 95% CI 7.4, 11). Most cases of newly detected diabetics were in the age group 36 - 40 years. There was no association between gender and diabetes (OR = 1.38, 95% CI 0.88, 2.17). Overweight status was associated with diabetes: 38.5% (35/91) of diabetics were overweight compared to 18.6% (169/909) of non-diabetics (OR = 2.74, 95% CI 1.69, 4.41). Similarly abnormal waist hip ratio was associated with diabetes: 47.25% (43/91) of diabetics had high waist hip ratio compared with 29.59% (269/909) of non-diabetics (OR = 2.13, 95% CI 1.35, 3.37). Also family history was strongly associated with diabetes: 27.5% (25/91) of diabetics gave positive family history compared with 9.4% (85/909) of non-diabetics (OR = 3.67, 95% CI = 2.13, 6.30). Conclusion: The burden of diabetes was present in the rural population studied. The associated known risk factors were also prevalent and showed strong relationship with diabetes. Diabetes mellitus erstwhile thought to be a disease of urban life appears to be equally prevalent in the rural setting.

India - Type 2 diabetes - risk factors - rural population

• References

• 1 Ramachandran A, Snehalatha C, Dharmaraj D, Viswanathan M. Prevalence of glucose intolerance in Asian Indians. Urban-rural difference and significance of upper body adiposity. Diabetes Care 1992; 15: 1348-1355
• 2 Patandin S, Bots ML, Abel R, Valkenburg HA. Impaired glucose tolerance and diabetes mellitus in a rural population in south India. Diabetes Res ClinPract 1994; 24: 47-53
• 3 Shah SK, Saikia M, Barman NN, Snehalatha C, Ramachandran A. High prevalence of type 2 diabetes in urban population in north-eastern India. Int J DiabetesDevCtries 1998; 18: 97-101
• 4 Raman KuttyV, Joseph A, Soman CR. High prevalence of type 2 diabetes in an urban settlement in Kerala, India. Ethn Health 1999; 4: 231-239
• 5 Zargar AH, Khan AK, Masoodi SR, Laway BA, Wani AI, Bashir MI. et al. Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent. Diabetes Res ClinPract 2000; 47: 135-136
• 6 Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK. et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia 2001; 44: 1094-1101
• 7 Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar KM. et al. The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: Prevalence of diabetes in India study (PODIS). Diabetes Res ClinPract 2004; 66: 301-307
• 8 Basavanagowdappa H, Prabhakar AK, Prasannaraj P, Gurudev KC. Virupaksha, Suma. Study of prevalence of diabetes mellitus and impaired fasting glucose in a rural population. Int J DiabetesDevCtries 2005; 25: 98-101
• 9 Mohan V, Deepa M, Deepa R, Shanthirani CS, Farooq S, Ganesan A. et al. Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India-the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia 2006; 49: 1175-1178
• 10 Menon VU, Kumar KV, Gilchrist A, Sugathan TN, Sundaram KR, Nair V. et al. Prevalence of known and undetected diabetes and associated risk factors in central Kerala - ADEPS. Diabetes Res ClinPract 2006; 74: 289-294
• 11 Deo SS, Zantye A, Mokal R, Mithbawkar S, Rane S, Thakur K. To identify the risk factors for high prevalence of diabetes and impaired glucose tolerance in Indian rural population. Int J DiabetesDev Countries 2006; 26: 19-23
• 12 Chow CK, Raju PK, Raju R, Reddy KS, Cardona M, Celermajer DS. et al. The prevalence and management of diabetes in rural India. Diabetes Care 2006; 29: 1717-1718
• 13 Reddy KS, Prabhakaran D, Chaturvedi V, Jeemon P, Thankappan KR, Ramakrishnan L. et al. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bull World Health Organ 2006; 84: 461-469
• 14 Mohan V, Ramachandran A, Snehalatha C, Rema M, Bharani G, Viswanathan M. High prevalence of maturity onset diabetes of the young (MODY) among Indians. Diabetes Care 1985; 8: 371-374
• 15 Varma NP, Mehta SP, Madhu SV, Mather HM, Keen H. Prevalence of known diabetes mellitus in an urban Indian environment: The Darya Ganji diabetes survey. Br Med J 1986; 293: 423
• 16 Kutty VR, Soman CR, Joseph A, Pisharody R, Vijayakumar K. Type 2 diabetes in southern Kerala: Variation in prevalence among geographic divisions within a region. Natl Med J India 2000; 13: 287-292
• 17 Mohan V, Shanthirani CS, Deepa R. Glucose intolerance (diabetes and IGT) in a selected South Indian population with special reference to family history, obesity and lifestyle factors - the Chennai Urban Population Study. J Assoc Physicians India 2003; 51: 771-777
• 18 Misra A, Pandey RM, Devi JR, Sharma R, Vikram NK, Khanna N. High prevalence of diabetes, obesity anddyslipidaemia in urban slum population in northern India. Int J ObesRelatMetabDisord 2001; 25: 1722-1729
• 19 Ramachandran A, Snehalatha C, Vijay V, King H. Impact of poverty on the prevalence of diabetes and itscomplications in urban southern India. Diabet Med 2002; 19: 130-135
• 20 World Health Organization. Laboratory diagnosis and monitoring of diabetes mellitus. 2002 Available from: http://whqlibdoc.who.int/hq/2002/9241590483.pdf [Last accessed on 2012 Jul 25].
• 21 Joshi PP. Integrateddisease surveillance project training manual for field workers and field supervisors. BMI, waist to hip ratio. WHO Stepwise approach to NCD surveillance. HANDOUTS. The GOI – WHO Collaborative Programme 04 -05.
• 22 Himanshu KN, Sheetal V, Anand S, Tiwari H. Prevalence of type 2 diabetes in urban population of Ahmedabad, Gujarat. Indian Journal of Medical Specialities J Med Spec 2011; 2: 101-105
• 23 Javid AhmadAhmedJ, Muneer Ahmad, Masoodi MasoodiMA, Ashraf M, Mohd Ashraf, Rauf Rashid, Rashid R, Ahmad RRafiqAhma, Ahmad A, Ashfaq Ahmad, Sheikh DawoodDawoodS. Prevalence of Diabetes Mellitus and Its Associated Risk Factors in Age Group of 20 Years and Above in Kashmir, India. A l Ameen J Med Sci 2011; 4: 38-44
• 24 Reaven GM. A syndrome of resistance to insulin stimulated uptake (Syndrome X). Definitions and implications. Cardiovasc Risk Factors 1993; 3: 2-11
• 25 Yajnik CS, Lubree HG, Rege SS, Naik SS, Deshpande JA, Deshpande SS. et al. Adiposity and hyper-insulinemia in Indians are present at birth. J ClinEndocrinolMetab 2002; 87: 5575-5580
• 26 Barker DJ, Eriksson JG, Forsén T, Osmond C. Fetal origins of adult disease: Strength of effects and biological basis. Int J Epidemiol 2002; 31: 1235-1239
• 27 Popkin BM, Horton S, Kim S, Mahal A, Shuigao J. Trends in diet, nutritional status, and diet-related noncommunicable disease in China and India: The economic costs of the nutrition transition. Nutr Rev 2001; 59: 379-390
• 28 Bhargava SK, Sachdev HS, Fall CH, Osmond C, Lakshmy R, Barker DJ. et al. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med 2004; 350: 865-875
• 29 Banerjee A, Bhawalkar JS, Jadhav SL, Rathod H, Khedkar DT. Access to health services among slum dwellers in an industrial township and surrounding rural areas: A rapid epidemiological assessment. J Fam Med Primary Care 2012; 1: 20-26