Diabetes in India

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Review Article
Indian J Med Res 133, April 2011, pp 369-380

The need for obtaining accurate nationwide estimates of diabetes prevalence in India - Rationale for a national study on diabetes R.M. Anjana, M.K. Ali*, R. Pradeepa, M. Deepa, M. Datta, R. Unnikrishnan, M. Rema & V. Mohan

Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases, Prevention & Control, Chennai, India & *Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA

Received October 5, 2009 According to the World Diabetes Atlas, India is projected to have around 51 million people with diabetes. However, these data are based on small sporadic studies done in some parts of the country. Even a few multi-centre studies that have been done, have several limitations. Also, marked heterogeneity between States limits the generalizability of results. Other studies done at various time periods also lack uniform methodology, do not take into consideration ethnic differences and have inadequate coverage. Thus, till date there has been no national study on the prevalence of diabetes which are truly representative of India as a whole. Moreover, the data on diabetes complications is even more scarce. Therefore, there is an urgent need for a large well-planned national study, which could provide reliable nationwide data, not only on prevalence of diabetes, but also on pre-diabetes, and the complications of diabetes in India. A study of this nature will have enormous public health impact and help policy makers to take action against diabetes in India. Key words Complications - diabetes - India - nationwide estimates - prevalence

The prevalence of diabetes mellitus is growing rapidly worldwide and is reaching epidemic proportions1,2. It is estimated that there are currently 285 million people with diabetes worldwide and this number is set to increase to 438 million by the year 20303. The major proportion of this increase will occur in developing countries of the world where the disorder predominantly affects younger adults in the economically productive age group4. There is also consensus that the South Asia region will include three of the top ten countries in the world (India, Pakistan and Bangladesh) in terms of the estimated absolute numbers of people with diabetes3. 369

Although the exact reasons why Asian Indians are more prone to type 2 diabetes at a younger age and premature cardiovascular disease (CVD) remain speculative, there is a growing body of evidence to support the concept of the “Asian Indian Phenotype”5. This term refers to the peculiar metabolic features of Asian Indians characterized by a propensity to excess visceral adiposity, dyslipidaemia with low HDL cholesterol, elevated serum triglycerides and increased small, dense LDL cholesterol, and an increased ethnic (possibly genetic) susceptibility to diabetes and premature coronary artery disease5,6.

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INDIAN J MED RES, APRIL 2011

However, to view it in the proper perspective, the estimates regarding the number of people with diabetes in India are derived from a few scattered studies conducted in different parts of the country. There have been a few multi-centre studies such as the ICMR studies conducted in 19797 and 19918, National Urban Diabetes Survey (NUDS) in 20019, the Prevalence of Diabetes in India Study (PODIS) in 200410 and the WHO-ICMR NCD Risk factor Surveillance study in 200811. However, to date, there has been no national study which has looked at the prevalence of diabetes in India as a whole, covering all the States of the country or indeed, even in any single State with comprehensive urban and rural representation. In this article we review the published studies on the prevalence of diabetes and its complications in India and make a case for the need for a truly representative national study on the prevalence of diabetes in India. The rise of...
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