Prevalence of diabetes and pre-diabetes in rural Tehri Garhwal, India

Influence of diagnostic method

Pam Anderson, Nathan Grills, Rajesh Singh, Rajkumari Singh, Roger G. Evans, Paramita Sengupta, Amanda G. Thrift

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: There are few available data regarding the prevalence of diabetes in the sub-Himalayan region of India. The aim of this study was to determine the prevalence of pre-diabetes and diabetes in rural Garhwal based on glycosylated hemoglobin. Methods: In a cross-sectional survey of 500 adults from five randomly selected villages in Chamba, a mountainous Tehri Garhwal district in Uttarakhand in north-west India, we determined the prevalence of diabetes (hemoglobin (Hb) A1c ≥ 6.5%) and pre-diabetes (5.7% ≤ HbA1c ≤ 6.4%). In a sub-sample of those diagnosed with diabetes or pre-diabetes (n = 140), fasting blood glucose (FBG, n = 117) or postprandial blood glucose (PBG, n = 23), and blood hemoglobin concentration, was measured at follow-up. Results: Based on HbA1c, 10.0% had diabetes and 56.4% pre-diabetes. Of those diagnosed as diabetic by HbA1c, 10 of 16 (62.5%) were diagnosed as diabetic by FBG (> 125 mg/dL) or PBG (≥200 mg/dL). In those diagnosed as pre-diabetic by HbA1c, only 55 of 124 (44.4%) were diagnosed as pre-diabetic by FBG (100-125 mg/dL) or PBG (140-199 mg/dL). A large proportion of these 140 individuals (67.1%) were moderately to severely anemic (Hb < 11.4 mg/dL). The diagnostic gap for pre-diabetes between HbA1c and FBG/PBG was similar for the groups with and without moderate to severe anemia. Conclusions: HbA1c and FBG/PBG have similar diagnostic performance for diabetes in this population. However, many individuals were diagnosed with pre-diabetes by HbA1c but not FBG/PBG. The relative excess diagnosis of pre-diabetes with HbA1c does not appear to be explained by anemia, an endemic condition in India. The prognostic significance of diagnosis of pre-diabetes by HbA1c but not FBG/PBG remains unknown, but merits investigation.

Original languageEnglish
Article number817
Number of pages8
JournalBMC Public Health
Volume19
Issue number1
DOIs
Publication statusPublished - 24 Jun 2019

Keywords

  • Anemia
  • Diabetes
  • Disadvantage
  • Fasting blood glucose
  • Glycosylated hemoglobin

Cite this

Anderson, Pam ; Grills, Nathan ; Singh, Rajesh ; Singh, Rajkumari ; Evans, Roger G. ; Sengupta, Paramita ; Thrift, Amanda G. / Prevalence of diabetes and pre-diabetes in rural Tehri Garhwal, India : Influence of diagnostic method. In: BMC Public Health. 2019 ; Vol. 19, No. 1.
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abstract = "Background: There are few available data regarding the prevalence of diabetes in the sub-Himalayan region of India. The aim of this study was to determine the prevalence of pre-diabetes and diabetes in rural Garhwal based on glycosylated hemoglobin. Methods: In a cross-sectional survey of 500 adults from five randomly selected villages in Chamba, a mountainous Tehri Garhwal district in Uttarakhand in north-west India, we determined the prevalence of diabetes (hemoglobin (Hb) A1c ≥ 6.5{\%}) and pre-diabetes (5.7{\%} ≤ HbA1c ≤ 6.4{\%}). In a sub-sample of those diagnosed with diabetes or pre-diabetes (n = 140), fasting blood glucose (FBG, n = 117) or postprandial blood glucose (PBG, n = 23), and blood hemoglobin concentration, was measured at follow-up. Results: Based on HbA1c, 10.0{\%} had diabetes and 56.4{\%} pre-diabetes. Of those diagnosed as diabetic by HbA1c, 10 of 16 (62.5{\%}) were diagnosed as diabetic by FBG (> 125 mg/dL) or PBG (≥200 mg/dL). In those diagnosed as pre-diabetic by HbA1c, only 55 of 124 (44.4{\%}) were diagnosed as pre-diabetic by FBG (100-125 mg/dL) or PBG (140-199 mg/dL). A large proportion of these 140 individuals (67.1{\%}) were moderately to severely anemic (Hb < 11.4 mg/dL). The diagnostic gap for pre-diabetes between HbA1c and FBG/PBG was similar for the groups with and without moderate to severe anemia. Conclusions: HbA1c and FBG/PBG have similar diagnostic performance for diabetes in this population. However, many individuals were diagnosed with pre-diabetes by HbA1c but not FBG/PBG. The relative excess diagnosis of pre-diabetes with HbA1c does not appear to be explained by anemia, an endemic condition in India. The prognostic significance of diagnosis of pre-diabetes by HbA1c but not FBG/PBG remains unknown, but merits investigation.",
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Prevalence of diabetes and pre-diabetes in rural Tehri Garhwal, India : Influence of diagnostic method. / Anderson, Pam; Grills, Nathan; Singh, Rajesh; Singh, Rajkumari; Evans, Roger G.; Sengupta, Paramita; Thrift, Amanda G.

