Prevalence and Correlates of Diabetes: Inception Cohort of a Semi-Urban Population of Southern India

ABSTRACT Introduction India has the second highest number of people with diabetes, however few studies assessed true burden and ensured screening of pre-diabetics. This cross sectional survey (inception cohort) was conducted to estimate the burden and correlates of one of the common risk factors (hyperglycemia / diabetes) likely to impact the morbidity and mortality due to Non-communicable diseases. Research Design and Methods A cross sectional survey was conducted in villages under Chittoor District, Andhra Pradesh, India. 15,888 individuals (62.1% females and 37.9% males) above 15 years of age participated in the study. Results 960 (6.04%) had a history of diabetes while 592 (3.67%) had high random capillary blood glucose (RCBG) ≥200 mg/dL. HbA1c and fasting blood sugar was tested in a subset of those with high RCBG (n = 248) but with no self-reported diabetes and 212 (85.48%) had HbA1c levels > 6.5 and fasting blood sugar ≥126 mg/dL. Thus, 85.48% (n = 506) with high RCBG were likely to be diabetic. The likely magnitude of diabetes in the community was 9.23%. Another 2,331 (14.67%) were found to be at a higher risk of developing diabetes (RCBG 140 to 200 mg/dL). Receiver Operator Characteristic analysis revealed waist circumference as the most important anthropometric measurement predicting high RCBG. Comparison of diabetes and non-diabetics by multivariate logistic regression showed that male gender, age, weight, history of hypertension, family history of diabetes and waist circumference played a significant role in the prevalence of diabetes. Conclusions There is high prevalence of diabetes in the rural and semi-urban India. Waist Circumference was the best predictor of Diabetes. RCBG can be considered as a easy, cheap, reliable and important tool for community diagnosis and management of diabetes. Strengths and limitations of the study A large planned cross-sectional survey to establish a cohort with community participation Quality assurance and control measures at all levels for high internl validity Follow up assurance for the entire community These results are from Cross Sectional survey data and thus provides only associations Generealizeability to similar populations What is already known? Global burden of disease projected India to have a manifold increase in diabetes between 1995–2025. Diabetes threat is being under-prioritised with increasing pool of undiagnosed diabetes. What are the new findings? Total prevalence of Diabetes 9.77% and 14.67% were at risk of developing Diabetes 85.5 % individuals with RCBG≥200mg/dL conform to diabetes as per ADA criteria. Waist Circumference was the best predictor of Diabetes. What do the new findings imply? RCBG can be a reliable, cheap and important tool for community diagnosis and management of diabetes. Cohort established, interventions being implememted with follow up.