|EVIDENCE-BASED MEDICINE: SUMMARY OF STUDY
|Year : 2017 | Volume
| Issue : 3 | Page : 243-244
Diabetes is more prevalent among the urban poor: A summary of the findings of the ICMR-INDIAB Study
|Date of Web Publication||7-Aug-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Diabetes is more prevalent among the urban poor: A summary of the findings of the ICMR-INDIAB Study. Curr Med Issues 2017;15:243-4
Source : This is a summary of the study: Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al., ICMR INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR INDIAB population based cross sectional study. Lancet Diabetes Endocrinol 2017;5:585-96. [Epub 2017 Jun 7]. Summary prepared by Dr. Tony Abraham Thomas, Christian Medical College, Vellore, India.
Clinical Question: What is the prevalence and distribution of diabetes in India? Should preventive and treatment strategies be aimed at the economically well off as it is a "disease of the rich."
Authors' conclusions: (1) The estimated overall prevalence of diabetes in India is 7.3%. (2) The prevalence of diabetes is higher in the more economically developed states and in urban settings than in rural areas. However, in urban areas, the prevalence is higher among the poor than those who are economically well off.
| Why This Study?|| |
It is not without reason that India has been called the “diabetes capital of the world.” The evidence that is available from studies conducted in India earlier point to a growing epidemic in the country. The results have also indicated that diabetes is a disease of higher socioeconomic status (SES) individuals. However, information regarding the actual prevalence and distribution of diabetes in India has not been properly established due to several reasons. The size, heterogeneous nature of populations, and economic status of people have meant that data from studies that have looked at people from a specific geographical region cannot be interpolated to represent the country as a whole. Indian Council of Medical Research–INdia DIABetes study (ICMR-INDIAB) Study is an attempt to address this issue and obtain a truly representative sample of the nation's population, both urban and rural with regard to diabetes.
This study (Phase 2) published in the lancet is the second phase of the ICMR-INDIAB study and is a continuation of the previous study (Phase 1) that sampled 4 regions (Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra). In Phase 2, data for prevalence of diabetes were collected from five mainland states (Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab) and six Northeastern states (Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya). The conclusions look at the cumulative data from all the 15 states studied and throw up some important areas of concern.
| Results|| |
The estimated overall prevalence of diabetes in India was 7.3%. The prevalence varied from 4.3% in Bihar to 13.6% in Chandigarh. This was from the cumulative data from 15 states representing a total adult population of 363.7 million people (51% of India's adult population). The overall prevalence was higher in the mainland states than in the Northeastern states. However, there were wide variations in prevalence among the Northeastern states (ranging from 4.5% in Meghalaya to 9.4% in Tripura), possibly reflecting the ethnic heterogeneity of this region.
Diabetes and socioeconomic status
There was a higher prevalence of diabetes in the more economically developed states. Within each state, diabetes was more common in individuals of medium or high SES than in those with low SES, which is in line with evidence from earlier studies in India.
Diabetes in urban and rural areas
The prevalence of diabetes is higher in urban areas than in rural areas. However, an interesting finding was that the prevalence of diabetes was higher in individuals of low SES in the urban areas of the seven most economically advanced states. In the urban regions of Chandigarh, for example, there was a higher prevalence of diabetes (26.9%) among people with low SES, than in individuals with high SES (12.9%). This is important because it appears to indicate that with increasing economic prosperity, the disease seems to disproportionately affect the poor more than the well off in the urban setting. This has implications in screening and therapeutic strategies used for diabetes in urban areas.
On the other hand, in the rural areas of the country, the prevalence of diabetes was higher in individuals of higher SES.
| Prediabetes|| |
The overall estimated prevalence of prediabetes was 10.3% (WHO criteria) or 24.7% (American Diabetes Association criteria), depending on which definition was used. This prevalence is higher than that of diabetes and implies that there is a large pool of individuals who may go on to develop diabetes in the future.
Risk factors for diabetes
Obesity, age, and family history of diabetes were the main risk factors for diabetes in both urban and rural areas of India. High SES seemed to be a risk factor for diabetes in rural areas but not in urban areas. Smoking and alcohol consumption were not found to be independent risk factors for developing diabetes in this study.
Strengths and limitations
The strengths of the study include the fact that it is the largest epidemiological study on diabetes in India, with a sample representative of most geographical regions, low and high SES, and urban and rural settings. The population sampled is large, and the methods are fairly robust. However, there are some important limitations. The states that have been sampled do not include Kerala, which has the highest reported prevalence of diabetes in India and Uttar Pradesh, which has the highest population in absolute terms and in population density. To obtain a truly representative estimate of the prevalence of diabetes, we may have to wait until the next phase of the study is completed.
| Conclusion|| |
This is a well-conducted study attempting to understand the prevalence and distribution of diabetes in a large country like India, with wide epidemiological variations. The results can be considered representative of the entire country to a great extent. Among the important results, the striking finding that the prevalence of diabetes was higher in individuals of low SES in the urban areas of the seven most economically advanced states has important implications. The impression that diabetes is a disease of the rich, though true to some extent, is not applicable in all settings. Screening for diabetes and treatment strategies, especially in urban areas must therefore be planned keeping the poor in mind. Investigating the reasons for the high prevalence of diabetes among the urban poor could be a topic for a study in the future.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al.
Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-INDIA DIABETES (ICMR-INDIAB) study. Diabetologia 2011;54:3022-7.
Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al
. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5:585-96. [Epub 2017 Jun 7.]
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