TY  - GEN
AU  - Shrestha, Umid Kumar.
TI  - Study of prevalence of diabetes mellitus in urban kathmandu and comparision of fasting and 2-hour plasma glucose criteria
PY  - 2002///
KW  - Prevelence
KW  - Diabetes mellitus
KW  - Comparison of fasting
KW  - 2-hour plasma glucose
KW  - Kathmandu
N1  - Thesis Report
N2  - ABSTRACT:  

OBJECTIVE: To evaluate the prevalence of diabetes, impaired fasting glucose and impaired glucose tolerance in the subjects aged 40 years and above in the urban community of Kathmandu and to compare the fasting and the 2-hour plasma glucose criteria as adopted by ADA and WHO, respectively for diagnosis of diabetes in Nepalese population. Research design and 

Methods: Field surveys of fasting and 2-hour plasma glucose of people 40 years and above in seven urban populations of Kathmandu were done by cluster sampling from 2001 to 2002. Fasting and 2-hour plasma glucose were estimated by glucose oxidase method within half an hour of blood collection in the survey sites. For those with a prior diagnosis of diabetes, only fasting plasma glucose was measured and they were excluded from the further glucose tolerance testing. Values of fasting plasma glucose (FPG) of ≥12mg/d1 and 2-hour plasma glucose (2-hPG) of ≥200mg/d1 were taken as diabetes and the subjects with only single test positive for diabetes were re-tested on the next day to confirm the diagnosis of diabetes. Similarly, fasting plasma glucose of 110 to 125mg/d1 was taken as impaired fasting glucose (IFG) and 2-hour plasma glucose of 140 to 199mg/d1 was taken as impaired glucose tolerance (IGT). Total 1012 persons (men 423 and women 589) were examined.  

