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ORIGINAL CONTRIBUTION |
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| Year : 1997 | Volume
: 51
| Issue : 12 | Page : 459-464 |
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Prevalence of NIDDM in the general population (> 40 years) in Shimla
D Dhadwal1, SK Ahluwalia1, DJ Das Gupta2, SS Kaushal2, R Yadav3, A Gupa1
1 Dept of Community Medicine: IG Med College Shimla, India
2 Dept of Medicine: IG Med College Shimla, India
3 Dept of Biochemistry : IG Med College Shimla, India
Correspondence Address:
D Dhadwal
Dept of Community Medicine: IG Med College Shimla
India
PMID: 9715545
How to cite this article:
Dhadwal D, Ahluwalia S K, Das Gupta D J, Kaushal S S, Yadav R, Gupa A. Prevalence of NIDDM in the general population (> 40 years) in Shimla. Indian J Med Sci 1997;51:459-64 |
How to cite this URL:
Dhadwal D, Ahluwalia S K, Das Gupta D J, Kaushal S S, Yadav R, Gupa A. Prevalence of NIDDM in the general population (> 40 years) in Shimla. Indian J Med Sci [serial online] 1997 [cited 2013 May 18];51:459-64. Available from: http://www.indianjmedsci.org/text.asp?1997/51/12/459/11485 |
Diabetes mellitus is one of the most prevalent non-communicable disease in the world and a modern threat to public health. [1] Being a slow onest and often a relatively asymptomatic diseases, non-insulin dependent diabetes mellitus (NIDDM) remains undiagnosed at onset and even if diagnosed, is often ignored by persons afflicted by it. [2] NIDDM today affects over 50 million people in the world and about one half of them are living in developing countries like India. [3]
Indians have a high ethnic susceptibility for developing diabetes. [4] With the demographic transition and urbanization, the burden of disease is expected to rise. As there is paucity of reliable estimates of burden of NIDDM and associated risk factors in our community in recent years using revised criteria, we conducted a screening programme in the urban population of Shimla town.
| ¤ Material and Methods | |  |
Shimla town is located at an altitude of 2213 mt. above sea level and covers an area of eighteen square kms. The area is undergoing rapid urbanization and the population of Shimla within municipal limits is 82,054. [5] Shimla is divided into 21 municipal wards. A two stage sampling with stratification followed by randomisation was used by clubbing wards into 7 strata consisting of 3 homogenous wards in each stratum. One ward was selected randomly from each stratum. Since NIDDM usually begins in middle years of life and beyond and thereafter it begins to rise in frequency, many studies have been conducted throughou the world on prevalence of NIDDM in population aged 40 years and above. [6],[7] So the target population was people with age 40 years and above. Based on review of literature and previous experience in the hospital, the sample size required was selected assuming maximum expected NIDDM prevalence of 10% with 5% margin of tolerance. Using tables, [8] this comes out to 139 or approximately 140 in each ward. So in seven wards, the minimum required sample size was 980. However, we screened 1195 subjects (140 to 190 from each of the wards) to further improve the limits of confidence.
A pretested semi-structured questionnaire on risk factors was used including height, weight, BP, waist, hip measurements. Screening was done by a capillary Ultra plus glucometer (Home Diagnostic Inc., USA) based on peroxidase reaction. Those persons having random blood capillary glucose values more than or equal to 120 mg/dl were evaluated by GTT later according to WHO criteria. [9]
Physical Activity Index (PAI)
Physical activity Index was calculated by questionnaire method, a subjective measure based on 24 hour recall of daily activities was selected. A composite score, (PAI) was calculated by summing up the products of hours at each level activity times weight factor based on oxygen consumption required for that activity as follows A person who sleeps continuously could receive a score of 24.[Additional file 1]
Similarly, labourer having 8 hours at basal level of activity, 8 hours a sedentary level, 2 hours at slight level, 3 hours at moderate level and 3 hours at a heavy level of activity would be having a composite scores of 42. PAI score was interpreted as follows : Mild physical activity - 24.0;-;28.9; Moderate physical activity - 29.0;-;36.9 , Heavy physical activity - 37.0 - 83.0.
Data was compiled and analysed on SPSS software for chi-square test. The study was in accordance with ethical guidelines embodied in the declaration of Helsinki.
| ¤ Results | | |
We screened 1195 subjects (715 males, 480 females), out of which, 58 (37 males and 21 females) were having diabetes i.e. a fasting venous plasma sugar level of 140 mg/dI and or a 2 hour after glucose load value of > 200 mg/dl.
Thus 4.86% of our subjects were having NIDDM, the prevalence of NIDDM being 5.17% in males and 4.38% in females. Of the diabetic cases, 38 were known diabetics and 20 were newly detected. The ratio of newly detected to known diabetics was 1:1.9 or 1:2 approximately. The prevalence of NIDDM increased with increasing age. It was 2.57% in the age group of 4049 years and 5.47% in the 50-59 years age group while it rose to 7.11 in the 60 and above age group. Family history of diabetes was present in 34.5% of the diabetic cases in the first degree relatives [Table 1].
Obesity was significantly associated with diabetes (NIDDM). In those having Body Mass Index (BMI) less than 25, the prevalence of NIDDM was 4.15% whereas this was 6.7%, in the obese individuals (BMI > 25). [Table 2]. The chis-quare was 3.88, p<.05.
Waist to hip ratio was also significantly associated with diabetes in both males and females [Table 3].
