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

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.

Secular TRends in DiabEtes in India (STRiDE–I): Change in Prevalence in 10 Years Among Urban and Rural Populations in Tamil Nadu

“…Our study shows that the prevalence of diabetes in 2016 is 21.9% in the city of Chennai. The estimate was similar to that reported by the Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study (26) in 2015, which was 22.8%. In that study, diagnosis of diabetes was made using the FPG and/or HbA 1c values.…”

Health-related quality of life variations by sociodemographic factors and chronic conditions in three metropolitan cities of South Asia: the CARRS study

“…Detailed baseline characteristics of the CARRS cohort are published elsewhere. [21][22][23][24] Briefly, the mean age was 42.4 (±13.3), 52.4% were female, 61% completed secondary schooling and the majority of respondents (72.5%) reported household income level <10 000 Indian rupees (US$200). Two-thirds (66%) of the study population had BMI ≥25, one-fifth (20%) of the respondents reported current tobacco use, and 37.5% had self-reported chronic conditions (hypertension, diabetes, heart disease, stroke or chronic kidney disease).…”

The rule of two-thirds in diabetes epidemiology

“…The proportion of diabetes to prediabetes was approximately 1:2 (i.e., one-third of total dysglycemia) in Chennai (22.8%:37.9% = 0.61), Karachi (16.3%:31.1% = 0.52), and Delhi (25.2%:47.6% = 0.54). [7]…”