BackgroundProgressive burden of diabetes mellitus is a major concern in India. Data on the predictors of poor glycemic control among diabetics are scanty. A population-based cross-sectional study nested in an urban cohort was thus conducted in West Bengal, India to determine the burden and correlates of total and uncontrolled abnormalities in glucose metabolism (AGM) in a representative population.MethodsFrom 9046 adult cohort-members, 269 randomly selected consenting subjects (non-response = 7.24%) were interviewed, examined [blood pressure (BP), anthropometry], tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C). Those having pre-diagnosed diabetes or FPG ≥126 or HbA1c≥6.5 were defined as diabetic. Among non-diabetics, subjects with FPG (mg/dl) = 100–125 or HbA1C(%) = 5.7–6.4 were defined as pre-diabetic. Pre-diagnosed cases with current FPG ≥126 were defined as uncontrolled AGM. Descriptive and regression analyses were conducted using SAS-9.3.2.ResultsAmong participants, 28.62% [95% Confidence Interval (95%CI) = 23.19–34.06)] were overweight [body mass index(BMI) = (25–29.99)kg/meter2], 7.81% (4.58–11.03) were obese(BMI≥30kg/meter2), 20.82% (15.93–25.70) were current smokers, 12.64% (8.64–16.64) were current alcohol-drinkers and 46.32% of responders (39.16–53.47) had family history of diabetes. 17.84% (13.24–22.45) had stage-I [140≤average systolic BP (AvSBP in mm of mercury)<160 or 90≤average diastolic BP (AvDBP)<100] and 12.64% (8.64–16.64) had stage-II (AvSBP≥160 or AvDBP≥160) hypertension. Based on FPG and HbA1c, 10.41% (6.74–14.08) were diabetic and 27.88% (22.49–33.27) were pre-diabetic. Overall prevalence of diabetes was 15.61% (11.25–19.98). Among pre-diagnosed cases, 46.43% (26.74–66.12) had uncontrolled AGM. With one year increase in age [Odds Ratio(OR) = 1.05(1.03–1.07)], retired subjects [OR = 9.14(1.72–48.66)], overweight[OR = 2.78(1.37–5.64)], ex-drinkers [OR = 4.66(1.35–16.12)] and hypertensives [ORStage I = 3.75(1.42–9.94); ORStage II = 4.69(1.67–13.17)] had higher odds of diabetes. Relatively older subjects [OR = 1.06(1.02–1.10)], unemployed [OR = 19.68(18.64–20.78)], business-owners [OR = 25.53(24.91–16.18)], retired [OR = 46.53(45.38–47.72)], ex-smokers [OR = 4.75(1.09–20.78)], ex-drinkers [OR = 22.43(4.62–108.81)] and hypertensives [ORStage II = 13.17(1.29–134.03)] were more likely to have uncontrolled AGM.ConclusionsBurden of uncontrolled AGM was high among participants. Efforts to curb the diabetes epidemic in urban India should include interventions targeting appropriate diabetic control among relatively older persons, unemployed, business-owners, retired, ex-smokers, ex-drinkers and hypertensives.
