Burden and Socio-Behavioral Correlates of Uncontrolled Abnormal Glucose Metabolism in an Urban Population of India

• Published in: PloS one Vol. 11; no. 10; p. e0163891
• Main Authors: Mahapatra, Tanmay, Chakraborty, Kaushik, Mahapatra, Sanchita, Mahapatra, Umakanta, Pandey, Naren, Thomson, Peter L, Musk, Arthur W, Mitra, Ramendra N
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.10.2016; Public Library of Science (PLoS)
• Subjects: Abnormalities; Adult; Adults; Aged; Alcohol use; Alcoholic beverages; Analysis; Anthropometry; Behavior - physiology; Biology and Life Sciences; Blood Glucose - analysis; Blood Pressure; Body mass; Body Mass Index; Body size; Body weight; Confidence intervals; Cross-Sectional Studies; Demography; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; Diabetes therapy; Disease control; Epidemics; Female; Genetics; Glucose; Glucose - metabolism; Glycated Hemoglobin - analysis; Glycosylated hemoglobin; Hemoglobin; Hospitals; Households; Humans; Hypertension; Hypertension - epidemiology; India - epidemiology; Information technology; Insulin resistance; Male; Medical diagnosis; Medical research; Medicine and Health Sciences; Mercury; Metabolism; Middle Aged; Migration; Obesity; Older people; Overweight; People and Places; Physiological aspects; Population; Population studies; Prediabetic state; Prediabetic State - blood; Prediabetic State - epidemiology; Regression analysis; Risk Factors; Smoking; Statistical analysis; Studies; Urban Population; Urban populations; India; Australia; West Bengal India
• DOI: 10.1371/journal.pone.0163891
• ISSN: 1932-6203

Progressive burden of diabetes mellitus is a major concern in India. Data on the predictors of poor glycemic control among diabetics are scanty. A population-based cross-sectional study nested in an urban cohort was thus conducted in West Bengal, India to determine the burden and correlates of total and uncontrolled abnormalities in glucose metabolism (AGM) in a representative population. From 9046 adult cohort-members, 269 randomly selected consenting subjects (non-response = 7.24%) were interviewed, examined [blood pressure (BP), anthropometry], tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C). Those having pre-diagnosed diabetes or FPG ≥126 or HbA1c≥6.5 were defined as diabetic. Among non-diabetics, subjects with FPG (mg/dl) = 100-125 or HbA1C(%) = 5.7-6.4 were defined as pre-diabetic. Pre-diagnosed cases with current FPG ≥126 were defined as uncontrolled AGM. Descriptive and regression analyses were conducted using SAS-9.3.2. Among participants, 28.62% [95% Confidence Interval (95%CI) = 23.19-34.06)] were overweight [body mass index(BMI) = (25-29.99)kg/meter2], 7.81% (4.58-11.03) were obese(BMI≥30kg/meter2), 20.82% (15.93-25.70) were current smokers, 12.64% (8.64-16.64) were current alcohol-drinkers and 46.32% of responders (39.16-53.47) had family history of diabetes. 17.84% (13.24-22.45) had stage-I [140≤average systolic BP (AvSBP in mm of mercury)<160 or 90≤average diastolic BP (AvDBP)<100] and 12.64% (8.64-16.64) had stage-II (AvSBP≥160 or AvDBP≥160) hypertension. Based on FPG and HbA1c, 10.41% (6.74-14.08) were diabetic and 27.88% (22.49-33.27) were pre-diabetic. Overall prevalence of diabetes was 15.61% (11.25-19.98). Among pre-diagnosed cases, 46.43% (26.74-66.12) had uncontrolled AGM. With one year increase in age [Odds Ratio(OR) = 1.05(1.03-1.07)], retired subjects [OR = 9.14(1.72-48.66)], overweight[OR = 2.78(1.37-5.64)], ex-drinkers [OR = 4.66(1.35-16.12)] and hypertensives [ORStage I = 3.75(1.42-9.94); ORStage II = 4.69(1.67-13.17)] had higher odds of diabetes. Relatively older subjects [OR = 1.06(1.02-1.10)], unemployed [OR = 19.68(18.64-20.78)], business-owners [OR = 25.53(24.91-16.18)], retired [OR = 46.53(45.38-47.72)], ex-smokers [OR = 4.75(1.09-20.78)], ex-drinkers [OR = 22.43(4.62-108.81)] and hypertensives [ORStage II = 13.17(1.29-134.03)] were more likely to have uncontrolled AGM. Burden of uncontrolled AGM was high among participants. Efforts to curb the diabetes epidemic in urban India should include interventions targeting appropriate diabetic control among relatively older persons, unemployed, business-owners, retired, ex-smokers, ex-drinkers and hypertensives.