Abstract

---

Background: Diabetes mellitus is a metabolic disorder and major health problem of all the countries. Low and middle income countries face the greatest burden of diabetes mellitus. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. Objectives: The main objective of this was to find out the prevalence of diabetes mellitus in urban and rural area of India and Nepal. Methods: Published research articles, books, bulletins, and online materials regarding to diabetes mellitus were studied both in national and international scenarios. Results: Diabetes in urban Indians is reaching an epidemic and the prevalence of type 2 diabetes mellitus in Asian Indians ranges from 2.7% in rural India to 14% in urban India. The latest report the total percentage of new and old cases of diabetes mellitus was 19.78%, 16.06% in males and 22.04% in females of Karnataka, India. Diabetes prevalence was 25.9% and higher proportion of diabetes was demonstrated in male (27.1%) than the females (24.8%) in Kathmandu valley of Nepal. All studies were showed the higher prevalence of diabetes in India and Nepal. Conclusion: Nationwide prevalence surveys of diabetes have never been undertaken in India and Nepal. Thus, the true magnitude of diabetes has remained unknown in both the country.

Background

---

Diabetes mellitus is one of the most common chronic diseases in nearly all countries, and continues to increase in numbers and significance, as changing lifestyles lead to reduced physical activity, and increased obesity. It is resulting from a defect in insulin secretion, insulin action, or both. Insulin deficiency in turn leads to chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism [1-3]. Diabetes mellitus may be categorized into several types but the two major types are type 1(Insulin Dependent Diabetes Mellitus) and type 2 (Non Insulin Dependent Diabetes Mellitus) [4, 5]. Type 1 diabetes mellitus is present in patients who have little or no endogenous insulin secretary capacity and who therefore require insulin therapy for survival [5, 6].  Type 2 diabetes is the commonest form of diabetes and is characterized by disorders of insulin secretion and insulin resistance [7] and about 90% of people with diabetes around the world have type 2. It is largely the result of excess body weight and physical inactivity [8] and common in individuals over the age of 40. There is a higher incidence of type 2 diabetes in urban than in rural areas [9] as well as  incidence is associated with population whose lifestyle has changed from traditional patterns to a modern “Westernized” model [10]. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The diabetes mellitus in urban population in developing countries is projected to double between 2000 and 2030 [11]. About 1.1 million people were estimated to have died due to diabetes in 2005 and almost 80% of diabetes deaths occur in low- and middle-income countries and mostly people under the age of 70 years; 55% of diabetes deaths are in women [12]. The current study was designed with an objective to assess the prevalence of diabetes mellitus on population of India and Nepal.

Methods

---

This review paper was prepared with extensive study of published articles that were available in web of science database, open access materials in the Google, books, institutional bulletins, and online material from the reliable sources. It coverage of more than 20 materials published from 1987 to 2011 both nationally and internationally. This review paper explores the magnitude of the constraints and factors that may contribute to the prevalence of diabetes mellitus in Nepal and India in relation to the global and regional scenario.  

Data abstraction and analysis:
Before preparing this review, it was attempted to collect as many published materials as possible regarding diabetes mellitus in India and Nepal. The prevalence of diabetes mellitus, types, etiology, epidemiology in India, Nepal and world etc. were the key words used for searching related materials in the web, library, and in institutions. The major findings in each research have been highlighted and the prevalence of diabetes mellitus has been discussed throughout this review paper.

Result

---

Diabetes mellitus in India:

India is often referred as the diabetes capital of the world. It is currently experiencing an epidemic of type 2 diabetes mellitus and has the largest number of diabetic patients [13]. The International Diabetes Federation 2009 report reveals that the total number of diabetic subjects in India is 50.8 million [14]. The Prevalence of diabetes in India study reported an age-standardized prevalence of 4.3%, 4.4% and 4.5% for all adults, and males and females, respectively [15]. However, more recent studies based on urban populations or rapidly developing regions have reported a higher prevalence of diabetes i.e.10.1% [16, 17],while other studies from rural Indian populations have demonstrated an even higher prevalence i.e.12.5%–13.2% [18, 19]. Diabetes in urban Indians is reaching an epidemic and the prevalence of type 2 diabetes mellitus in Asian Indians ranges from 2.7% in rural India to 14% in urban India [20, 21]. A study conducted by Ramachandran et al showed the prevalence of diabetes in an urban Indian population has significantly increased from 8.3% in 1989 to 18.6% in 2005, and during the same period a similar increase from 2.2% to 9.2% was observed in a rural Indian population [22].

