International Journal of MCH and AIDS (2016), Volume 5, Issue 2, 103-111 INTERNATIONAL JOURNAL of MCH and AIDS ISSN 2161-864X (Online) ISSN 2161-8674 (Print) Available online at www.mchandaids.org DOI: 10.21106/ijma.91 ORIGINAL ARTICLE Comparative Study of the Prevalence of Type-2 Diabetes Mellitus in Various Demographic Regions of Andhra Pradesh, India: a Population based Study 1 2 3 Pangi Vijaya Nirmala, PhD; Mani Gudivada, PhD; ChikkamVijaya Lashmi, PhD 1School of Life and Health Sciences, Adikavi Nannaya University, Rajahmundry, Andhra Pradesh, India 533105, 2Department of Zoology, Maharajah’s Col- lege (Autonomous), Vizianagaram, Andhra Pradesh, India 535002, 3Formerly Department of Zoology, Andhra University, Visakhapatnam, Andhra Pradesh, India 530003 Corresponding author email: [email protected] ABSTRACT Background and Introduction: Diabetes is increasing at alarming rate among Indians especially South Indians with prevalence of diabetes mellitus (PODM) varying in populations of different regions. This study assesses PODM in three geographical areas, namely: tribal, semi-urban, and urban, and to compare the diabetes risk in northern coastal districts of Andhra Pradesh state in India. Methodology: A random sampling method was followed to study the prevalence of diabetes in about 3,000 individuals of age group between 15-68 years, selecting 1,000 individuals from each area. As per 1988 World Health Organization criteria and norms, diabetes mellitus was diagnosed on the basis of 75-g oral glucose tolerance test (OGT). Statistical analyses were conducted using Microsoft Excel 2007. Results: The analysis of the study indicates that 35.5% individuals were identified to be diabetic, especially 7.8% from Tribal area, 12.5% from semi-urban and 15.1% from urban area. Conclusion and Global Health Implications: The study indicates that people in urban area were more prone to type-2 diabetes than those in Tribal and semi-urban area. New cases of diabetes were reported in tribal areas when compared to semi-urban and urban areas indicating that rural people were not spared from diabetes. The study also indicates that there is an increase in the prevalence of diabetes in tribal area of Andhra Pradesh State of India when compared to previous studies. Key words: Diabetes Mellitus (DM) • Prevalence of Diabetes Mellitus (PODM) • Oral Glucose Tolerance Test (OGT) Copyright © 2016 Nirmala et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0. 103 Nirmala et al. International Journal of MCH and AIDS (2016), Vol. 5, No. 2, 103-111 1. Background and Introduction Andhra Pradesh which reported a high prevalence of 4.7%.[5] The first study in South India at Vellore in Now the time has come to allocate resources Tamil Nadu has shown that prevalence of diabetes and permit national planning to quantify the is 2.5%.[6] A population based survey carried out prevalence of diabetes mellitus and the number of in Chandigarh, Pondicherry and Varanasi towns people affected by diabetes, now and in the future. reported the prevalence rates of 2.9%, 0.7% and Population growth, aging, urbanization, low physical 2.7% respectively.[7-9] activity and obesity are main causative factors of high prevalence of DM.[1] Diabetes mellitus (DM) is a Some researchers have shown prevalence of 5.0% chronic metabolic disorder in which the body does DM in Kudremukh, a semi-urban area in Karnataka. [10] not produce or properly utilize insulin. Insulin is a The prevalence of known diabetes in Eluru, another hormone produced by the β-cells of the pancreas town in west Godavari district of Andhra Pradesh that is needed to absorb the glucose from the was 1.5%.[11] The prevalence of type 2 diabetes had bloodstream into the cell which is utilized for the risen to 11.6% in the same urban area, that is Eluru, production of energy. The characteristic symptoms which had a prevalence of 8.2% five years before.[11, 12] of diabetes are excessive urine production (polyuria), Differences in the prevalence of diabetes have excessive thirst or increased fluid intake (polydipsia), been consistently reported from India in Urban and excessive food intake (polyphagia), blurred vision, rural area. A recent study from rural Maharashtra hypertension etc. These symptoms may not be showed a high prevalence of 9.3% DM.[13] The observed if the blood sugar is mildly elevated. Prevalence of Diabetes in India Study carried out The World Health Organization (WHO) stated in 108 centers of India opines that 5.9% of urban that the incidence of DM appears to be increasing population and 2.7% of rural population was affected by about 6% per year and also predicted that the by diabetes as per the WHO criteria.