[Table 4] shows the distribution of physical activity among diabetics and non-diabetics individls. The prevalence of diabetes was more than two times higher in persons doing only mild physical activity as compared with other groups.
| ¤ Discussion | | |
The prevalence of NIDDM in our study was 4.86%. This is higher than the revised ICMR study of 1989-90 in which, the prevalence was 4.1 and the Darya Ganj survey where it was 3.1 %. [3],[10] However, this is lower than recent urban study in South India where prevalence of NIDDM in urban areas was 8.2%. [11] These differences may be due to different populations being studied. Heredity played a major role in the causation of NIDDM as is evident by presence of positive family history in more than one third of the diabetic cases. This finding is comparable with those of Ramachandran." We found that the prevalence of N'IDDM increased with increasing age. It was 2.57% in the stage group 40-49 years and it increased to 7.11% in 60 years and above age group. This is consistent with other epidemiological studies [4] ,[7],[11] The association between obesity and NIDDM observed in our study is in accordance wish ,he current evidence that increase in BMI is associated with the risk of developing NIDDM. [12],[13] Waist to Hip ratio was significantly associated with the development of NIDDM in our study. It is supported by many epidemiological studies conducted throughout the world. [11],[14] Ramachandran et al. [11] found WHR to be independently associated with the risk of developing NIDDM. The greater the WHR, the more is the risk of diabetes. Higher proportion of diabetic subjects were doing only mild physical activity than the normal subjects, which was statistically significant in our study. Several crossectional studies have shown 2 to 4 folds differences in NIDDM prevalence between the least ac' ive and the most active individuals. [15] Recently prospective studies have also shown that physical activity is associated with a reduced risk of NIDDM. [16] Thus, exercise appears to have a protective effect against NIDDM, possibly through improved insulin sensitivity, which can be accentuated by weight loss achieved through increased physical activity. [9] This fact seems to be particularly true in our study because the terrain of Shimla town is such, that most of the people of Shimla have to walk long distances daily (moderate physical activity). This appears to be one of the main reasons for low prevalence of NIDDM in population aged 40 years and above in Shimla town as compared with other urban cities of India.
| ¤ Summary | | |
A random survey for determining the prevalence of NIDDM was conducted in the population aged 40 years and above of Shimla town. 1195 subjects were screened for etsimation of NIDDM prevalence from seven randomly selected wards. The prevalence of NIDDM in age group 40 years and above was 4.86 (5.17% in males and 4.38% in females). NIDDM was found to be positively associated with increasing age, BMI, WHR, family history of diabetes and negatively wit physical activity. Stress should be on early detection of diabetes to reduce the heavy burden of morbidity and mortality caused by diabetes.
| ¤ References | | |
| 1. | World Health Organization. World Health Assembly Resolution 42.36 Prevention and control of diabetes mellitus. In : Handbook of Resolution (1085-89), Vol. III, 2nd Ed. Geneva W.H.O. 1990:71.  |
| 2. | Harris MI. Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4-7 years before linical diagnosis. Diabetes Care 1)92 ;15:815-819. |
| 3. | Ahuja M.MS. Recent contributions to the epidemiology of diabetes mellitus in India. Intnl J Diab Dev Countries 1991:11:5-8. |
| 4. | Mather HM, Keen H. The Southhall diabetes survey: Prevalence of xnown diabetes in Asians and Europeans. Br Med J 1985:291:1081-84. |
| 5. | Census India. 1990, Government of India Press. |
| 6. | Ohmura T, Veda K, Iwamoto H. Prevalence of Type 2 (NIDDM) and IGT in the Japanese general population. Diabetalogia 1993;36:11981203. |
| 7. | Garancini MP, Calori G, Ruotolo G. Prevalence of NIDDM and impaired glucose tolerance in Italy : an OGTT based population study. Diabetologia 1995;38:306-15. |
| 8. | Baughan JP, Marrow RH. Manual of Epidemiology for District Health Management. W.H.O. Geneva 1989; 175-6 and 76-78. |
| 9. | Prevention of Diabetes Mellitus. W.H.O. Technical Report Series 1994;844. |
| 10. | Verma NP, Mehta SP, Madhu S, Mather HM. Prevalence of known diabetics in an urban Indian Environment: The Daryagunj diabetes survey. Br Med J 1986;293:423-4. |
| 11. | Ramachandran A, Dharamraj D, Snehlata C. Prevalence of glucose intolerance in Asian Indians. Diabetes Care 1992:1348-55. |
| 12. | Ramachandran A, Jali MV, Mohan V, Vishwanathan M. High prevalence of diabetes in an urban population in South India, 1988:297:58790. |
| 13. | Chan JM, Rimn EB, Colditz GA, Stampfer M. Obesity, fat distribution and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:1-10. |
| 14. | Dopse GK, Zimmet P, Garebo H. George A. Abdominal Obesity and Physical Inactivity as Risk factors for NIDDM and IGT in Indian, Creole and Chinese Mauritians. Diabetes Care 1991:14:271-82. |
| 15. | Zimmet P. Challenges in diabetes epidemiology from West to the rest. Diabetes Care, 1992;15:232-252. |
| 16. | Helmrich SP, et al. Physical activity and reduced occurrence of Non-Insulin dependent diabetes mellitus. New Eng J Med 1991;323: 1.47-152. |
[Table 1], [Table 2], [Table 3], [Table 4]
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