Indian diabetic risk score screening of rural adults in Tamil Nadu

INTRODUCTION

Diabetes is a major public health problem and the prevalence rate is increasing globally and reaching epidemic proportions.^[1] Diabetes is a chronic and metabolic disease pigeonholed by raised blood sugar levels which leads to grave impairment of the eyes, nerves, kidneys, heart, and blood vessels over time.^[2] Diabetes currently affects 425 million adults globally, a total that is set to reach 629 million by 2045.^[3]

It is a well-known fact that the Indian population is known to have an increased liability to develop diabetes mellitus. The race and genetic vulnerability of Asians manifest in diabetes when exposed to unfavorable lifestyles.^[4] The prevalence of diabetes in India among adults was 8.8% and a total of 73 million cases, which is the second highest in the world. Over half of the people living in the country are predicted to be undiagnosed, there is an urgency to escalate awareness and knowledge of diabetes and its associated complications among healthcare professionals to promote screening and early diagnosis to improve health outcomes and help save lives.^[5]

India is an agricultural predominant nation, where most adults are living in rural areas. About 72.2% of the population was living in rural areas. Rapid socioeconomic development in the Indian rural population is leading to a thespian lifestyle transition in the current scenario.^[6] A 1970s Indian council of medical research reported that the rural diabetes prevalence was 1% which in the 2000s, has increased to 4–10%.^[6] The national program for prevention and control of cancer, diabetes, cardiovascular disease, and stroke was implemented by the ministry of health and family welfare, Government of India in an attempt to plateau this exponential growth in non-communicable disease prevalence, with a primary focus on screening.^[7] In alignment with this goal, the present study reports the identification of high-risk candidates for developing Type-2 diabetes using the Indian diabetic risk score (IDRS) screening in rural Tamil Nadu.

MATERIALS AND METHODS

RESULTS

A total of 396 people were screened by the IDRS score in a rural area of Chengalpattu district. Among them, 187 (47.2%) were males and 209 (52.8%) were females. Most of the participants were aged more than 50 years (67.3%) and were Hindus (80.6%). Among the participants, 41.2% were illiterate, while 58.8% were literate which ranged from primary school to the professional degree. Around one-third of the participants were unemployed/housewives (Not-earning). Most of the participants (36.9%) were from the middle class, followed by the lower-middle class (27.3%), upper-middle class (18.9%), lower class (9.6%), and upper class (7.3%). Alcohol and tobacco use was seen in 17.4% and 19.4% of the study participants [Table 1].

Among the study participants, 54.2% (n = 198) were found to have a BMI within the normal range, 18.4% were underweight, 20.5% were overweight and obesity was seen in 6.8% of the participants [Figure 1].

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Figure 1:

Distribution of participants based on body mass index.

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Many of the participants, 68.9% were more than 50 years of age. A waist circumference of more than 80 cm for males and 90 cm for females was considered as the Asian cut-off for abdominal obesity was seen only in 53.8% of the participants. About 90% of the participants were found to have no family history and many of them were having either mild or moderate physical activity. Finally, the higher IDRS risk score was seen in 48.2% of participants, 47.2% had moderate risk, while only 3.5% had low risk [Table 2].

In the review of the association between gender and IDRS risk status using Pearson’s Chi-square test, a statistically significant association was observed [Table 3].

In the review of the association between BMI categorization and IDRS risk status using Pearson’s Chi-square test after yates continuity correction, a statistically significant association was not established [Table 4].

DISCUSSION

The Indian diabetes risk score was used in the study to identify the risk status of diabetics in rural adults. Mohan et al. developed IDRS, which was considered to be one of the strongest predictors of diabetes risk screening in India.^[7] It comprises two modifiable risk factors such as waist circumference and physical activity; and two non-modifiable risk factors such as age and family history of diabetes.

This study identified that only 3.5% were having low risk, whereas 47.2% and 48.2% were found to have moderate and severe risk, respectively. A similar study was conducted by Brinda et al.^[9] In the rural area of Karnataka have found that 26% had a lower risk, 49% had moderate risk and 26% had a higher risk. This difference could be due to the fact that the age of the participants was higher in our study and in a different geographical area. Another study done by Gupta et al.^[10] found that 31% of the population had a higher risk, and varied lifestyles could be the reason for this difference. As this study was conducted in urban areas, while our study was done in rural areas. Nandeshwar et al.^[1] in 2010 have shown that only 2.8% were at low risk, 28.4% had moderate risk, whereas 68.8% had high risk and Ranadip Chowdhury et al.^[11] in 2012 have shown that 46% had moderate risk and 31.5% had risk, which was similar to our findings.

In this study, 89% of the participants do not have any family history; this result was concurrent with the other studies done in similar settings. A study by Brinda et al.^[9] has shown that 91% of the participants had no family history and Patil et al.^[12] in their study found that 89% had no family history. Whereas, the study by Gupta et al.^[10] found that only 68% of participants had no family history of diabetes; this could be due to a lack of screening tests at the population level to detect diabetes mellitus.

A statistically significant association was found between gender and IDRS risk status, whereas no significant association was found between BMI category and IDRS risk status. A study by Brinda and Santosh^[9] had no significant association was found between BMI category, which was similar to our study findings. However, they found no significant difference between gender and risk status, this could be because our study had a higher female predominance

CONCLUSION

In our study, it was seen that almost half of the study participants belonged to the high-risk category using IDRS screening. Gender and IDRS risk status showed a statistically significant association, whereas no significant association was found between the BMI category and IDRS risk status. For the mass screening of diabetes, IDRS seems practically feasible and acceptable.