ASSIGNMENT: WRITE A REVIEW ARTICLE ON CURRENT

BURDEN OF DIABETES AND PREDIABETES IN INDIA.

Instructions:

1. Choose five or more research articles supporting the topic

2. Write a systemic review compiling the data from all the scientific research articles
3. The review should not exceed 4-5 pages

Review title

A systematic review on prevalence and burden of prediabetes and diabetes in different

states of India (As per the results from INDIAB population-based cross-sectional study
conducted by ICMR)

Abstract

The studies conducted on diabetes were mostly region-specific. And thus ICMR decided to
study a load of prediabetes and diabetes nationwide by studying 57,117 individuals from 14
different states and one union territory of India. These different states were divided into 3
phases, with states belonging to similar regions of India in each phase. The capillary oral
glucose tolerance test conducted for this study did not allow differentiation between type 1
and type 2 diabetes. The prevalence of these conditions in each state was associated with
Socio-economic status (SES) of people as well as the GDP of that state. The statistical
analysis of the data collected stated that the states with higher GDP had a higher prevalence
of diabetes while the lower socio-economic group of urban areas from some affluent states
showed a higher prevalence of diabetes.

Introduction

Diabetes is a national epidemic, and it develops from the stage of prediabetes. India, being a
country with vast heterogeneity, there can be many factors impacting diabetes and pre-
diabetic condition. Many studies have been conducted in different regions of India. But the
samples belonged to different races, ethnicity, and culture. Thus, ICMR decided to know
about the exact burden of this disease on the nation, and as a result of this idea, they stated
the INDia DIABetes study, in which 14 states and one union territory of India was selected
for sampling.

The aim of this study was to generate firm information on heterogeneity in diabetes as well as
prediabetes phenotypes due to varied state, urban, rural and individual characteristics. Once
this data is generated, this can be made available to public health workers and other health
workers to curb this disease by targeting the factors. This study was conducted from the
samples that represented 50.7% of the Indian adult population, including those from the six
northeastern states of India where the least amount of studies have been conducted for the
prevalence of diabetes.

The previous studies were researched by browsing the platforms like PubMed, Google
Scholar, IndMED and Cochrane Database of Systematic Reviews.

Methods

1. Sampling:
The samples were collected from six northeastern states, five mainlands and four
affluent states included in phase 1. The adults with an age of 20 years or more were
selected for this study. Under this study, 11 states were considered, and estimated
sample size from each state was 4000, among which 2800 were rural, and 1200 were
from urban areas. Other factors considered while sampling was as follows:
a. The estimated prevalence of diabetes and prediabetes: 10% in urban areas and 4%
in rural areas
b. The relative precision of estimated prevalence: 20%
c. Alpha error: 5%
d. Non-response rate: 20%

Sampling strategies used:

a. Three-level stratified sampling: For obtaining a representative sample from the

population
b. Systematic sampling: For the selection of sample houses from rural as well as
urban areas.
c. WHO Kish method: For selecting a suitable sample from each house.

2. Demographic, behavioural, social, and economic assessment

Questionnaires were prepared for this assessment and were given to the selected
samples.

3. Anthropometric and clinical analysis

Following parameters were measured using standardized techniques, and the values
were studied against the normal cutoffs to derive inference from this analysis:
a. Bodyweight
b. Height
c. Waist circumference
d. Blood pressure
e. Calculation of BMI using body weight and height

Obesity was measured as generalized as well as abdominal obesity. Generalized

obesity was characterized by a BMI of 25kg/m2, whereas abdominal obesity was
characterized by waist circumference of 80cm or more for females and 90cm or more
for males.
 4. Biochemical analysis
a. Fasting capillary blood glucose was measured with a glucose meter.
b. Oral glucose tolerance test with an 82.5 g oral glucose load and 2h post-load CBG
was performed
5. Outcome assessment
Diabetes in the samples was characterized by:
a. Diabetes diagnosed by physicians
b. Presence of criteria mentioned in WHO consultation group reports for diabetes
and intermediate hyperglycemia

Prediabetes was characterized by:

a. Impaired fasting glucose

b. Impaired glucose tolerance
c. Both a and b
6. Statistical analysis
SAS version 9 was used to perform the following statistical analysis of the data:
a. Normalization of the sample parameters
b. Students t-test: For comparing continuous variables
c. ² test: For assessment of differences
d. Odds ratio were derived from multiple logistic regression analysis

Result and conclusion

The prevalence of diabetes was high in:

a. Mainland states
b. More economically developed states
c. People belonging to medium and high SES in rural areas
d. People belonging to low SES in urban areas

Limitations of the case study:

a. Casualty interferences were not allowed as it was a cross-sectional study

b. Tdeally, Venous plasma glucose estimations would have been appropriate for this
study as most of the studies similar to this used the comparison between venous
plasma glucose estimations and CBG.
c. Repeated blood tests were not performed for diabetes as recommended by WHO
d. HBA1C measurement cannot be performed as there was a high prevalence of anaemia
in the selected population

Fundings

1. Indian Council of Medical Research and Department of Health Research

2. Ministry of Health and Family Welfare
3. Government of India
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