Diabetes Control in Indians
- Control of blood sugar, blood pressure, and high cholesterol is significantly worse in South Asians than whites primarily due to a suboptimal use of appropriate diabetic medications.1-4 This results in high prevalence of complications such as retinopathy (eye damage), nephropathy (kidney damage), and neuropathy (nerve damage) found in approximately one in five Indians with diabetes.5
- A wide gap exists between practice, recommendations, and delivery of diabetes care in Delhi.6 The Delhi Diabetes Community (DEDICOM) and DiabCare Asia surveys suggest that quality of diabetes care remains sub-optimal even in the nation’s capital.6, 7
- Frequency of self-monitoring of blood glucose was very low. Only 13% of the patients had an A1C estimation and 16% had a dilated eye examination and 32% had blood cholesterol estimation in the previous year.
- The blood sugar control was poor with a mean HbA1c of 8.9 and fasting blood sugar (FBS) of 150 mg/dl. An estimated 42% had an A1C value >8%, 41% had an LDL cholesterol level >130 mg/dl, and 63% had blood pressure levels >140/90 mmHg and only 19% were taking aspirin. 6
- Poor clinical practices such as these help explain the remarkable proportion (54%) that reported severe late-stage complications.8
- Pioglitazone, an insulin sensitizing agent has a promising role in controlling blood sugar and decreasing CVD risk in Asian Indians.9 This agent has been shown to decrease CRP and plasminogen activator inhibitor-1 and increase adiponectin without any change in visceral fat. These changes were 50% greater in South Asians.
- Among Indians with diabetes, transition from low to moderate-risk CAD category occurs at 37 years for men and 50 years for women. Statins should be routinely prescribed to all Asian Indian men and women with diabetes above these ages regardless of dyslipidemia and below this age when the LDL is >70 mg/dl or non- HDL cholesterol levels >100 mg/dl. 10
- Cost of medical care is high and many spend 25-34% of the income on diabetes care even without complications.
- Given the considerable disparity in the availability and affordability of diabetes care, as well as low awareness of the disease, the overall outcome even among treated patients is far from ideal. 11
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2. AllawiJ, Rao PV, Gilbert R, et al. Microalbuminuria in non-insulin-dependent diabetes: its prevalence in Indian compared with Europid patients. Br Med J (Clin Res Ed). Feb 13 1988;296(6620):462-464.
3. Hawthorne K, Mello M, Tomlinson S. Cultural and religious influences in diabetes care in Great Britain. Diabet Med. Jan-Feb 1993;10(1):8-12.
4. Chowdhury TA., Lasker SS, Mahfuz R. Ethnic differences in control of cardiovascular risk factors in patients with type 2 diabetes attending an Inner London diabetes clinic. Postgraduate medical journal. Mar 2006;82(965):211-215.
5. Raman R, Gupta A, Pal SS, et al. Prevalence of Metabolic Syndrome and its influence on microvascular complications in the Indian population with Type 2 Diabetes Mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (SN-DREAMS, report 14). Diabetol Metab Syndr. 2010;2:67.
6. Nagpal J, Bhartia A. Quality of diabetes care in the middle- and high-income group populace: the Delhi Diabetes Community (DEDICOM) survey. Diabetes Care. Nov 2006;29(11):2341-2348.
7. Raheja BS, Kapur A, Bhoraskar A, et al. DiabCare Asia–India Study: diabetes care in India–current status. J Assoc Physicians India. Jul 2001;49:717-722.
8. Brown J B, Nichols GA, Perry A. The burden of treatment failure in type 2 diabetes. Diabetes Care. Jul 2004;27(7):1535-1540.
9. Raji A, Gerhard-Herman MD, Williams JS, O’Connor M E, Simonson DC. Effect of pioglitazone on insulin sensitivity, vascular function and cardiovascular inflammatory markers in insulin-resistant non-diabetic Asian Indians. Diabet Med. May 2006;23(5):537-543.
10. Idris I, Deepa R, Fernando DJ, Mohan V. Relation between age and coronary heart disease (CHD) risk in Asian Indian patients with diabetes: A cross-sectional and prospective cohort study. Diabetes Res Clin Pract. Aug 2008;81(2):243-249.
11. Ramachandran A, Snehalatha C. Current scenario of diabetes in India. J Diabetes. Mar 2009;1(1):18-28.