Prevalence of Type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent
Introduction
Type 2 diabetes mellitus (type 2 DM) is the commonest form of diabetes mellitus resulting from a combination of genetic and environmental factors. Its prevalence ranges greatly, for example, 10% in Japan and 40% in Pima Indians [1], [2]. The first authentic data on the prevalence of diabetes mellitus in India came from the multicentre study conducted by the Indian Council of Medical Research in the early seventies. This study reported a prevalence of 2.3% in the urban and 1.5% in the rural areas [3]. Prevalence of type 2 DM in migrant Indians is higher than that in the population residing in the Indian subcontinent and is also usually higher than in other racial groups in the host country [4]. In one study from south India prevalence of type 2 DM in subjects more than 60 years of age was 23.7% in urban areas and 9.9% in rural areas [5]. It has been reported that in Southall UK, Asians aged 40–64 years had five times higher prevalence of diabetes as compared to Europeans [6]. The prevalence rates of diabetes mellitus have been reported to be higher in Indians compared with other ethnic groups in Singapore and Malaysia [4]. However, in Mauritius the prevalence rates of impaired glucose tolerance (IGT) and diabetes mellitus did not differ much between Indian Hindus (16.2 and 12.4%), Indian Muslims (15.3 and 13.3%), Creoles (17.5 and 10.4%) and Chinese (16.6 and 11.9%) [7]. The absence of any significant differences between the ethnic groups was attributed to the exposure of all the communities to common environmental factors.
Major differences in the prevalence rates of DM have been observed in migrant Indians in different countries and even in different parts of India [4]. Most of the studies consider Indians as one homogenous group, which is inappropriate. Indians differ in ethnicity, religion, place of origin (different parts of India) and diet. The Valley of Kashmir lies in the northern region of the Indian subcontinent, in the state of Jammu & Kashmir and has a population of about 4.51 million [8]. The population is predominantly Muslim and of uniform ethnicity. No data is available about the magnitude of diabetes mellitus, particularly type 2 DM, from this region. The present study was undertaken to determine the prevalence of type 2 DM and IGT in subjects aged 40 years or more in Kashmir Valley; and to study the relationship of diabetes with age, sex, family history of diabetes, and rural/urban background.
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Material and methods
The Valley of Kashmir, with a population of 4.51 million, lies in the Temperate Zone and is surrounded on all sides by the Himalayas. The valley is divided into six districts (administrative units) which include Srinagar, Budgam, Baramulla, Kupwara, Pulwama, and Anantnag. Each district is subdivided into Tehsils (blocks), and each Tehsil consists of many villages and/or towns. The valley has a single major city-Srinagar, while the other districts are semi-urban and rural. There is uniformity in
Prevalence of known diabetes mellitus
Six thousand and ninety one subjects, 40 years or older, were interviewed for presence of diabetes in all the six districts of Kashmir valley. Out of these, 3442 (56.51%) were males and 2649 (43.49%) were females. Of 6091 subjects interviewed, 115 (1.89%) were known cases of diabetes mellitus (Table 1). The prevalence of known diabetes in males was 1.98% while as prevalence of known diabetes in females was 1.77%. However, this difference in the prevalence between males and females was not
Discussion
There has been a paucity of well-defined epidemiological studies on diabetes mellitus in the valley of Kashmir; and in order to understand the magnitude of this problem, primarily of non-insulin dependent diabetes mellitus, an extensive survey was planned across the entire valley. The study, completed over a period of 3 years, was carried out in two phases. In the first phase prevalence of known diabetes mellitus, and in the second phase prevalence of undiagnosed (asymptomatic) diabetes
Acknowledgements
We are grateful to Professor Mehrajuddin, Director, Sheri-Kashmir Institute of Medical Sciences (SKIMS) Srinagar, Kashmir, (India) for providing all the facilities to conduct this study. We express our gratitude to Miss Sakina, Nutritionist, Department of Endocrinology, SKIMS for her help. Many residents of the Department of Medicine and some doctors in the field helped us during the survey. We are thankful to all of them.
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