Elsevier

Diabetes & Metabolism

Volume 37, Issue 3, June 2011, Pages 216-221
Diabetes & Metabolism

Original article
Prevalence and risk factors of diabetes in a community-based study in North India: The Chandigarh Urban Diabetes Study (CUDS)Prévalence et facteurs de risque de diabète dutype 2 : étude en population urbaine de l’Inde du Nord : Chandigarh Urban Diabetes Study (CUDS)

https://doi.org/10.1016/j.diabet.2010.10.004Get rights and content

Abstract

Aims

As there have been few studies in North India of the prevalence of diabetes within the past decade, this study aimed to assess the prevalence and risk factors associated with diabetes in the North Indian city of Chandigarh.

Methods

This cross-sectional survey of 2227 subjects (response rate: 94%), aged  20 years and representative of the urban Chandigarh population, was conducted from April 2008 to June 2009. Fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) following ingestion of 75 g of an anhydrous glucose equivalent were estimated by glucometer in all subjects except those with known diabetes, in whom only FPG was measured. Diagnosis of diabetes was based on 1999 WHO criteria. The collected prevalence data was age-standardized for the Chandigarh population, and multivariate logistic-regression analysis was used to correlate risk factors with the presence of diabetes.

Results

A total of 349 subjects (15.7%, 95% CI: 13.9–16.9) were diabetic, comprising 210 (9.4%) with known diabetes and 139 (6.2%) with newly diagnosed diabetes, and 344 (15.4%, 95% CI: 14.3–17.1) subjects were prediabetic. The age-standardized prevalence of diabetes and prediabetes were 11.1% (95% CI: 9.7–12.4) and 13.2% (95% CI: 11.8–14.6), respectively. Age  50 years, a family history of diabetes, BMI  23 kg/m2, abdominal obesity and hypertension were significantly and positively associated with the presence of diabetes, whereas educational status was negatively associated with diabetes (P < 0.001 for all).

Conclusion

The age-standardized prevalence of diabetes and prediabetes were 11.1% and 13.2%, respectively. Older age, family history of diabetes, obesity and hypertension were positively related, while educational status was negatively related, to the presence of diabetes.

Résumé

Objectifs

Peu d’études portant sur la prévalence du diabète ont été réalisées en Inde du Nord au cours de la dernière décennie. Cette étude visait à évaluer la prévalence et les facteurs de risque associés à la présence d’un diabète dans une ville du Nord de l’Inde, Chandigarh.

Méthodes

Enquête transversale en population sur un échantillon pris au hasard réalisée d’avril 2008 à juin 2009 chez 2227 sujets âgés de 20 ans et plus, avec un taux de réponse de 94 %. La glycémie à jeun (FPG) et 2 h après 75 g de glucose (2hPG) ont été dosées avec un lecteur de glycémies capillaires, sauf chez les patients qui avaient un diabète déjà connu, chez qui seule la glycémie à jeun a été dosée. Le diagnostic du diabète a reposé sur les critères OMS de 1999. Les données de prévalence recueillies dans la présente étude ont été normalisées selon l’âge pour la population de Chandigarh. Une analyse multivariée par régression logistique a été utilisée pour chercher une corrélation entre les facteurs de risque et la présence d’un diabète.

Résultats

Un diabète était présent chez 349 sujets (15,7 % ; IC à 95 % 13,9–16,9), dont 210 (9,4 %) avaient un diabète déjà connu. Trois cent quarante-quatre sujets (15,4 % ; IC 14,3–17,1) avaient un prédiabète. La prévalence du diabète et celle du prédiabète normalisées selon l’âge étaient respectivement de 11,1 % (IC 9,7–12,4) et 13,2 % (IC 11,8–14,6). L’âge (> 50 ans), les antécédents familiaux de diabète, un IMC  23 kg/m2, une obésité abdominale et une hypertension artérielle était associés de manière significative avec l’existence d’un diabète, une corrélation inverse étant mise en évidence entre le niveau d’éducation et le diabète (P < 0,001 pour toutes les corrélations).

Conclusion

Dans la population étudiée, la prévalence du diabète et celle du prédiabète normalisées selon l’âge étaient respectivement de 11,1 % et 13,2 %. L’âge, les antécédents familiaux de diabète, l’obésité, un faible niveau de formation et l’hypertension étaient associés au diabète.

