Aims/hypothesis: Lifestyle modification helps in the primary prevention of diabetes in multiethnic American, Finnish and Chinese populations. In a prospective community-based study, we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger, leaner and more insulin resistant than the above populations. Methods: We randomised 531 (421 men 110 women) subjects with IGT (mean age 45.9±5.7 years, BMI 25.8±3.5 kg/m 2 ) into four groups. Group 1 was the control, Group 2 was given advice on lifestyle modification (LSM), Group 3 was treated with metformin (MET) and Group 4 was given LSM plus MET. The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria. Results: The median follow-up period was 30 months, and the 3-year cumulative incidences of diabetes were 55.0%, 39.3%, 40.5% and 39.5% in Groups 1-4, respectively. The relative risk reduction was 28.5% with LSM (95% CI 20.5-37.3, p=0.018), 26.4% with MET (95% CI 19.1-35.1, p=0.029) and 28.2% with LSM + MET (95% CI 20.3-37.0, p=0.022), as compared with the control group. The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM, 6.9 for MET and 6.5 for LSM + MET. Conclusions/interpretation: Progression of IGT to diabetes is high in native Asian Indians. Both LSM and MET significantly reduced the incidence of diabetes in Asian Indians with IGT; there was no added benefit from combining them.

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OBJECTIVE -Due to a background of high prevalence of type 2 diabetes and the increasing rate of obesity occurring in relatively young urban children, we felt the need to look for type 2 diabetes in children. RESEARCH DESIGN AND METHODS-A study of cases of type 2 diabetes with age at diagnosis of Յ15 years seen at a diabetes speciality center in Chennai, India, is reported. A total of 18 children (5 boys and 13 girls) aged 9 -15 years with insidious onset of diabetes responding to oral antidiabetic agents (ODAs) for periods from 2 months to 12 years were studied. Clinical details, anthropometry, and details of family history of diabetes were elicited. All of them were tested for the presence of anti-GAD 65 antibodies and for pancreatic ␤-cell reserve by measuring serum C-peptide response (radioimmunoassay procedures).RESULTS -All children showed a response to ODAs, had good ␤-cell reserve (Ն0.6 pmol/ml on stimulation), and negligible GAD 65 antibodies indicating the presence of type 2 diabetes. The children were nonketotic; nine were obese, four had acanthosis nigricans, and one had polycystic ovary syndrome. Positive family history of diabetes was present in all cases.CONCLUSIONS -The clinical, immunological, and biochemical profile showed that the children had type 2 diabetes. The profile of type 2 diabetes was similar to that described in children in many other countries. Although less common than type 1 diabetes, type 2 diabetes in children is a condition that needs to be recognized and looked for in Asian-Indians. Diabetes Care 26:1022-1025, 2003T ype 2 diabetes poses a major health problem globally, especially in many developing countries (1). In urban India, type 2 diabetes is reaching epidemic proportions (2-5). Diabetes develops at a younger age in Indians, i.e., at least a decade or two earlier than in the Western population (4,6). We have reported a high prevalence of maturityonset diabetes of the young (MODY) in our population (7). Reports from different parts of the world, especially from the U.K. (8 -10) and the U.S. (11-13), show an increasing occurrence of type 2 diabetes in children, particularly in the minority populations, including Asians. The American Diabetes Association has highlighted a high prevalence of type 2 diabetes in children in ethnic minority populations such as the American and Canadian Indians, Hispanics, African Americans, Japanese, Pacific Islanders, and Asian and Middle-Eastern populations (14). Obesity has been on the rise in the adolescent age, which might have a causative role for the rising prevalence of diabetes in the young (8 -13,15).A recent survey in southern India has shown that obesity among adolescent school children was related to decreased physical activity (16). It is likely that with the emerging epidemic of diabetes and obesity, type 2 diabetes could occur in children in India. This report highlights the need to look for type 2 diabetes in children in India.RESEARCH DESIGN AND METHODS -Children with diabetes diagnosed Յ15 years who had features of type 2 diab...

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