According to the Zaman et al latest report the total percentage of new and old cases of diabetes mellitus was 19.78%, 16.06% in males and 22.04% in females (Table 1). They also observed the frequency of diabetic cases was highest in the 50-59 years age group (32.10%) [23].Ravikumar et al reported the age-standardized prevalence of diabetes (11.1%) and pre-diabetes (13.2%) study were conducted at Chandigarh, India [24].

Table 1: prevalence of diabetes mellitus in rural India

Author (first name)	Location		Prevalence (%)
		Males	Females	Total
Zaman [23]	Karnataka	16.06	22.04	19.78
Vijayakumar [19]	Kerala	16.5	13.5	12.5
Balagopal [25]	Tamilnadu	6.2	4.4	5.1
Ramachandran [22]	Tamilnadu	10.4	8.0	9.2
Khatib [26]	Wardha	8.8	8.1	8.5
Deo [27]	Maharashtra	9.2	9.9	9.3
Chow [18]	Andhra Pradesh	14.3	12.0	13.2
Basavanagowdappa [28]	Mysore	4.58	2.66	3.77
Sadikot [15]	National	2.5	2.5	2.7
Zargar [29]	Kashmir	3.5	4.5	4.0

 

Diabetes mellitus in Nepal

Diabetes is an endemic disease in Nepal, and is bringing new challenges in connection with rapid urbanization and modernization [30]. A survey conducted in urban Nepal between 2001 and 2002 showed that 10.8% and 13.2% of males suffered from diabetes and pre-diabetes respectively, with the values for females being 6.9% and 10.2%, respectively [31]. The Nepal Diabetes Association reported that diabetes affects approximately 15% of people ≥ 20 years and 19% of people ≥ 40 years of age in urban areas [32]. According to WHO, diabetes affects more than 436,000 people in Nepal, and this number will rise to 1,328,000 by 2030 [33]. The percentage of diabetic patients has increased from 19.04% in 2002 to 25.9% in 2009 in Nepal [34].

The study conducted by Chhetri et al showed diabetes prevalence was 25.9% and higher proportion of diabetes was demonstrated in male (27.1%) than the females (24.8%) in Kathmandu valley of Nepal [35]. Mehta et al reported the prevalence of diabetes mellitus in people of urban and rural area were 22.8% and 20.0% respectively (Table 2) [36].

Table 2: Prevalence of diabetes mellitus according area of residence in Nepal

Author (FirstName)		Urban area (%)			Rural area (%)
	Male	Females	Total	Males	Females	Total
Mehta [36]	-	-	22.8	-	-	20.0
Singh [37]	14.9	14.3	14.6	4.1	1.2	2.5
Shrestha [31]	10.8	6.9	8.5	-	-	-

 

The data published in April 2011by WHO showed deaths due to diabetes mellitus reached 3,224 (2.17%) of the total deaths in Nepal[38].

This may be due to changes in life style, urbanization and physical inactivity. A strong association is well recognized between the presence of diabetes, hypertension, chronic kidney disease and cardiovascular diseases [39]. A study conducted by Mittal et al in Phokhara valley showed diabetic  patients in between 41-100 years were 2.8 times more at risk of developing kidney disease as compared to age group (0-40 years)(Odds Ratio=2.8, p=0.0001). Diabetic patients were twice at risk of developing kidney disease than non diabetics (Odds Ratio=1.97, p=0.001) [40].

Discussion

---

This is an updated review of the diabetes mellitus in India and Nepal focused in prevalence status in males and females as well as in rural and urban area. Diabetic mellitus is a metabolic disorder, characterized by hyperglycemia may be due to insulin deficiency or insulin resistance [41]. The global diabetes prevalence in the age group 20-79 years were estimated to be 6.6% for the year 2010 which translates into 285 million people suffering from diabetes, according to international diabetes federation diabetes atlas [42].  The reasons for increasing prevalence are not clearly evident but changes in lifestyle and physical inactivity can be an important contributor. Low and middle income countries face the greatest burden of diabetes. A study conducted by Zaman et al showed higher prevalence of diabetes (19.78%) in Karnataka [23] as well as Vijaykumar et al also showed higher prevalence of diabetes (12.5%) in Kerala, south India. Many villages in south India especially Kerala and Karnataka have undergone a marked change in living standards and lifestyles on account of the influx of money in recent years from people working abroad in the Gulf States and other affluent countries higher prevalence of diabetes could be expected in south India especially Kerala since it has the highest proportion of elderly in India [19]. The prevalence of diabetes was more in women (22.04%) compare to men (16.06%) in Karnataka people [23].
Mehta et al showed higher prevalence of diabetes in people staying in Sunsari district, eastern Nepal [36]. Nepal is a developing country and people are changing their lifestyle like anything, they like to work by not doing hard work, this are making people physically inactive which is risk factor for development of obesity as well as diabetes. The prevalence of diabetes is increasing day by day in Nepal may be due to urbanization. Mehta et al and Singh et al showed the prevalence of diabetes in urban area were higher in compare to the rural area [36, 37].