Introduction

The prevalence of diabetes is increasing worldwide and is expected to reach 4.4% by 2030 [1]. India, China and the US are the three countries with the largest numbers of people with diabetes. According to the US National Institutes of Health (NIH), the prevalence of diabetes was 7.8% across all ages, and 10.7% in those aged  20 years in 2007 [2] while, in the UK, it was reported to be 4.3% in those aged 10–79 years in 2005 [3] and, in China, 5.5% in those aged 35–74 years in 2001 [4]. Estimates of diabetes prevalence in India have varied widely (from 4.3% to 19.5%) [5], [6], [7], [8], [9], [10], [11], [12], and most of the studies were from southern parts of the country. Two nationwide studies – the Prevalence of Diabetes in India Study (PODIS), involving a population aged  25 years in 1999–2002 [5], and the National Urban Diabetes Study (NUDS), which had a study population aged  20 years in 2000 [6] – reported a diabetes prevalence of 4.3% (urban: 5.6%; rural: 2.7%) and 12.1%, respectively. However, these studies were fraught with methodological problems, including selection of subjects, criteria used to define diabetes and dosages of glucose administered. Chandigarh, a North Indian city, is unique among other Indian states in that it has a high literacy rate, the highest income per capita and a standard of living that approaches those of many Western countries. However, as it has an urban population of 76%, the prevalence data from the rest of the country cannot be extrapolated to this population. To the best of our knowledge, there has been only one study of the prevalence of diabetes in Chandigarh, conducted in 1995–2000 [7]. It relied mostly on history of diabetes, with oral glucose tolerance tests (OGTTs) performed in only a small number (n = 188) of subjects. Thus, the true prevalence of diabetes could not be estimated.

Known risk factors for diabetes include increasing age [1], [5], [11], family history of diabetes [1], [5], [11], obesity [11], hypertension [13], coronary artery disease [14], physical inactivity [5], [15], socioeconomic status [1] and level of education [15]. Only a few studies have examined the risk factors associated with the presence of diabetes. Therefore, the present study aimed to examine the prevalence and risk factors associated with diabetes in urban Chandigarh.

Section snippets

Study subjects

This cross-sectional study of a representative sample of more than 2000 people living in urban Chandigarh was conducted from April 2008 to June 2009. According to the 2001 census, the total population of Chandigarh was 900,635 at the time. Assuming a diabetes prevalence of 10%, achieving an absolute value < 1.7% (95% CI: 8.3–11.7) required a sample size of 1250 subjects. To further strengthen the data, the study was expanded to include more than 2000 subjects. Urban Chandigarh is a well-planned

Results

In the present study, 2368 individuals were approached, of whom 123 were non-responders. However, the latter's baseline characteristics were similar to those of the study subjects in terms of age, gender distribution and body mass index (BMI). Of the remaining 2245 subjects, 18 were excluded because no 2hPG data were available, leaving 2227 subjects evaluable for the study with a response rate of 94% (Fig. 1). The baseline characteristics of the final study population are shown in Table 1: 85%

Discussion

The present study of 2227 subjects showed an age-standardized prevalence of diabetes and prediabetes of 11.1% (crude prevalence: 15.7%) and 13.2% (crude prevalence: 15.4%), respectively, based on 1999 WHO criteria. Increasing age, and a family history of diabetes, obesity and hypertension, were positively associated with the presence of diabetes, whereas educational status was negatively associated.

India had 33 million patients with diabetes in 2000, a figure that is projected to increase to

Conclusion

In urban Chandigarh, the age-standardized prevalence of diabetes and prediabetes was 11.1% and 13.2%, respectively. Increasing age, and a family history of diabetes, obesity and hypertension, were positively associated with the presence of diabetes, while level of education was negatively related to the disease.

Conflict of interest statement

Nothing to declare.

Acknowledgements

We are grateful to the Department of Science and Technology in Chandigarh for its financial assistance in the present project. We also wish to thank Mr Ravinder Kumar, Mr Pardeep Kumar, Mr Sunil, Ms Anshu Malik and Mr Lavneesh for their unwavering support and technical assistance during the study.

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