Prevalence of diabetes and prediabetes in 15 states of India

results from the ICMR–INDIAB population-based cross-sectional study

Ranjit Mohan Anjana, Mohan Deepa, Rajendra Pradeepa, Jagadish Mahanta, Kanwar Narain, Hiranya Kumar Das, Prabha Adhikari, Paturi Vishnupriya Rao, Banshi Saboo, Ajay Kumar, Anil Bhansali, Mary John, Rosang Luaia, Taranga Reang, Somorjit Ningombam, Lobsang Jampa, Richard O. Budnah, Nirmal Elangovan, Radhakrishnan Subashini, Ulagamathesan Venkatesan & 31 others Ranjit Unnikrishnan, Ashok Kumar Das, Sri Venkata Madhu, Mohammed K. Ali, Arvind Pandey, Rupinder Singh Dhaliwal, Tanvir Kaur, Soumya Swaminathan, Viswanathan Mohan, Ranjit Mohan Anjana, Mohan Deepa, Rajendra Pradeepa, Jagadish Mahanta, Kanwar Narain, Hiranya Kumar Das, Prabha Adhikari, Paturi Vishnupriya Rao, Banshi Saboo, Ajay Kumar, Anil Bhansali, Mary John, Rosang Luaia, Taranga Reang, Somorjit Ningombam, Lobsang Jampa, Richard O. Budnah, Nirmal Elangovan, Radhakrishnan Subashini, Arvind Pandey, Sathish B. Rao, ICMR–INDIAB Collaborative Study Group

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research–INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state. Methods We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes. Findings The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0–7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7–5·0) to 10·0% (8·7–11·2) in Punjab and was higher in urban areas (11·2%, 10·6–11·8) than in rural areas (5·2%, 4·9–5·4; p<0·0001) and higher in mainland states (8·3%, 7·9–8·7) than in the northeast (5·9%, 5·5–6·2; p<0·0001). Overall, 1862 (47·3%) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13·6%, 12.8–15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3% (10·0–10·6). The prevalence of prediabetes varied from 6·0% (5·1–6·8) in Mizoram to 14·7% (13·6–15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas. Interpretation There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures. Funding Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Original languageEnglish
Pages (from-to)585-596
Number of pages12
JournalThe Lancet Diabetes and Endocrinology
Volume5
Issue number8
DOIs
Publication statusPublished - 01-08-2017

Fingerprint

Prediabetic State
India
Cross-Sectional Studies
Population
Gross Domestic Product
Social Class
Glucose Intolerance
Family Health
Vulnerable Populations
Glucose Tolerance Test
Type 1 Diabetes Mellitus