In: BMC Public Health, Vol. 19, No. 1, 817, 24.06.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Prevalence of diabetes and pre-diabetes in rural Tehri Garhwal, India

T2 - Influence of diagnostic method

AU - Anderson, Pam

AU - Grills, Nathan

AU - Singh, Rajesh

AU - Singh, Rajkumari

AU - Evans, Roger G.

AU - Sengupta, Paramita

AU - Thrift, Amanda G.

PY - 2019/6/24

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N2 - Background: There are few available data regarding the prevalence of diabetes in the sub-Himalayan region of India. The aim of this study was to determine the prevalence of pre-diabetes and diabetes in rural Garhwal based on glycosylated hemoglobin. Methods: In a cross-sectional survey of 500 adults from five randomly selected villages in Chamba, a mountainous Tehri Garhwal district in Uttarakhand in north-west India, we determined the prevalence of diabetes (hemoglobin (Hb) A1c ≥ 6.5%) and pre-diabetes (5.7% ≤ HbA1c ≤ 6.4%). In a sub-sample of those diagnosed with diabetes or pre-diabetes (n = 140), fasting blood glucose (FBG, n = 117) or postprandial blood glucose (PBG, n = 23), and blood hemoglobin concentration, was measured at follow-up. Results: Based on HbA1c, 10.0% had diabetes and 56.4% pre-diabetes. Of those diagnosed as diabetic by HbA1c, 10 of 16 (62.5%) were diagnosed as diabetic by FBG (> 125 mg/dL) or PBG (≥200 mg/dL). In those diagnosed as pre-diabetic by HbA1c, only 55 of 124 (44.4%) were diagnosed as pre-diabetic by FBG (100-125 mg/dL) or PBG (140-199 mg/dL). A large proportion of these 140 individuals (67.1%) were moderately to severely anemic (Hb < 11.4 mg/dL). The diagnostic gap for pre-diabetes between HbA1c and FBG/PBG was similar for the groups with and without moderate to severe anemia. Conclusions: HbA1c and FBG/PBG have similar diagnostic performance for diabetes in this population. However, many individuals were diagnosed with pre-diabetes by HbA1c but not FBG/PBG. The relative excess diagnosis of pre-diabetes with HbA1c does not appear to be explained by anemia, an endemic condition in India. The prognostic significance of diagnosis of pre-diabetes by HbA1c but not FBG/PBG remains unknown, but merits investigation.

AB - Background: There are few available data regarding the prevalence of diabetes in the sub-Himalayan region of India. The aim of this study was to determine the prevalence of pre-diabetes and diabetes in rural Garhwal based on glycosylated hemoglobin. Methods: In a cross-sectional survey of 500 adults from five randomly selected villages in Chamba, a mountainous Tehri Garhwal district in Uttarakhand in north-west India, we determined the prevalence of diabetes (hemoglobin (Hb) A1c ≥ 6.5%) and pre-diabetes (5.7% ≤ HbA1c ≤ 6.4%). In a sub-sample of those diagnosed with diabetes or pre-diabetes (n = 140), fasting blood glucose (FBG, n = 117) or postprandial blood glucose (PBG, n = 23), and blood hemoglobin concentration, was measured at follow-up. Results: Based on HbA1c, 10.0% had diabetes and 56.4% pre-diabetes. Of those diagnosed as diabetic by HbA1c, 10 of 16 (62.5%) were diagnosed as diabetic by FBG (> 125 mg/dL) or PBG (≥200 mg/dL). In those diagnosed as pre-diabetic by HbA1c, only 55 of 124 (44.4%) were diagnosed as pre-diabetic by FBG (100-125 mg/dL) or PBG (140-199 mg/dL). A large proportion of these 140 individuals (67.1%) were moderately to severely anemic (Hb < 11.4 mg/dL). The diagnostic gap for pre-diabetes between HbA1c and FBG/PBG was similar for the groups with and without moderate to severe anemia. Conclusions: HbA1c and FBG/PBG have similar diagnostic performance for diabetes in this population. However, many individuals were diagnosed with pre-diabetes by HbA1c but not FBG/PBG. The relative excess diagnosis of pre-diabetes with HbA1c does not appear to be explained by anemia, an endemic condition in India. The prognostic significance of diagnosis of pre-diabetes by HbA1c but not FBG/PBG remains unknown, but merits investigation.

KW - Anemia

KW - Diabetes

KW - Disadvantage

KW - Fasting blood glucose

KW - Glycosylated hemoglobin

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