Prevalence of Type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent

https://doi.org/10.1016/S0168-8227(99)00110-2Get rights and content

Abstract

This cross-sectional population survey was undertaken to determine the prevalence of type 2 diabetes and impaired glucose tolerance in subjects aged 40 years or more in Kashmir Valley, India. The study was carried out in two phases. In phase one, 6091 randomly selected subjects, 40 years or older, from all six districts of the valley were surveyed for prevalence of known diabetes mellitus. In phase two, 5083 subjects, 40 years or older, were screened with oral glucose tolerance test for prevalence of undiagnosed (asymptomatic) diabetes mellitus and impaired glucose tolerance. Abnormalities of carbohydrate intolerance were determined as recommended by WHO. Of 6091 subjects interviewed, 115 were known cases of diabetes mellitus with an overall prevalence of 1.89% (1.98% in males and 1.77% in females). Results of glucose tolerance test revealed that mean fasting as well as mean 2 h blood glucose was significantly more in females as compared to males (4.68±0.91 and 6.40±2.12 vs. 4.49±0.96 and 5.94±2.03 mmol/l, respectively, P<0.0001). Of 5083 subjects who were subjected to glucose tolerance test (GTT), 627 (12.34%) had an abnormal test; with 411 (8.09%) having impaired glucose tolerance (IGT) and 216 (4.25%) having diabetes mellitus. The prevalence of IGT as well as of diabetes was significantly more in females as compared to males (P<0.001). Subjects who had family history of diabetes had a significantly higher prevalence of abnormal GTT. Prevalence of known diabetes as well as that of abnormal GTT steadily increased with age, with a highest prevalence in the age group of ≥70 years (P<0.001). Obese subjects had a significantly higher basal as well as 2 h blood glucose in males as well as in females. Subjects with diabetes on GTT had a higher waist/hip ratio. Overall the prevalence of diabetes as well as IGT was significantly higher in the urban population. We conclude that 1.89% of the general population have known diabetes, 4.25% have undiagnosed diabetes and 8.09% have impaired glucose tolerance test; making the total load of abnormal glucose tolerance 14.23% in Kashmir Valley. In subjects greater than 40 years of age having a family history of diabetes, obesity, higher age (50 years or above), female sex, and urban origin have more chance (odds ratio: 4.65, 2.30, 1.87, 1.49 and 1.16, respectively) of developing abnormal glucose tolerance.

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.

Section snippets

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.

References (38)

  • P.V. Rao et al.

    The Eluru survey: prevalence of known diabetes in a rural Indian population

    Diabetes Res. Clin. Pract.

    (1989)
  • S. Patandin et al.

    Impaired glucose tolerance and diabetes mellitus in a rural population in South India

    Diabetes Res. Clin. Pract.

    (1994)
  • R. Kawate et al.

    Diabetes mellitus and its vascular complications in Japanese migrants on the island of Hawaii

    Diabetes Care

    (1979)
  • P.H. Bennett et al.

    Epidemiological studies on diabetes in Pima Indians

    Recent Prog. Horm. Res.

    (1976)
  • Ahuja MMS. Epidemiological studies on diabetes mellitus in India. In: Epidemiology of diabetes in developing countries....
  • K.L. Ramiya et al.

    Epidemiology of diabetes in Asians of the Indian Subcontinent

    Diabetes. Metab. Rev.

    (1990)
  • A. Ramachandran et al.

    High prevalence of NIDDM and IGT in an elderly south Indian population with low rates of obesity

    Diabetes Care

    (1994)
  • H.M. Mather et al.

    The Southall diabetes survey; prevalence of known diabetes in Asians and Europeans

    Br. Med. J.

    (1985)
  • G.K. Dowse et al.

    The high prevalence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance in Indian, Creole and Chinese Mauritians

    Diabetes

    (1990)
  • Khan AH, IAS, Director of Census Operations J&K: Village and Town director- Part XIII A and B Series -8. Jammu and...
  • World Health Organization. Diabetes Mellitus: Report of a WHO Study Group. Geneva, World Health Org., 1985 (Tech. Rep....
  • P.H. Bennett

    Standardization of methods and reporting of tests in epidemiological studies

    Diabetes Care

    (1979)
  • N.P.S. Verma et al.

    Prevalence of known diabetes in an urban Indian environment: the Darya Ganj diabetes survey

    Br. Med. J.

    (1986)
  • A. Ramachandran et al.

    High prevalence of diabetes in an urban population in South India

    Br. Med. J.

    (1988)
  • E. Barrett-Connor

    The prevalence of diabetes mellitus in an adult community as determined by history or fasting hyperglycemia

    Am. J. Epidemiol.

    (1980)
  • M.I. Harris et al.

    Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in US population aged 20–74 year

    Diabetes

    (1987)
  • E. Agner et al.

    Impaired glucose tolerance and diabetes mellitus in elderly subjects

    Diabetes Care

    (1989)
  • J. Woo et al.

    The prevalence of diabetes mellitus and an assessment of methods of detection among community of elderly Chinese in Hong Kong

    Diabetologia

    (1987)
  • G. Pagano et al.

    Prevalence and clinical features of known type 2 diabetes in the elderly: a population-based study

    Diabetic Med.

    (1994)
  • Cited by (0)

    View full text