Research

The Prevalence and Management of Diabetes in Rural India

Very high levels of diabetes have been reported in urban areas of India (1), bur few data area available for rural regions where >70% of the population lives. Data from a new large-scale survey done in 2005 suggest rural India may soon experience the same epidemic of diabetes. A total of 4,535 individuals aged ≥ 30 years (response rate 84%, mean age 46.8 years) were sampled at random age and sex strata from 20 villages representative of Godavari, a developing rural area of Andhra Pradesh. Data were collected suing a structured questionnaire and a brief physical examination with fasting finger-prick blood glucose measured in all participants using B-Braun USV meters (Melsungen, Germany). Fasting venous samples were also done in a randome subsample of 1,0.70 individuals. Estimates of diabetes prevalence for the 20 villages were calculated by applying sampling weights derived from a cenus done in 2004 with diabetes defined by disease history and/or fasting glucose of 7.0 mmol or over.

On the basis of the finger-prick measurements, the prevalence of diabetes was 13.5% (95% CI 12.1-14.3), of which 6.4% (5.6-7.2) were known and 6.8% (5.9-7.6) were previously undiagnosed. A further 15.5% (14.2-16.8) had impaired fasting glucose (Table 1). Overall estimated mean fasting glucose levels from USV meters was 5.8 mmol/l (5.7-5.9). In the subsample, venous blood measurements gave a lower estimated mean glucose of 5.6 mmol/1 (5.7-5.9). In the subsample, venous blood measurements gave a lower estimated mean glucose of 5.6 mmol/1 (5.4-5.7). The systematically lower levels for the venous samples likely reflect the delay in assay, consequent upon transport of the samples to the local laboratory, and the higher finger-prick estimates are probably a more accurate reflections of the true prevalence of diabetes in this community.

Table -1

Of those with known diabetes, 67% (61-73) were taking oral hypoglycemic therapy, 3% (1-5) were using insulin, and 46% (40-53) were taking blood pressures-lowering agents. These relatively high levels of treatment suggest that even in fairly poor rural settings, proven preventive therapies are accessible to many and that strategies to improve detection and treatment rates could produce substantial health benefits.

While these data are by no means representative of rural India as a whole, they do provide a reasonably precise and reliable estimate of diabetes and its treatment in the study are. Since much of rural India is likely to develop to a similar or greater extent as the Godavari region of Andhra Pradesh (2), the data provide an early indication of the likely huge burden of diabetes that will occur in rural India in the coming few decades. The generation of new evidence about detection and management strategies suited to resource poor setting is an urgent public health priority for India.

Additional data form this study can be viewed at : http://www.thegeorgeinstitute.org/

CLARA K. CHOW, MBBS ^1,4
P. KRISHNAM RAJU, MBBS ³
RAMA RAJU, MBBS ²
K. SRINATH REDDY, MD ⁵
MAGNOLIA CARDONA, MPH ¹

DAVID S. CELERMAJER, PHD ^4,6

BRUCE C. NEAL, PHD ^1,4

From ¹The George Institute for International Health, Sydney, Australia; the ²Byrraju Foundation, Hyderabad, India; the ³CARE (cooperative for Assistance and Relief Every where) Foundation, Hyderabad, India; the ⁴Royal Prince Alfred Hospital, Sydney, Australia; the ⁵Centre for Chronic Disease Control, Delhi, India ; and the ⁶Department of Medicine, University of Sydney, Sydney, Australia.

Address correspondence to
Dr. Clara Chow, The George Institute for International Health,
P.O. Box M201, Missenden Road, Sydney, NSW 2050, Australia.
E-mail : cchow@thegeorgeinstitute.org

References

1. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, Rao PV, Yajnik CS, Prasanna Kumar KM, Nair JD, the Diabetes Epidemiology Study Group in India (DSEI): High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia 44:1094-1101,2001.

2. Yusuf S, Redd S, Ounpuu S, Anand S: Global burden or cardiovascular disease: part I: general considerations, the epidemiologic transition, risk factors, and impact or urbanization. Circulation 104:2746-2753,2001

Back