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Anjana, R. M., Deepa, M., Pradeepa, R., Mahanta, J., Narain, K., Das, H. K., ... ICMR–INDIAB Collaborative Study Group (2017). Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study. The Lancet Diabetes and Endocrinology, 5(8), 585-596. https://doi.org/10.1016/S2213-8587(17)30174-2
Anjana, Ranjit Mohan ; Deepa, Mohan ; Pradeepa, Rajendra ; Mahanta, Jagadish ; Narain, Kanwar ; Das, Hiranya Kumar ; Adhikari, Prabha ; Rao, Paturi Vishnupriya ; Saboo, Banshi ; Kumar, Ajay ; Bhansali, Anil ; John, Mary ; Luaia, Rosang ; Reang, Taranga ; Ningombam, Somorjit ; Jampa, Lobsang ; Budnah, Richard O. ; Elangovan, Nirmal ; Subashini, Radhakrishnan ; Venkatesan, Ulagamathesan ; Unnikrishnan, Ranjit ; Das, Ashok Kumar ; Madhu, Sri Venkata ; Ali, Mohammed K. ; Pandey, Arvind ; Dhaliwal, Rupinder Singh ; Kaur, Tanvir ; Swaminathan, Soumya ; Mohan, Viswanathan ; Anjana, Ranjit Mohan ; Deepa, Mohan ; Pradeepa, Rajendra ; Mahanta, Jagadish ; Narain, Kanwar ; Das, Hiranya Kumar ; Adhikari, Prabha ; Rao, Paturi Vishnupriya ; Saboo, Banshi ; Kumar, Ajay ; Bhansali, Anil ; John, Mary ; Luaia, Rosang ; Reang, Taranga ; Ningombam, Somorjit ; Jampa, Lobsang ; Budnah, Richard O. ; Elangovan, Nirmal ; Subashini, Radhakrishnan ; Pandey, Arvind ; Rao, Sathish B. ; ICMR–INDIAB Collaborative Study Group. / Prevalence of diabetes and prediabetes in 15 states of India : results from the ICMR–INDIAB population-based cross-sectional study. In: The Lancet Diabetes and Endocrinology. 2017 ; Vol. 5, No. 8. pp. 585-596.
@article{afb7509d63be46f4a9ee1328c89f63c0,
title = "Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study",
abstract = "Background Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research–INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state. Methods We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes. Findings The overall prevalence of diabetes in all 15 states of India was 7·3{\%} (95{\%} CI 7·0–7·5). The prevalence of diabetes varied from 4·3{\%} in Bihar (95{\%} CI 3·7–5·0) to 10·0{\%} (8·7–11·2) in Punjab and was higher in urban areas (11·2{\%}, 10·6–11·8) than in rural areas (5·2{\%}, 4·9–5·4; p<0·0001) and higher in mainland states (8·3{\%}, 7·9–8·7) than in the northeast (5·9{\%}, 5·5–6·2; p<0·0001). Overall, 1862 (47·3{\%}) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13·6{\%}, 12.8–15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3{\%} (10·0–10·6). The prevalence of prediabetes varied from 6·0{\%} (5·1–6·8) in Mizoram to 14·7{\%} (13·6–15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas. Interpretation There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures. Funding Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.",
author = "Anjana, {Ranjit Mohan} and Mohan Deepa and Rajendra Pradeepa and Jagadish Mahanta and Kanwar Narain and Das, {Hiranya Kumar} and Prabha Adhikari and Rao, {Paturi Vishnupriya} and Banshi Saboo and Ajay Kumar and Anil Bhansali and Mary John and Rosang Luaia and Taranga Reang and Somorjit Ningombam and Lobsang Jampa and Budnah, {Richard O.} and Nirmal Elangovan and Radhakrishnan Subashini and Ulagamathesan Venkatesan and Ranjit Unnikrishnan and Das, {Ashok Kumar} and Madhu, {Sri Venkata} and Ali, {Mohammed K.} and Arvind Pandey and Dhaliwal, {Rupinder Singh} and Tanvir Kaur and Soumya Swaminathan and Viswanathan Mohan and Anjana, {Ranjit Mohan} and Mohan Deepa and Rajendra Pradeepa and Jagadish Mahanta and Kanwar Narain and Das, {Hiranya Kumar} and Prabha Adhikari and Rao, {Paturi Vishnupriya} and Banshi Saboo and Ajay Kumar and Anil Bhansali and Mary John and Rosang Luaia and Taranga Reang and Somorjit Ningombam and Lobsang Jampa and Budnah, {Richard O.} and Nirmal Elangovan and Radhakrishnan Subashini and Arvind Pandey and Rao, {Sathish B.} and {ICMR–INDIAB Collaborative Study Group}",
year = "2017",
month = "8",
day = "1",
doi = "10.1016/S2213-8587(17)30174-2",
language = "English",
volume = "5",
pages = "585--596",
journal = "The Lancet Diabetes and Endocrinology",
issn = "2213-8587",
publisher = "Elsevier BV",
number = "8",

}

Anjana, RM, Deepa, M, Pradeepa, R, Mahanta, J, Narain, K, Das, HK, Adhikari, P, Rao, PV, Saboo, B, Kumar, A, Bhansali, A, John, M, Luaia, R, Reang, T, Ningombam, S, Jampa, L, Budnah, RO, Elangovan, N, Subashini, R, Venkatesan, U, Unnikrishnan, R, Das, AK, Madhu, SV, Ali, MK, Pandey, A, Dhaliwal, RS, Kaur, T, Swaminathan, S, Mohan, V, Anjana, RM, Deepa, M, Pradeepa, R, Mahanta, J, Narain, K, Das, HK, Adhikari, P, Rao, PV, Saboo, B, Kumar, A, Bhansali, A, John, M, Luaia, R, Reang, T, Ningombam, S, Jampa, L, Budnah, RO, Elangovan, N, Subashini, R, Pandey, A, Rao, SB & ICMR–INDIAB Collaborative Study Group 2017, 'Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study', The Lancet Diabetes and Endocrinology, vol. 5, no. 8, pp. 585-596. https://doi.org/10.1016/S2213-8587(17)30174-2

