OBJECTIVE -To compare prevalence of diabetes, impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and cardiovascular risk factors between a city, a town, and periurban villages (PUVs) in southern India and to look for temporal changes in the city and PUVs.RESEARCH DESIGN AND METHODS -Subjects aged Ն20 years were studied in Tamilnadu, India, in Chennai (city, n ϭ 2,192; 1,053 men and 1,138 women), Kanchipuram (town, n ϭ 2,290; 988 men and 1,302 women), and Panruti (PUVs, n ϭ 2,584; 1,280 men and 1,304 women) in 2006. Demographic, socioeconomic, and anthropometric details; blood pressure; physical activity; diet habits; and lipids were studied. Risk associations with diabetes were analyzed using multiple logistic regression analyses. Present and previous data in the city and the PUVs were compared.RESULTS -Mean BMI, waist circumference, and family history of diabetes were significantly lower in the PUVs. The PUVs had a lower prevalence of diabetes (9.2 [95% CI 8.0 -10.5], P Ͻ 0.0001) than the city (18.6 [16.6 -20.5]) and town (16.4 [14.1-18.6]). Approximately 40% of subjects were newly diagnosed. Prevalence of impaired glucose tolerance (IGT) was higher (P Ͻ 0.0001) in the city (7.4 [6.2-8.5]) than in the town (4.3 [3.3-5.3]) and the PUVs (5.5 [4.6 -6.5]). Prevalence of IFG was generally low. Age, family history, and waist circumference were significantly associated with diabetes, while physical activity was not. Overweight, elevated waist circumference, hypertension, and dyslipidemia were more prevalent in the city.CONCLUSIONS -In the city, diabetes increased from 13.9 to 18.6% in 6 years and IGT decreased significantly. The town and city had similar prevalences; the PUVs had lower diabetes prevalence, but prevalence had increased compared with that in a previous survey. Cardiometabolic abnormalities were more prevalent in urban populations.
OBJECTIVE -In the Indian Diabetes Prevention Programme (IDPP), a 3-year randomized, controlled trial, lifestyle modification (LSM) and metformin helped to prevent type 2 diabetes in subjects with impaired glucose tolerance (IGT). The direct medical costs and cost-effectiveness of the interventions relative to the control group are reported here. (LSM, metformin, and LSM and metformin) in the IDPP were estimated from the health care system perspective. Costs of intervention considered were only the direct medical costs. Direct nonmedical, indirect, and research costs were excluded. The cost-effectiveness of interventions was measured as the amount spent to prevent one case of diabetes within the 3-year trial period. CONCLUSIONS -Both LSM and metformin were cost-effective interventions for preventing diabetes among high risk-individuals in India and perhaps may be useful in other developing countries as well. The long-term cost-effectiveness of the interventions needs to be assessed. RESEARCH DESIGN AND METHODS -Relative effectiveness and costs of interventions RESULTS Diabetes Care 30:2548-2552, 2007T he global burden of diabetes is increasing, and developing countries face a grave health care burden due to this disease (1). Although the clinical and economic benefits of good glycemic control of diabetes in preventing vascular complications are well known (2-5), prevention of diabetes may have more farreaching benefits by curbing the epidemic. India is facing a huge burden owing to the emerging epidemic of diabetes, with the largest number of diabetic individuals in the world (1). In the context of primary prevention, the results of the Indian Diabetes Prevention Programme (IDPP) have great significance. This program has demonstrated that moderate but consistent lifestyle modification (LSM) or therapeutic intervention with metformin could prevent or delay progression of impaired glucose tolerance (IGT) to diabetes with relative risk reductions of 28.5 and 26.4%, respectively (6). Combining the two did not enhance the benefits. A few other studies in Western populations had also shown that intensive LSM and pharmacological interventions can delay or prevent progression of IGT to diabetes (7-10).Assessment of the cost-effectiveness of the IDPP is relevant for two reasons. First, although the cost and costeffectiveness of preventing diabetes among high-risk individuals have been evaluated in Western populations (11,12), the cost-effectiveness of preventing diabetes in developing countries is unknown. Second, health care resources are more limited in developing countries such as India than in developed countries. Although both LSM and metformin intervention were shown to be cost-effective in developed countries, it is not clear whether such interventions should be implemented with the limited health resources in developing countries. Differences in the effectiveness and particularly in the cost of the intervention and treatments of diabetes and its complications would lead to different cost-effectiveness ratios for ...
OBJECTIVE -We sought to study the occurrence of cardiometabolic risk variables, their clustering, and their association with insulin resistance among healthy adolescents in urban south India.RESEARCH DESIGN AND METHODS -School children aged 12-19 years (n ϭ 2,640; 1,323 boys and 1,317 girls) from diverse socioeconomic backgrounds were studied. Demographic, social, and medical details were obtained; anthropometry and blood pressure were measured. Fasting plasma glucose, insulin, and lipid profiles were measured. Clusters of risk variables were identified by factor analysis. Association of insulin resistance (homeostasis model assessment) with individual risk variables and their clusters were assessed.RESULTS -One or more cardiometabolic abnormalities (i.e., low HDL cholesterol, elevated triglycerides, fasting plasma glucose, or blood pressure) was present in 67.7% of children (in 64.8% of normal weight and 85% of overweight children). Insulin resistance was associated with the above abnormalities except HDL cholesterol. It also showed significant positive association with BMI, waist circumference, body fat percentage, and total cholesterol (P Ͻ 0.0001). Factor analysis identified three distinct clusters, with minor differences in the sexes: 1) waist circumference and blood pressure; 2) dyslipidemia, waist circumference, and insulin; and 3) waist circumference, glucose, and plasma insulin, with minor differences in the sexes. Insulin was a component of the lipid and glucometabolic cluster. In girls, it was a component of all three clusters.CONCLUSIONS -Cardiometabolic abnormalities are present in nearly 68% of young, healthy, Asian-Indian adolescents and even among those with normal weight. Insulin resistance is associated with individual cardiometabolic factors, and plasma insulin showed association with clustering of some variables. Diabetes Care 30:1828-1833, 2007I nsulin resistance is associated with obesity, type 2 diabetes, cardiovascular disease, and subclinical cardiometabolic risk markers, such as dyslipidemia, hypertension, and central adiposity (1,2). In fact, many have hypothesized that insulin resistance may be the common pathophysiological factor tying together a "syndrome" of cardiometabolic disturbance, affecting adiposity, glucose intolerance, dyslipidemia, and altered blood pressure control (2-4). On the other hand, the concept that such a syndrome exists has recently been challenged (5).The association between insulin resistance and cardiometabolic risk factors is often confounded once the disease sets in. The ideal population for examining these associations in depth would be one that is: 1) at high risk of insulin resistance, 2) young and has not yet acquired clinical disease, and 3) undergoing rapid environmental and lifestyle change.Asian Indians are at high risk of type 2 diabetes and cardiovascular disease and have an insulin-resistant phenotype, characterized by low muscle mass, upperbody adiposity, and high percentage of body fat (6,7). While insulin resistance runs in families and may h...
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