[14] According greatest number of diabetic individuals in the world to the American Diabetic Association (ADA) criteria, by the year 2030 would be 9.40 million. Studies of the diabetic prevalence rates were 4.6% and 1.9% industrial populations in India revealed that diabetes in urban and rural areas respectively.[15] It is quite has become top most major problem in India and also evident from these studies that diabetes is becoming worldwide and the deaths have increased by 35%.[2] a major health problem in India. Diabetes cases are The blue circle was recently adopted as the symbol increasing day by day in rural as well as in tribal areas for diabetes; much like the Red Ribbon is for AIDS. of Andhra Pradesh state also. The risk factors for DM include stress, environment, food habits, style of India had 32 million diabetic patients in the year living, etc. vary in the three areas selected for the 2000 and this number would increase to 80 million study. Apart from that the first author of this paper by the year 2030.[1] International Diabetes Federation is from one of the study areas, that is Paderu tribal (IDF) also reported that the total number of diabetic village and she could observe an increase of cases subjects in India is 41 million in 2006 and that this of DM in many tribal people who are going towards would rise to 70 million by the year 2025.[3] modernization and change of food habits when In a study from Cuttack, India showed that compared to earlier days. We could also observe the population based surveys carried out in the early difference in some distinguishing characteristics like 1970s in different Indian cities and nearby rural population, literacy and urbanicity of the three areas areas reported prevalence of diabetes ranging from selected for the study. With the above supporting 1.2% to 2.5%.[4] The first multi-center study in India data we could draw some conclusions to our study was done by the Indian Council of Medical Research (Table 1). Based on the above sociodemographic (ICMR) between 1972 and 1975. This study reported and socio economic data of rural people and a prevalence of 3.0 % in urban areas and 1.3% in their counterparts, a survey has been carried out rural areas. The early signs of the looming diabetes to understand the prevalence of type-2 diabetes epidemic were seen in Tenali, a semi-urban town in and to understand its spread, increase and causes 104 www.mchandaids.org Type-2 diabetes mellitus in demographic regions Table 1: Distinguishing characteristics of study area Region Urbanicity Population Literacy (Rural/Urban/Semi urban) Total Male Female Total Male Female Paderu Rural 58,983 28902 30081 60.0 57.1 42.9 Visakhapatnam city Urban 1,728,128 873,599 854,529 81.79 81.25 76.22 Rajahmundry Semi urban 341,831 168,735 173,096 84.12 87.91 80.45 in a tribal area (around Paderu village), urban area Table 2: Socio-economic status of Paderu area (Visakhapatnam city) in Visakhapatnam district and Indicator Status Percent in a semi-urban area (i.e. Rajahmundry town) in East Godavari district of Andhra Pradesh state in India. Education Illiterate 41 This paper presents the results of the study. Primary 21.6 Secondary 19.2 2. Methodology Above 14.1 2.1. Study area Income (in Rupees) >1000/- 39.7 >5000/- 30.8 To understand the prevalence of diabetes and its >10000/- 29.5 causes the present study was carried out in and Occupation Employed around Paderu (PDR) village that comes under tribal M 75.5 area and in Visakhapatnam (VSKP) city coming under F 57.8 urban area and in Rajahmundry (RJY) town falling in Unemployed Semi-urban area. The first two areas are located in M 13.3 Visakhapatnam district and the third one is located F 21.2 in East Godavari (EG) district of Andhra Pradesh. As per 2011 census based on population, Paderu area has total population of 58,983. Out of which 49% are male and 51% are female. Coming to the socio economic conditions like Education of Paderu area, illiterates are 41%, people having school education are 40.8% and higher education is about 14.1%. Overall literacy is 60%, in which males are dominant. Regarding population-level incomes, higher income groups earning more than 10,000/- rupees per month are less (29.5%) when compared to people earning more than 1000/-(39.7%) rupees and more than 5000/- (30.8%). Nearly 76% of males are employed when compared to females (57.8%) in this tribal area. The main occupation for these people is marketing of minor forest produce and to some Figure 1: Study area extent Agriculture, fishing and hunting. Nowadays, some tribal people are also employed in government the disease, height, weight, body mass index (BMI), sectors.