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Cardio Diabetes Medicine 2017 83

Pre Diabetes- Beyond

The Tip of The Iceberg

Dr. Arulprakash
MD., MRCP(UK)., MCA., FRCP(London)
Indra Diabetes and Endocrine Centre,Tuticorin

Introduction was large variation in state-specific diabetes preva-
lence. The differences in the prevalence of diabetes
Prevalence of impaired fasting glucoseand IGT gen- between states might be explained by factors such
erally considered as prediabetic state. It stands at 3% as differences in SES, physical activity, dietary pat-
of the total adult population as per latest estimates terns, obesity prevalence, and possibly genetic varia-
by the IDF and the phenomenon is commonto all tion. The overall prevalence of diabetes was higher in
geographical regions. The prevalence of pre diabetes the mainland than in the northeast states. Diabetes
is increasing world wide and by 2035 projected 471 prevalence was higher in the more economically de-
million people will have this condition. It has attained veloped states, and even within states diabetes was
clinical significance because of epidemiological as- more common in individuals of medium or high SES
sociation with macro-vascular disease and neurop- than in individuals of low SES, which agrees with
athy. Compounding this problem, Indians show a results from earlier studies in India. However, the
high conversion rate from pre- diabetes to diabetes prevalence of diabetes was higher in individuals of
(approximately 18%) as seen in the Indian Diabetes low SES in the urban areas of seven states, most of
Prevention Programme-1 (IDPP-1) , a 3 year prospec- which are also ranked among the more economically
tive study. Such high conversion may even slow in- advanced states of India. Conversely, in rural areas,
creased prevalence of overt diabetes at the expense the prevalence of diabetes was higher in individuals
of (declining) population with prediabetes. The prev- of higher SES in all the states studied. This find-
alence rate of IGT amongst two North Indian cohorts ing suggests that the urban areas of more affluent
were comparable with the National Urban Diabetes states have transitioned further along the diabetes
Survey(1001) reporting 8.6% in Delhi, and Zargar AH et epidemic, such that less affluent individuals have a
all(200) in their study reporting 8.1% in Kashmir, An- higher prevalence of diabetes than their more afflu-
jana RM et all(2011) in ICMR-INDIAB found somewhat ent counterparts. However, in rural areas throughout
higher pre diabetes prevalence amongst pre domi- India, diabetes continues to be a disease of more af-
nantly south indian (14.5%) and rural (14.7%) areas. A fluent sections of society, suggesting that the epide-
much higher crude prevalence of 37% was described miological transition is less advanced in these areas.
in a cross-sectional survey (2009) among employees This finding is all the more important because Asian
aged 20-59 years of a large industry near Delhi.
Indians have been shown to progress faster through
The ICMR–INDIAB study is the largest nationally rep- the prediabetes stage than do people of other eth-
resentative study of diabetes in India. The cumulative nic groups. Declines have previously been noted in
data from 15 states represent a total adult population the prevalence of prediabetes in Chennai and other
of 363·7 million people (51% of India’s adult popula- south Asian populations. The prevalence of impaired
tion). The estimated overall prevalence of diabetes in fasting glucose was substantially higher than that of
India to be 7·3% and the prevalence of prediabetes impaired glucose tolerance.The main factors driving
to be 10·3% (WHO criteria) or 24·7% (ADA criteria), the diabetes epidemic in both urban and rural areas
depending on which definition was used. However, of India are obesity, age, and family history of diabe-
these estimates are based on data from 15 states tes. Results from an earlier study have shown similar
out of a total of 31 to be studied, and cannot be con- prevalence of impaired fasting glucose and impaired
sidered as final. Among the 15 states studied, there glucose tolerance in the urban population of south

GCDC 2017 & Cardio Diabetes Medicine