Prevention:
There is an urgent need of educating the public about diabetes risk factors, prevention, and complications, using clear and simple messages. Global evidence shows that awareness strengthens national  policy  efforts  and  improves  health  outcomes.

Conclusion

---

Nationwide prevalence surveys of diabetes have never been undertaken in India and Nepal and there are few published reports of population prevalence of diabetes. Thus, the true magnitude of diabetes has remained unknown. To get actual data for the prevalence of diabetes mellitus in India and Nepal requires the nationwide study in the future.

 

References

---

1. Kumar PJ, Clark M. Textbook of Clinical Medicine. Pub: Saunders (London) 2002; pp 1099-1121.
2. Beverley B, Eschwège E. The diagnosis and classification of diabetes and impaired glucose tolerance. In: Textbook of Diabetes 1 Ed: John C Pickup and Gareth Williams Third edition 2003; pp 2.1-2.11.
3. Lindblad U, Lindberg G, Mansson NO et al. can sulphonylurea addition to lifestyle changes help to delay diabetes development in subjects with impaired fasting glucose? The Nepi a antidiabetes study (NANSY). Diabetes Obes Metab 2011; 13:185-8.
4. Diabetes mellitus. Report of a WHO study group technical report series 727. Geneva, World Health Organization 1985; pp113.
5. Zimmet P, Cowie C, Ekoe JM, et al. Classification of diabetes mellitus and other categories of glucose intolerance. International Textbook of Diabetes Mellitus chapter 1, 3rd Ed., 2004; 3-14.
6. Atkinson MA, Maclaren NK. The pathogenesis of insulin-dependent diabetes mellitus. N Engl J Med 1994; 331: 1428-36.
7. DeFronzo RA, Bonadonna RC, Ferrannini E. Pathogenesis of NIDDM. In Albert KGMM, Zimmet P, DeFronzo RA (eds) International Textbook of Diabetes Mellitus, 2nd edn. Chichester: Wiley, 1997; pp 635-712.
8. Diabetes Fact Sheet, WHO, November 2008  (http://www.who.int/mediacentre/factsheets/fs312/en/)
9. King H, Aubert R, Herman W. Global burden of diabetes, 1995-2025. Prevalence, numerical estimates and projections. Diabetes Care 1998; 21: 1414-31.
10. Bloomgarden ZT. American Diabetes Association annual meeting 1996: the etiology of type II diabetes, obesity, and the treatment of type II diabetes. Diabetes Care 1996; 19: 1311-15.
11. Sarah Wild, MB BCHIR et al. Global prevalence of Diabetes. Diabetes Care 2004; 27:1047-53.
12. Gabriel NS. The global pandemic of diabetes: an update. African health 2009; 50-4.
13. International Diabetes Federation. Diabetes atlas, 3rd ed., Brussels: International Diabetes Federation 2006
14. http://www.idf.org/latest-diabetes-figures-paint-grimglobal-picture
15. Sadikot SM, Nigam A, Das S. et al: The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes in India study (PODIS). Diabetes Res Clin Pract 2004; 66:301–7.
16. Menon VU, Kumar KV, Gilchrist A. et al. Prevalence of known and undetected diabetes and associated risk factors in central Kerala–ADEPS. Diabetes Res Clin Pract 2006; 74:289–94.
17. Ajay VS, Prabhakaran D, Jeemon P, Thankappan KR. et al.  Prevalence and determinants of diabetes mellitus in the Indian industrial population. Diabet Med 2008; 25:1187–94.
18. Chow CK, Raju PK, Raju R. et al. The prevalence and management of diabetes in rural India. Diabetes Care 2006; 29:1717–8.
19. Vijayakumar G, Arun R, Kutty VR: High prevalence of type 2 diabetes mellitus and other metabolic disorders in rural Central Kerala. J Assoc Physicians India 2009; 57:563–7.
20. Wild S, Roglic G, Green A. et al. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047-53.