Objective: Hypertension is one of the predominant major contributors of chronic disease burden among global non communicable diseases. The study evaluated trends in self-reported doctor diagnosed hypertension (DDH) and measured blood pressure (mBP) prevalence along with associated risk factors in an Indian urban population over 20 years. Design and method: Longitudinal cohort was established in 2001 with 3030 households based on the stratified multistage cluster sampling. Adult participants (N = 7275; Male = 3765, Female = 3510) were enrolled. Three household questionnaire surveys were performed in year 2001–02, 2011–12, 2018–19 with the same population size to determine DDH trend. Two representatives’ cross-sectional surveys were conducted (In 2014–15, n:5741, male = 2319, female = 3422; In 2018–19, n = 5741, male = 2204, female = 3537) to evaluate trends in hypertension based on the mBP value. Blood pressure and anthropometric data were also recorded according to the established protocol. mBP classification was derived from Joint National Committee (JNC-8) guideline. Results: Prevalence of DDH (%) in successive surveys increased from 9.70, 17.86, 22.67 and measured BP (%) among pre-hypertensive 32.12, 39.17, hypertension-stage1 14.41, 19.91, hypertension-stage2 7.05, 8.26 over the time. Gender specific prevalence of hypertension showed progressive rise of DDH [OR = 0.69, CI: 0.61,0.78, p < .0001]and mBP [In 2014, PreHTN: OR = 1.69, CI = 1.49, 1.91, p < .0001; HTNstg1: OR:1.43, CI = 1.22, 1.68, p < .0001, HTNstg2: OR = 1.44,CI = 1.17, 1.78, p = 0.0007; In 2018, PreHTN: OR = 2.04, CI = 1.79,2.32, p < .0001; HTNstg1: OR = 2.23, CI = 1.91,2.60, p < .0001; HTNstg2: OR = 1.948, CI = 1.58,2.40, p < .0001] in men when compared to women. Association of DDH with smoking [In 2001–02, OR = 0.62, CI = 0.52,0.74, p < .0001; In 2018–19, OR = 0.75, CI = 0.63, 0.90, p = .0020] and duration of sleep (>8 hrs.) [In 2001–02, OR = 0.71, CI = 0.61, 0.82, p < .0001; In 2018–19, OR = 1.18, CI = 1.01, 1.38, p = 0.0401] established. Trend revealed higher education was a lower risk of hypertension. Increasing trends were observed across all hypertension categories among obese compared to normal. Conclusions: In mBP group, HTNstg2 prevalence has increased marginally over 7 years, among remaining groups increasing prevalence trend was unequivocal. Most of the long-established reversible risk factors association prevalence also increasing. Higher education having lower risk may well suggest importance of increased awareness. A strategy to reverse the rising trend of the chronic disease burden is required.
Objective: The study objectives are to assess the challenges faced, individual awareness of pandemic, attitudes, and compliance of guidelines during lockdown. Design and method: This telephonic survey of 404 adult individuals were administered among hypertensive population with and without comorbidities of a longitudinal cohort in Barrackpore, West Bengal, India in Aug-Sept’2020. Comorbidities comprised with cardiovascular diseases, diabetes, asthma, OSA, BMI, epilepsy, stroke, arthritis, and cancer. Convenience sampling was considered to outline socio-demographics; chronic illness status; knowledge, attitude and practices; mood changes; and difficulties faced during lockdown. Association between variables have been conformed through multivariate logistic regression. Results: A total of 404 respondents, lone hypertensive 6.4%, hypertensive with other comorbidities 93.6%. Overall mean score of knowledge was 18.4 ± 5.2 (Range 1–23), practices 6.1 ± 1.1 (Range 2–8). Direct impacts on income 25.7%. Compliance of prescribed handwashing 93.3%, frequently hand sanitization 82.9%, using mask appropriately 91.1%, physical distancing 95.1%. Awareness of pandemic being contagious respiratory virus infection 97.8%, dispersion from human-to-human close contact 97.2%, curable 13.6%, could be fatal 4.5%, regarding symptoms 94.6%. Adverse impact due to the non-availability of medicine at home 4.5%, in pharmacy 2.2%; absence of doctors 9.4%; procured medicine at higher cost 6.2%; inaccessibility of transport 2.7%. On 3 or more drugs 33.2%, stored drugs 34.7%. Required and received medical advice due to polypharmacy 2.5%. Inadequate knowledge regarding 14-days isolation 4.5%; isolation and treatment reduce spread 2.7%; Lockdown was not an effective measure 11.4%; unconcerned regarding family members protection 34.2%; vaccine available in market 12.4%; and non-compliance of personal hygiene 6.2%. Pandemic still uncontrolled 14.4%. Multiple physical and sedentary activities less among hypertensive with comorbidities compared to lone hypertensives (AOR = 0.96, CI: 0.95, 0.97, p < .0001). Hypertensives with comorbidities expressed better knowledge and practices compared to lone hypertensives. Conclusions: Short term impact during lockdown on hypertensive with or without comorbidities individuals was not significant. For effective control of the pandemic each and every individual of the cohort needs fully to comply with the prescribed isolation regime, personal protective measures and physical distancing beside real understanding of preventive function of safe-effective vaccine for everyone when available.
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