Results:  The prevalence of diagnosed diabetes was found to be 8.7% (men 11.35% and women 6.79%) for the subjects 40 years and above. Using FPG criteria, 7.31% (men 8.98% and women 6.11%) of people 40 years and above had undiagnosed diabetes and 9.78% (men 13.95 and women 6.79%) had impaired fasting glucose. with 2-hour plasma glucose criteria, 8.2% (men 10.40% and women 6.62%) of people 40 years and above had undiagnosed diabetes and 10.675 (men 11.35% and women 10.19%) had impaired glucose tolerance. this study showed that 54.4% of all diabetic individuals of 40 years and above in the urban population of Kathmandu, was undiagnosed, when either or both FPG or 2-h PG criteria were used. By 2-h PG criteria, undiagnosed diabetes represented 48.54% of total diabetic subjects and using FPG criteria, it represented only 45.68%. Based on FPG criteria, the prevalence of diabetes (diagnosed and undiagnosed) in the population of ≥ 40 years was 16.0% and with 2-hPG criteria, the prevalence was 16.9%. When either or both criteria were included, the prevalence of diabetes ( diagnosed and undiagnosed) in the population of 40 years and above was 19.07%. The age-and sex- standardized prevalence proportions were very similar to the crude estimates. When the prevalence of newly diagnosed diabetic subjects diagnosed by fasting glucose criteria was compared with 2-hour glucose criteria, the change in the prevalence from FPG to 2-h PG was found to be -0.9% (95% C1-3.2%, +1.4%). Among total new diabetes diagnosed by FPG (n=74), 22 had diabetes by FPG only and among total new diabetes diagnosed by 2-h PG (n=83), 31 had diabetes by 2-h PG only. Similarly, 52 of total new diabetic subjects (n=105) had diabetes diagnosed by both FPG and 2-h PG criteria. The sensitivity and specificity of FPG against 2-h PG criteria for a diagnosis of diabetes were found to be 62.65% (95% C1:51.3%, 72.8%) and 97.38% (95% C1: 96.0%, 98.3%), respectively. Similarly, the sensitivity and specificity of 2-h PG against FPG criteria for a diagnosis of diabetes were found to be 70.27% (95% C1:58.4%, 80.1%) and 96.35% (95%C1:94.8%, 97.5%), respectively. The sensitivity of 2-h PG criteria was slightly more than that of FPG for diagnosing diabetes. In both of the cases, the observed agreement and agreement beyond change were 94.3% and 63.1%, respectively (p=000). The fasting and the 2-hour plasma glucose criteria did not identify the same subjects as diabetic. In this study, 29.5% of new diabetic subjects (n=105) and 25% of subjects with impaired glucose tolerance (n=160) according to 2-hour glucose criteria would be classified as normal if only the fasting glucose criterion was used. Similarly 20.95% of new diabetic subjects (n=105) and 18.1% of subjects with impaired fasting glucose according to fasting glucose criteria would be classified as normal if only the 2-hour glucose criterion was used. In Newar ethnic group, the prevalence of past diabetes was 9.98% (men 11.72% and women 8.84%) and that of newly diagnosed diabetes by FPG criteria was 8.32% (men 10.46% and women 6.91%), by 2-h PG criteria 7.99% (men 10.46% and women 6.35%) and by either or both criteria 10.65% (men 12.97% and women 9.12%). In Brahman ethnic group, the prevalence of past diabetes was 5.45% (men 6.67%) and women 4.52%) and that of newly diagnosed diabetes by FPG criteria was 5.11% ( men 6% and women 4.37%), by 2-h PG criteria 8.11% (men 10% and women 6.56%) and by either or both criteria 8.71 % (men 8.67% and women 8.74%). In the age group of 40-49 years, the prevalence of past diabetes was 5.19%, new diabetes by FPG criteria 4.29% and by 2-h PG 6.09%, IFG 8.13% and IGT 8.35%. In the age group of 50-59 years, the prevalence of past diabetes was 9.8%, new diabetes by FPG criteria 8.63% and by 2-h PG 9.41%, IFG 12.16% and IGT 12.94%. In the age group of 60-69 years, the prevalence of past diabetes was 12.4%, new diabetes by FPG criteria 10.8% and by 2-h PG 10.4%, IFG 10.4% and IGT 12.8%. In the age group of ≥75 years, the prevalence of past diabetes was 14.06%, new diabetes by FPG criteria 9.38% and by 2-h PG 9.38%, IFG 9.38% and IGT 9.385. The prevalence rates of diabetes increased with age, although there was a slight decline of new diabetes in men at age ≥75 years. The prevalence of diabetes was higher in men than in women (p=.000). Among the subjects with the past history of diabetes, 28.4% had BMI≥25kg/m2and 34.1% had central obesity. Among the subjects with diabetes by fasting glucose criteria, 22.97% had BMI≥25kg/m2 and 50% had central obesity. Similarly, among the individuals with diabetes by 2-hour glucose criteria, 21.69% had BMI≥25kg/m2 and 51.81% had central obesity. At the same time, more than 60% of diabetic women and more than 30% of diabetic men were found to be centrally obese.  The prevalence of clinical hypertension of subjects 40 years and above was 23.32% (men 23.40% and women 23.26%). Among total diabetes (past and newly diagnosed), 36.79% had hypertension. Among subjects with known diabetes, 43.18% had hypertension. The hypertension was found in 29.73% of subjects with new diabetes by FPG and 32.53% of subjects with new diabetes by 2-hPG. Multiple logistic regression models were used to show the association of age, sex, hypertension, BMI, WH ratio and ethnicity with diabetes in the urban population Nepal. Among the total diabetic subjects (past and newly diagnosed, n=193), the association of diabetes with age of 45 years and above, sex and hypertension was found to be highly significant (p=.000). The odds of having diabetes increased by 953 times in age of 45 years and above, by 907 times in men than in women and by 955 times in hypertensive subjects. Similarly, the odds of having diabetes increased by 1.858 times, if the subject was of 45 years and above, men and hypertensive (p=.000). However, the association of diabetes with BMI, WH ratio and ethnicity was not found to be statistically significant. The association of diabetes with age and sex was found to be statistically significant in new diabetes diagnosed by both FPG and 2-hPG criteria (p<.05). the association of hypertension was found to be statistically significant only with new diabetes diagnosed by 2-h Pg criteria (p=.048), but with new diabetes diagnosed by FPG criteria, the association of hypertension was not found to be statistically significant. Among new diabetes diagnosed by FPG, the odds of having diabetes in men increased by .665 times than in women (p=0.38) and among new diabetes diagnosed by 2-hPG, the odds of having diabetes in men increased by .795 times than in women (p=.012). Age was a major determinant in the disagreement in the subject classification. The fasting plasma glucose criteria was more likely to diagnosed diabetes among elderly subjects of 60 years and above (p=.004, odds ratio=2.033).; Among the hypertensive subjects, 2-hour plasma glucose criteria was more likely to diagnose diabetes (p=.011, odds ratio=1.889) Conclusion and recommendation :  It is obvious that the increased yield of undiagnosed diabetes can be detected, if both fasting and 2-hour plasma glucose tests are used. When fasting and 2-hour plasma glucose tests are compared, 2-hour plasma glucose criteria is more likely to diagnose diabetes in Nepalese urban population. However, the increased number of new diabetes can be picked up by fasting plasma glucose test because it is more easy, less costly, convenient and there will be more compliance. The high rates of abnormal fasting and postchallenge glucose found in the population of urban community of Kathmandu, Nepal, along with increasing obesity and sedentary lifestyles, make it likely that diabetes will continue to be a major health problem in Nepal. The population of impaired glucose tolerance should be encouraged to increase their physical activity level, aim for an optimum desirable weight, and follow a healthy, balanced diet in order to prevent the progression to clinical diabetes. Diabetes is one of the most costly and burdensome chronic diseases of our time and is increasing in epidemic proportion in Nepal that has called upon the need for the development of national diabetes strategy for the prevention and control of diabetes.
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