Global estimates of the prevalence of diabetes for 2010 and 2030.

The metabolic syndrome

OBJECTIVE To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years. RESULTS A total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A 1c , and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

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Global Prevalence and Major Risk Factors of Diabetic Retinopathy

http://hub.hku.hk/bitstream/10722/235686/1/content.pdf

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)61249-0.pdf

Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis

India leads the world with largest number of diabetic subjects earning the dubious distinction of being termed the "diabetes capital of the world". According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. The so called "Asian Indian Phenotype" refers to certain unique clinical and biochemical abnormalities in Indians which include increased insulin resistance, greater abdominal adiposity i.e., higher waist circumference despite lower body mass index, lower adiponectin and higher high sensitive C-reactive protein levels. This phenotype makes Asian Indians more prone to diabetes and premature coronary artery disease. At least a part of this is due to genetic factors. However, the primary driver of the epidemic of diabetes is the rapid epidemiological transition associated with changes in dietary patterns and decreased physical activity as evident from the higher prevalence of diabetes in the urban population. Even though the prevalence of microvascular complications of diabetes like retinopathy and nephropathy are comparatively lower in Indians, the prevalence of premature coronary artery disease is much higher in Indians compared to other ethnic groups. The most disturbing trend is the shift in age of onset of diabetes to a younger age in the recent years. This could have long lasting adverse effects on nation's health and economy. Early identification of at-risk individuals using simple screening tools like the Indian Diabetes Risk Score (IDRS) and appropriate lifestyle intervention would greatly help in preventing or postponing the onset of diabetes and thus reducing the burden on the community and the nation as a whole.

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Epidemiology of type 2 diabetes: Indian scenario.

PURPOSE. To assess the prevalence of diabetic retinopathy (DR)
in type 2 diabetic subjects in urban India using four-field stereo
color photography.
METHODS. The Chennai Urban Rural Epidemiology Study
(CURES) is a population-based study conducted on a representative
population of Chennai (formerly Madras) city in South
India. Individuals 20 years in age (n 26,001) were screened
for diabetes. Of the 1529 known diabetic subjects, 1382
(90.4%) participated in the study. Subjects with newly detected
diabetes (n 354) by the oral glucose tolerance test (OGTT)
also consented to participate in the study. All the subjects
underwent four-field stereo color photography, and retinopathy
was graded in the color fundus photographs according to
Early Treatment Diabetic Retinopathy Study (ETDRS) criteria.
RESULTS. The overall prevalence of DR in the population was
17.6% (95% confidence interval [CI]: 15.8 –19.5), which included
20.8% (95% CI: 18.7–23.1) in known diabetic subjects
and 5.1% (95% CI: 3.1– 8.0) in subjects with newly detected
diabetes. The prevalence of DR was significantly higher in men
than in women (21.3% vs. 14.6%; P 0.0001) and among
subjects with proteinuria (P 0.002). Logistic regression analysis
showed that for every 5-year increase in the duration of
diabetes, the risk for DR increased 1.89-fold (95% CI: 1.679–
2.135; P 0.0001). For every 2% elevation of glycated hemoglobin
(HbA1c), the risk for DR increased by a factor of 1.7
(95% CI: 1.545–1.980; P 0.0001).
CONCLUSIONS. This study shows that the prevalence of diabetic
retinopathy is lower in urban South Indians than in other
ethnic groups. However, due to the large number of diabetic
subjects, DR is likely to pose a public health burden in India;
hence, routine retinal examination is mandatory to detect DR
in the early stages.

Prevalence of diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology Study (CURES) eye study, I.

Aims/hypothesis
The aim of this study was to determine the secular trends in prevalence of diabetes and IGT in urban India.

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Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India--the Chennai Urban Rural Epidemiology Study (CURES-17).

http://www.mdrf-eprints.in/132/1/CUPS_5_Prevalence_of_Coronary_Artery.pdf

Coronary Artery Disease Prevalence of Coronary Artery Disease and Its Relationship to Lipids in a Selected Population in South India The Chennai Urban Population Study (CUPS No. 5)

The report of World Health Organization (WHO) shows that India tops the world with the largest number of diabetic subjects. This increase is attributed to the rapid epidemiological transition accompanied by urbanization, which is occurring in India. There is very little data regarding the influence of affluence on the prevalence of diabetes and its complications particularly retinopathy in the Indian population. Furthermore, there are very few studies comparing the urban/rural prevalence of diabetes and its complications. The Chennai Urban Rural Epidemiology Study (CURES) is designed to answer the above questions. CURES is initially planned as a cross-sectional study to evolve later into a longitudinal study. Subjects for the urban component of the CURES have been recruited from within the corporation limits of Chennai City. Chennai (formerly Madras), the largest city in Southern India and the fourth largest in India has been divided into 10 zones and 155 wards. 46 wards were selected by a systematic random sampling method to represent the whole of Chennai. Twenty thousand and one individuals were recruited for the study, this number being derived based on a sample size calculation. The study has three phases. Phase one is a door to door survey which includes a questionnaire, anthropometric, fasting capillary blood glucose and blood pressure measurements. Phase two focussed on the prevalence of diabetic complications particularly retinopathy using standardized techniques like retinal photography etc. Diabetic subjects identified in phase one and age and sex matched non-diabetic subjects will participate in these studies. Phase three will include more detailed studies like clinical, biochemical and vascular studies on a sub-sample of the study subjects selected on a stratified basis from phase one. CURES is perhaps one of the largest systematic population based studies to be done in India in the field of diabetes and its complications like retinopathy, nephropathy and neuropathy.

/pdf/the-chennai-urban-rural-epidemiology-study-cures-study-tnuvw84880.pdf

Raj Deepa

Papers

Epidemiology of type 2 diabetes: Indian scenario.

Prevalence of diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology Study (CURES) eye study, I.

Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India--the Chennai Urban Rural Epidemiology Study (CURES-17).

Coronary Artery Disease Prevalence of Coronary Artery Disease and Its Relationship to Lipids in a Selected Population in South India The Chennai Urban Population Study (CUPS No. 5)

The Chennai Urban Rural Epidemiology Study (CURES)--study design and methodology (urban component) (CURES-I).