Indians likely to turn diabetic faster

Recent study indicate that India is witnessing alarming rate of conversion, especially of those with normal glucose level moving to pre-diabetes and diabetes in ten years

For a country that is competing with China to be the diabetes capital of the world, here’s more sobering news. The results of a recent study published in Diabetes Care indicate that Asian Indians have one of the highest incidence rates for diabetes, with the movement from normal and pre-diabetes stages to diabetes being rapid.

The results of the study, published in the peer-reviewed journal, indicate among the highest conversion rates from normal glucose levels and pre-diabetes into diabetes. The tests were done on over 1,300 individuals, their levels recorded initially and then, followed up after 10 years.

“There are a number of studies measuring the prevalence (a statistical concept referring to the number of cases of a disease that are present in a particular population at a given time) of diabetes, but this is the first time we are measuring incidence – the number of new cases per population at risk in a given time period,” claims V.Mohan, co-author and founder, Madras Diabetes Research Foundation (MDRF).

Diabetes is acknowledged as the most common metabolic disorder. According to the International Diabetes Federation, India has an estimated 40.9 million individuals with diabetes, and this number is set to increase to 69.9 million by 2025. “What we find with this study is the alarming rate of conversion, not only of pre-diabetes to diabetes, but also people with normal glucose levels moving to pre-diabetes and diabetes in ten years,” says R.M. Anjana, author of the paper and vice president, MDRF

“The incidence rate of diabetes among individuals with pre-diabetes in our cohort was 78.9 per 1,000 person years, which is one of the highest reported in a large ethnic group and is comparable to the rates reported in small, isolated populations such as the Pima Indians (87.3 per 1,000 person years),” explains Dr. Mohan. While part of this can be explained by the high prevalence of family history of diabetes in our population, it is also an indicator of rapid epidemiological transition, he adds.

Advancing age, family history of diabetes, low HDL cholesterol (‘good’ cholesterol) and physical inactivity predict progression from normal glucose levels to abnormal levels. The results also indicated that while development of pre-diabetes is linked to environmental factors, such as a sedentary lifestyle, subsequent development is perhaps governed by a combination of genetic and environmental factors. “Therefore, we think it is reasonable to suggest that in this population, efforts to prevent diabetes should be initiated prior to the pre-diabetes stage itself,” Dr. Anjana said.

The New American Diabetes Association guidelines even say that if a person has both impaired tolerance at fasting and the glucose test (IFT and IGT) fasting and glucose tolerance then it is even a case for considering putting the patient on metformin (a drug for type 2 diabetes), says Dr. Mohan. “But lifestyle is the key, unless changes are made to improve physical activity, and eat healthily, we will not be able to prevent the march of diabetes in our population.”

Chennai Urban Rural Epidemio-logy Study (Cures)

1

The diabetes study was performed on a sample of 26,000 adults over 20 years in Chennai between the years 2001 and 2003.

2

All individuals with diabetes and one in 10 persons underwent detailed investigation process.

3

Total number was 3,589 people. Of the total, 645 individuals could not be allowed up, due to migration and unwillgness to participate

4

Follow-up after 10 yrs: 534 died, of whom those with normal sugar or pre-dia-betes at baseline & whose blood sugar status was known at death - 29.

5

Final tests performed on 1,376 individuals - 1,077 had normal glucose tolerance, and 299, pre-dia-betes

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Blood samples were tested at fasting state and two hours after oral glucose was administered to the individuals.

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Details pertaining to demography, social status, medical and family history, were recorded

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Diagnosed if FPG level was > or = to 126 mg/dL and the two-hour plasma glucose > or = to 200 mg/dL.

9

Normal glucose tol-erance = FPG less than 100 mg/dL and 2-h PG was less than 140 mg/dL

Results
Over all the incidence of diabetes for the entire cohorts was 33.1 per 1000 person years, and the incidence of prediabetes was 29.5 per 1000 person year
385 individuals progressed to diabetes and 269 developed diabetes before the final follow-up examination	209 out of the 1,077 individuals with normal glucose tolerance(NGT) at baseline, 209 developed diabetes (Incidence rate of 22.2 per 1000 person years)
	19.4% of those with NGT converted to diabetes	25.7% of those with NGT converted to prediabetes
	58.9%Among the 299 individuals with pre-diabetes at baseline, 176 developed diabetes (Incidence rate of 78.9 per 1000 years) converted to diabetes