21. Gupta A, Gupta R, Sarna M et al. Prevalence of diabetes, impaired fasting glucose and insulin resistance syndrome in an urban Indian population. Diabetes Res Clin Pract 2003; 61:69-76.
22. Ramachandran A, Mary S, Yamuna A. et al. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care 2008; 31:893–8.
23. Zaman FA, Pal R, Zaman GS. et al. Glucose indices, frank and undetected diabetes in relation to hypertension and anthropometry in a south Indian rural population. Indian Journal of Public Health 2011; 55:34-7.
24. Ravikumar P, Bhansali A, Ravikiran M. et al. prevalence and risk factors of diabetes in a community-based study in north India: the Chandigarh urban diabetes study (CUDS). Diabetes Metab 2011; 37:216-21.       
25. Balagopal P, Kamalamma N, Patel TG et al. A community based diabetes prevention and management education program in a rural village in India. Diab Care 2008; 31:1097–104.
26. Khatib NM, Quazi ZS, Gaidhane AM, et al. Risk factors of type 2 diabetes mellitus in rural Wardha; a community based study. Int J Diab Dev Ctries 2008; 28:79–82.
27. Deo SS, Zantye A, Mokal R, et al. To identify the risk factors for high prevalence of diabetes and impaired glucose tolerance in Indian rural population. Int J diab Dev Ctries 2006; 26:19–23.
28. Basavanagowdappa H, Prabhakar AK, Prasannaraj P, et al. Study of prevalence of diabetes mellitus and impaired fasting glucose in a rural population. Int J Diab Dev Ctries 2005; 25:98–101.
29. Zargar AH, Khan AK, Masoodi SR, et al. Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent. Diab Res Clin Pract 2000; 47:135–46.
30. Subedi S, Subedi KU, Bandhu BP. Doctors role in early detection of diabetic retinopathy and prevention of blindness from its complications. J Nepal Med Assoc 2005; 44: 26-30
31. Shrestha UK, Singh DL, Bhattarai MD. The prevalence of hypertension and diabetes defined by fasting and 2-h plasma glucose criteria in urban Nepal. Diabet Med 2006; 23:1130–5.
32. Bhattarai MD, Singh DL. Learning the lessons – preventing type 2 diabetes in Nepal. Diabetes Voice 2007; 52: 9-10.
33. Wild SH, Roglic G, Sicree R, et al. Global Burden of Diabetes mellitus in the Year 2000. [online] 2004 [cited 2010 October 15]. Available from: http://www3.who. int/whosis/menu.cfm?path=evidence,burden,burden—gbd 2000 docs&language=english
34. Dulal RK, Karki S. Disease management programme for Diabetes mellitus in Nepal. J Nepal Med Assoc 2009; 48:281-6.
35. Chhetri MR and Chapman RS. Prevalence and determinants of diabetes among the elderly population in the Kathmandu valley of Nepal. Nepal Med Col J. 2009; 11:34-8.
36. Mehta KD, Karki P, Lamsal M, et al. Hyperglycemia, glucose intolerance, hypertension and socioeconomic position in eastern Nepal. Southeast Asian J Trop Med Public Health 2011; 42:197–207.
37. Singh DL, Bhattarai MD. High prevalence of diabetes and impaired fasting glycaemia in urban Nepal. Diabet Med 2003; 20:170–1.
38. http://www.worldlifeexpectancy.com/nepal-diabetes-mellitus
39. Whaley-Connell A , Sowers JR, McCullough PA, et al. Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES). Am J Kidney Dis 2009; 53:S11-21.
40. Mittal A, Sathian B, Kumar A. et al. Diabetes mellitus as a potential risk factor of renal disease among Nepalese: A hospital based case control study. Nepal Journal of Epidemiology 2010; 1:22-5.
41. Mehta RS, Karki P, Sharma SK. Risk factors, associated health problems, reasons for admission and knowledge profile of diabetes patients admitted in BPKIHS. Kathmandu Univ Med J 2006; 4:11-3.

Source(s) of Funding

---

Not Applicable

Competing Interests

---

None

Disclaimer

---

This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.