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Year : 1997  |  Volume : 51  |  Issue : 12  |  Page : 459-464

Prevalence of NIDDM in the general population (> 40 years) in Shimla

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
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Source of Support: None, Conflict of Interest: None

PMID: 9715545

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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 2016 May 27];51:459-64. Available from:

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 Top

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 Top

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 Top

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 Top

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 Top

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.  Back to cited text no. 1      
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.  Back to cited text no. 2      
3.Ahuja M.MS. Recent contribu­tions to the epidemiology of dia­betes mellitus in India. Intnl J Diab Dev Countries 1991:11:5-8.  Back to cited text no. 3      
4.Mather HM, Keen H. The South­hall diabetes survey: Prevalence of xnown diabetes in Asians and Euro­peans. Br Med J 1985:291:1081-84.  Back to cited text no. 4      
5.Census India. 1990, Government of India Press.  Back to cited text no. 5      
6.Ohmura T, Veda K, Iwamoto H. Prevalence of Type 2 (NIDDM) and IGT in the Japanese general popu­lation. Diabetalogia 1993;36:1198­1203.  Back to cited text no. 6      
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.  Back to cited text no. 7      
8.Baughan JP, Marrow RH. Manual of Epidemiology for District Health Management. W.H.O. Geneva 1989; 175-6 and 76-78.  Back to cited text no. 8      
9.Prevention of Diabetes Mellitus. W.H.O. Technical Report Series 1994;844.  Back to cited text no. 9      
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.  Back to cited text no. 10      
11.Ramachandran A, Dharamraj D, Snehlata C. Prevalence of glucose intolerance in Asian Indians. Dia­betes Care 1992:1348-55.  Back to cited text no. 11      
12.Ramachandran A, Jali MV, Mohan V, Vishwanathan M. High preva­lence of diabetes in an urban popu­lation in South India, 1988:297:587­90.  Back to cited text no. 12      
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.  Back to cited text no. 13      
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.  Back to cited text no. 14      
15.Zimmet P. Challenges in diabetes epidemiology from West to the rest. Diabetes Care, 1992;15:232-252.  Back to cited text no. 15      
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.  Back to cited text no. 16      


  [Table 1], [Table 2], [Table 3], [Table 4]

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