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Diabetes in Urban India

Diabetes Urban India 

  • India is facing an epidemic of diabetes; with a higher prevalence in urban India─ approximately double that of rural India.1, 2 The prevalence of diabetes and prediabetes is not only high but increasing steadily in urban India.3
  • A 6-fold higher prevalence of diabetes in the urban population compared to rural (12% vs 2%) with periurbans or suburbans having intermediate rates (6%) have been reported from South India.4 Other studies show an even higher prevalence of 14% for diabetes and 11% for prediabetes.5
  • The prevalence of prediabetes was uniform in all 3 groups (7%). The periurban population was largely  sedentary.4 Sedentary lifestyle appears to be an important determinant for the higher prevalence of diabetes in an urbanizing population.4
  • The self reported prevalence of diabetes is much lower─3% in rural India and 7% in urban India.6This large discrepancy between measured and self reported diabetes suggest a high burden of undiagnosed diabetes.6
  • Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in most of the studies.6 Rich people who have multiple servants, (to do all the physical activity) have the highest rates of diabetes.1, 2
  • The epidemic of diabetes and CAD is now spreading to the middle- and lower-income groups in India.
  • Obesity is common among urban children and adults and is inversely related to physical activity and directly related to socioeconomic status.7
  • In India, the percentage of energy from animal products increased substantially between 1975 and 1995, mostly among urban residents who consumed 30% of energy from fat compared to 17% from those in rural areas.8
  • The urban poor in the developing world has a lower prevalence of diabetes than the urban poor in developed societies. However, the former have higher rates of complications of diabetes.9
  • Type 2 diabetes has also been reported in urban children but not rural children. Ramachandran et al10 have reported a total of 18 children (5 boys and 13 girls aged 9-15 years) with insidious onset of    diabetes responding to oral antidiabetic agents. The profile of these children with type 2 diabetes was      similar to that described in children in other countries. Although less common than type 1 diabetes, type          2 diabetes in children is a condition that needs to be recognized and looked for in Asian-Indians.10
  • The prevalence of diabetes is high among urban Indians and is comparable with the high prevalence seen in the Indian Diasporas. The prevalence is as high as 21% in those >40 years of age and 41% in those 55-64 years of age.11
  • In people with normal glucose tolerance (NGT), the incidence of diabetes is also very high ─ 20 per 1000 person-years for diabetes and 13 per 1000 person-years for pre-diabetes. People with prediabetes had the highest incidence of diabetes (65 per 1000 person years).12

Sources

1. 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.

2. Mohan V, Gokulakrishnan K, Deepa R, Shanthirani CS, Datta M. Association of physical inactivity with components of metabolic syndrome and coronary artery disease–the Chennai Urban Population Study (CUPS no. 15). Diabet Med. Sep 2005;22(9):1206-1211.

3. Ramachandran  A, Snehalatha C, Vijay V. Temporal changes in prevalence of type 2 diabetes and impaired glucose tolerance in urban southern India. Diabetes Res Clin Pract. 2002;58(1):55-60.

4. Ramachandran  A, Snehalatha C, Latha E, Manoharan M, Vijay V. Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population. Diabetes Res Clin Pract. 1999;44(3):207-213.

5. 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.

6. Mohan V, Mathur P, Deepa R, et al. Urban rural differences in prevalence of self-reported diabetes in India–the WHO-ICMR Indian NCD risk factor surveillance. Diabetes Res Clin Pract. Apr 2008;80(1):159-168.

7. Ramachandran  A, Snehalatha C, Vinitha R, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract. 2002;57(3):185-190.

8. Shetty PS. Nutrition transition in India. Public Health Nutr. Feb 2002;5(1A):175-182.

9. Ramachandran  A, Snehalatha C, Vijay V, King H. Impact of poverty on the prevalence of diabetes and its complications in urban southern India. Diabet Med. 2002;19(2):130-135.

10. Ramachandran  A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Type 2 diabetes in asian-Indian urban children. Diabetes Care. 2003;26(4):1022-1025.

11. Ramachandran A, Jali MV, Mohan V, Snehalatha C, Viswanathan M. High prevalence of diabetes in an urban population in south India. BMJ. Sep 3 1988;297(6648):587-590.

12. 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.

13. 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.

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