High burden of prediabetes and diabetes in three large cities in South Asia: The Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study

• Type of Material: Article
• Authors: Mohan Deepa, Madras Diabetes Research Foundation (MDRF); Mundu Grace, Public Health Foundation of India (PHFI); Bhaskarapillai Binukumar, National Institute of Mental Health and Neuro Sciences, India; Rajendra Pradeepa, Madras Diabetes Research Foundation (MDRF); Shivashankar Roopa, Public Health Foundation of India (PHFI); Hassan M. Khan, Aga Khan University; Zafar Fatmi, Aga Khan University; Muhammad M. Kadir, Aga Khan University; Imran Naeem, Aga Khan University; Vamadevan S. Ajay, Public Health Foundation of India (PHFI); Ranjit Mohan Anjana, Madras Diabetes Research Foundation (MDRF); Mohammed Ali, Emory University; Dorairaj Prabhakaran, Public Health Foundation of India (PHFI); Nikhil Tandon, All India Institute of Medical Sciences (AIIMS); Viswanathan Mohan, Madras Diabetes Research Foundation (MDRF); Kabayam Venkat Narayan, Emory University
• Language: English
• Date: 2015-11-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier Ireland Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.diabres.2015.09.005
• Title of Journal or Parent Work: Diabetes Research and Clinical Practice
• ISSN: 0168-8227
• Volume: 110
• Issue: 2
• Start Page: 172
• End Page: 182
• Grant/Funding Information: This project is funded in part by the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under Contract No. HHSN268200900026C, and the United Health Group, Minneapolis, Mn, USA.; Several members of the research team at PHFI, Emory University, and CCDC were/are supported by the Fogarty International Clinical Research Scholars – Fellows programme (FICRS-F) through Grant Number 5R24TW007988 from NIH, Fogarty International Center (FIC) through Vanderbilt University; D43 NCDs in India Training Program through Award Number D43HD05249 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) and FIC; and Wellcome Trust (grant number 096735/A/11/Z).; Ajay was supported by a Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities.
• Keywords: Prediabetes; Diabetes; IMPAIRED GLUCOSE-TOLERANCE; CARRS Surveillance; South Asians; Science & Technology; Life Sciences & Biomedicine; Dysglycemia; PAKISTAN; PLASMA; Endocrinology & Metabolism; INDIA; Urban; PREVALENCE; OBESITY
• Research Categories: Health Sciences, Epidemiology

Abstract

Aim: To estimate the prevalence of, and assess factors associated with, diabetes and prediabetes in three South Asian cities. Methods: Using a multi-stage cluster random sample representative of each city, 16,288 subjects aged ≥20 years (Chennai: 6906, Delhi: 5365 and Karachi: 4017) were recruited to the Centre for cArdiometabolic Risk Reduction in South-Asia (CARRS) Study. Fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) were measured in 13720 subjects. Prediabetes was defined as FPG 100-125mg/dl (5.6-6.9 mmol/l) and/or HbA1c 5.7-6.4% (39-46mmol/mol) and diabetes as self-report and/or drug treatment for diabetes and/or FPG ≥126 mg/dl (≥7.0mmol/l) and/or HbA1c ≥6.5% (48mmol/mol). We assessed factors associated with diabetes and prediabetes using polytomous logistic regression models. Results: Overall 47.3-73.1% of the population had either diabetes or prediabetes: Chennai 60.7% [95%CI: 59.0-62.4%] (diabetes-22.8% [21.5-24.1%], prediabetes-37.9% [36.1-39.7%]); Delhi 72.7% [70.6-74.9%] (diabetes-25.2% [23.6-26.8%], prediabetes-47.6% [45.6-49.5%]); and Karachi 47.4% [45.7-49.1%]; (diabetes-16.3% [15.2-17.3%], prediabetes-31.1% [29.5-32.8%], respectively). Proportions of self-reported diabetes were 55.1%, 39.0%, and 48.0% in Chennai, Delhi, and Karachi, respectively. City, age, family history of diabetes, generalized obesity, abdominal obesity, body fat, high cholesterol, high triglyceride, and low HDL cholesterol levels were each independently associated with prediabetes, while the same factors plus waist-to-height ratio and hypertension were associated with diabetes. Conclusion: Six in ten adults in large South Asian cities have either diabetes or prediabetes. These data call for urgent action to prevent diabetes in South Asia.