Diabetes South India
- Diabetes has been studied extensively in South India, especially Chennai replete with many major diabetic centers. The prevalence of diabetes among adults has increased steadily over the past 30 years and has reached approximately 20% in urban populations and approximately 10% in rural populations.1, 2 Age standardized prevalence of diabetes 12% and prediabetes 14% in South India, with no gender difference.3, 4
- Over the past 30 years the prevalence of diabetes has increased 3 times from 5% to 14% and prediabetes 5 times from 2% to 10% (Figure 046).4 Recent studies have shown a rapid conversion of prediabetes to diabetes ─65 per 1000 person years.4
- South Indians develops diabetes at a younger age (45years) and yet have a very high prevalence of risk factors:5 hypertension 57%; obesity 48%; abdominal obesity 63%; dyslipidemia 50%; sedentary lifestyle 41%.5, 6 Even those with prediabetes have a high prevalence of cardiovascular risk factors.7
- Asian Indians have the highest prevalence of undiagnosed diabetes upon international comparison (50% or more).8 Prevalence of undiagnosed diabetes increases with an increasing body mass index (BMI) or waist circumference.
- In urban south Indians, total dietary carbohydrate (5-fold risk) and glycemic load (4-fold risk) are associated with an increased risk, whereas dietary fiber intake decreases the risk of diabetes.9
- Lifestyle factors and family history have a synergistic effect on increasing the risk for diabetes.10 Abdominal obesity is a strong predictor of diabetes as well as hypertension.11
- The triglyceride levels are high and HDL levels are low among Indians in general and diabetics in particular. The triglycerides/HDL ratio greater than 3-4 is a strong predictor of small dense LDL, metabolic syndrome and even diabetes among Indians and other populations.12, 13 Lifestyle modifications have beneficial effects on this atherogenic lipid profile.7
- Ramachandran et al. 14 reported an increase in the prevalence of diabetes in urban Chennai from 5% to 19% between 1985 and 2006. In the Chennai Urban Population Study (1997 to 2005), the prevalence rate of diabetes increased from 12% to 18% over 8 years (0.8% annual incidence).15 If this increase continued at the same rate the prevalence of diabetes in Chennai would be 30% by 2020.16
- These high rates impose a huge economic burden on the country as well as upon individuals many of whom may be thrown into poverty as they spend 25-34% of their income on diabetes care (see Diabetes and Poverty).
- The clinical outcome in known diabetic cases is far from satisfactory even in Chennai, where specialized diabetes care is available.5 Approximately half of the diabetics are undiagnosed and only half of the known diabetic patients are taking medications, among whom less than 30% attain control of blood sugar.5 Control of blood pressure and cholesterol is even lower at 10%. 5
- Massive diabetes education programs are urgently needed throughout India. Preventive measures such as lifestyle modification with healthy diet and adequate physical activity could help prevent the twin epidemics of diabetes and heart disease.17
1. Ramachandran A, Snehalatha C. Current scenario of diabetes in India. J Diabetes. Mar 2009;1(1):18-28.
2. Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care. May 2008;31(5):893-898.
3. Ramachandran A, Snehalatha C, Kapur A, et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001;44(9):1094-1101.
4. Mohan V, Deepa M, Deepa R, 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. Jun 2006;49(6):1175-1178.
5. Ramachandran A, Mary S, Sathish CK, et al. Population based study of quality of diabetes care in southern India. J Assoc Physicians India. Jul 2008;56:513-516.
6. Subburam R, Sankarapandian M, Gopinath DR, Selvarajan SK, Kabilan L. Prevalence of hypertension and correlates among adults of 45-60 years in a rural area of Tamil Nadu. Indian journal of public health. Jan-Mar 2009;53(1):37-40.
7. Snehalatha C, Mary S, Joshi VV, Ramachandran A. Beneficial effects of strategies for primary prevention of diabetes on cardiovascular risk factors: results of the Indian Diabetes Prevention Programme. Diab Vasc Dis Res. Mar 2008;5(1):25-29.
8. Nyamdorj R, Pitkaniemi J, Tuomilehto J, et al. Ethnic comparison of the association of undiagnosed diabetes with obesity. International journal of obesity (2005). Feb 2010;34(2):332-339.
9. Mohan V, Radhika G, Sathya RM, Tamil SR, Ganesan A, Sudha V. Dietary carbohydrates, glycaemic load, food groups and newly detected type 2 diabetes among urban Asian Indian population in Chennai, India (Chennai Urban Rural Epidemiology Study 59). The British journal of nutrition. Jul 9 2009:1-9.
10. 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 (CUPS 14). J Assoc Physicians India. Aug 2003;51:771-777.
11. Kaur P, Radhakrishnan E, Sankarasubbaiyan S, et al. A comparison of anthropometric indices for predicting hypertension and type 2 diabetes in a male industrial population of Chennai, South India. Ethn Dis. Winter 2008;18(1):31-36.
12. Bhalodkar NC, Blum S, Enas EA. Accuracy of the ratio of triglycerides to high-density lipoprotein cholesterol for predicting low-density lipoprotein cholesterol particle sizes, phenotype B, and particle concentrations among asian indians. Am J Cardiol. Apr 1 2006;97(7):1007-1009.
13. Mohan V, Deepa R, Velmurugan K, Gokulakrishnan K. Association of small dense LDL with coronary artery disease and diabetes in urban Asian Indians – the Chennai Urban Rural Epidemiology Study (CURES-8). J Assoc Physicians India. Feb 2005;53:95-100.
14. Ramachandran A, Ma RC, Snehalatha C. Diabetes in Asia. Lancet. Jan 30 2010;375(9712):408-418.
15. Mohan V, Deepa M, Anjana RM, Lanthorn H, Deepa R. Incidence of diabetes and pre-diabetes in a selected urban south Indian population (CUPS-19). J Assoc Physicians India. Mar 2008;56:152-157.
16. Huffman M D, Prabhakaran D, Osmond C, et al. Incidence of cardiovascular risk factors in an Indian urban cohort results from the new delhi birth cohort. J Am Coll Cardiol. Apr 26 2011;57(17):1765-1774.
17. Mohan V., Venkatraman JV, Pradeepa R. Epidemiology of cardiovascular disease in type 2 diabetes: the Indian scenario. J Diabetes Sci Technol. 2010;4(1):158-170.