Original articlePrevalence 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)
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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