Diabetes in rural Pondicherry, India: a population-based study of the incidence and risk factors.
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Date
2013-07
Journal Title
Journal ISSN
Volume Title
Publisher
WHO Regional Office for South-East Asia
Abstract
Background: For India, the ‘diabetes capital’ of the world, it is essential to know
the incidence of type 2 diabetes mellitus (T2DM) and its key determinants. As
two thirds of Indians live in rural areas, a study was undertaken to assess the
incidence and risk factors of T2DM in rural Pondicherry, India.
Methods: In a population-based cohort study initiated in 2007, a sample of 1223
adults > 25 years of age from two villages of Pondicherry were selected using cluster
random sampling. Data on risk factor exposure were collected using a structured
questionnaire, anthropometric tests and fasting blood glucose assessment. During
house visits, 1223 of 1403 invited subjects participated. Of these, 71 (5.8%) were
found to have diabetes. In 2010–2011, 85% of the non-diabetics (979/1152) were
followed up using the same protocol. We calculated the risk of T2DM per annum
standardized by age and sex. Population estimates of the risk factors associated
with T2DM were analysed using the Generalized Estimating Equation model and
the Population Attributable Risk (PAR) for T2DM calculated.
Results: During 2937 person-years (PY) of follow-up, 63 new cases of T2DM
occurred, giving an incidence rate of 21.5/1000 PY. Almost one third (31.7%)
of cases occurred in people aged below 40 years. The incidence was double
among males (28.7/1000 PY; 95% confidence interval (CI): 21.0–38.7) compared
with females (14.6/1000 PY; 95% CI: 9.4–21.7). Applying these rates to rural
populations, it is estimated that each year 8.7 million people develop T2DM in
rural India. Nearly half of the T2DM incidence was attributed to overweight/obesity
and alcohol usage.
Conclusion: T2DM incidence was 2% per year in adults in rural Pondicherry,
India, with the rate increasing twice as fast in men. Increasing age, obesity, alcohol
use and a family history of T2DM independently predicted the development of
diabetes. As half of T2DM incidence was attributed to overweight/obesity and
alcohol use, health promotion interventions focusing on maintaining an optimal
weight and decreasing alcohol consumption may be effective in reducing the rise
in T2DM cases.
Description
Keywords
type 2 diabetes, incidence studies, risk factors, rural population, India
Citation
WHO South-East Asia Journal of Public Health 2013;2(3&4): 149-155.