Prevalence of diabetes and prediabetes in 15 states of India : results from the ICMR–INDIAB population-based cross-sectional study. / Anjana, Ranjit Mohan; Deepa, Mohan; Pradeepa, Rajendra; Mahanta, Jagadish; Narain, Kanwar; Das, Hiranya Kumar; Adhikari, Prabha; Rao, Paturi Vishnupriya; Saboo, Banshi; Kumar, Ajay; Bhansali, Anil; John, Mary; Luaia, Rosang; Reang, Taranga; Ningombam, Somorjit; Jampa, Lobsang; Budnah, Richard O.; Elangovan, Nirmal; Subashini, Radhakrishnan; Venkatesan, Ulagamathesan; Unnikrishnan, Ranjit; Das, Ashok Kumar; Madhu, Sri Venkata; Ali, Mohammed K.; Pandey, Arvind; Dhaliwal, Rupinder Singh; Kaur, Tanvir; Swaminathan, Soumya; Mohan, Viswanathan; Anjana, Ranjit Mohan; Deepa, Mohan; Pradeepa, Rajendra; Mahanta, Jagadish; Narain, Kanwar; Das, Hiranya Kumar; Adhikari, Prabha; Rao, Paturi Vishnupriya; Saboo, Banshi; Kumar, Ajay; Bhansali, Anil; John, Mary; Luaia, Rosang; Reang, Taranga; Ningombam, Somorjit; Jampa, Lobsang; Budnah, Richard O.; Elangovan, Nirmal; Subashini, Radhakrishnan; Pandey, Arvind; Rao, Sathish B.; ICMR–INDIAB Collaborative Study Group.

In: The Lancet Diabetes and Endocrinology, Vol. 5, No. 8, 01.08.2017, p. 585-596.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prevalence of diabetes and prediabetes in 15 states of India

T2 - results from the ICMR–INDIAB population-based cross-sectional study

AU - Anjana, Ranjit Mohan

AU - Deepa, Mohan

AU - Pradeepa, Rajendra

AU - Mahanta, Jagadish

AU - Narain, Kanwar

AU - Das, Hiranya Kumar

AU - Adhikari, Prabha

AU - Rao, Paturi Vishnupriya

AU - Saboo, Banshi

AU - Kumar, Ajay

AU - Bhansali, Anil

AU - John, Mary

AU - Luaia, Rosang

AU - Reang, Taranga

AU - Ningombam, Somorjit

AU - Jampa, Lobsang

AU - Budnah, Richard O.

AU - Elangovan, Nirmal

AU - Subashini, Radhakrishnan

AU - Venkatesan, Ulagamathesan

AU - Unnikrishnan, Ranjit

AU - Das, Ashok Kumar

AU - Madhu, Sri Venkata

AU - Ali, Mohammed K.

AU - Pandey, Arvind

AU - Dhaliwal, Rupinder Singh

AU - Kaur, Tanvir

AU - Swaminathan, Soumya

AU - Mohan, Viswanathan

AU - Anjana, Ranjit Mohan

AU - Deepa, Mohan

AU - Pradeepa, Rajendra

AU - Mahanta, Jagadish

AU - Narain, Kanwar

AU - Das, Hiranya Kumar

AU - Adhikari, Prabha

AU - Rao, Paturi Vishnupriya

AU - Saboo, Banshi

AU - Kumar, Ajay

AU - Bhansali, Anil

AU - John, Mary

AU - Luaia, Rosang

AU - Reang, Taranga

AU - Ningombam, Somorjit

AU - Jampa, Lobsang

AU - Budnah, Richard O.

AU - Elangovan, Nirmal

AU - Subashini, Radhakrishnan

AU - Pandey, Arvind

AU - Rao, Sathish B.

AU - ICMR–INDIAB Collaborative Study Group

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research–INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state. Methods We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes. Findings The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0–7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7–5·0) to 10·0% (8·7–11·2) in Punjab and was higher in urban areas (11·2%, 10·6–11·8) than in rural areas (5·2%, 4·9–5·4; p<0·0001) and higher in mainland states (8·3%, 7·9–8·7) than in the northeast (5·9%, 5·5–6·2; p<0·0001). Overall, 1862 (47·3%) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13·6%, 12.8–15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3% (10·0–10·6). The prevalence of prediabetes varied from 6·0% (5·1–6·8) in Mizoram to 14·7% (13·6–15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas. Interpretation There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures. Funding Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

AB - Background Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research–INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state. Methods We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes. Findings The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0–7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7–5·0) to 10·0% (8·7–11·2) in Punjab and was higher in urban areas (11·2%, 10·6–11·8) than in rural areas (5·2%, 4·9–5·4; p<0·0001) and higher in mainland states (8·3%, 7·9–8·7) than in the northeast (5·9%, 5·5–6·2; p<0·0001). Overall, 1862 (47·3%) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13·6%, 12.8–15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3% (10·0–10·6). The prevalence of prediabetes varied from 6·0% (5·1–6·8) in Mizoram to 14·7% (13·6–15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas. Interpretation There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures. Funding Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

UR - http://www.scopus.com/inward/record.url?scp=85020282159&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020282159&partnerID=8YFLogxK

U2 - 10.1016/S2213-8587(17)30174-2

DO - 10.1016/S2213-8587(17)30174-2

M3 - Article

VL - 5

SP - 585

EP - 596

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

SN - 2213-8587

IS - 8

ER -