The prevalence of diabetes mellitus and impaired fasting glucose/glycaemia (IFG) in suburban and rural Nepal—the communities-based cross-sectional study during the democratic movements in 1990

Abstract

A rising prevalence of Type 2 diabetes and impaired fasting glucose/glycaemia (IFG) was recently reported in the urban areas of Nepal by Singh and Bhattarai [D.L. Singh, M.D. Bhattarai, High prevalence of diabetes and impaired fasting glycaemia in urban Nepal, Diabet. Med. 20 (2003) 170–171] in the first population-based study based on the revised diagnostic criteria of ADA-1997 and WHO-1998. In comparison with our community-based survey done in 1990 in suburban and rural areas of Nepal, the current data show a surprisingly rapid increase in the prevalence of diabetes in the Nepalese population. In our 1990 study, diabetes and IFG, respectively, were present in 1.4 and 2.5% of people ≥20 years old in suburban village (Bhadrakali) compared with 0.3 and 0.7% in a rural village (Kotyang). In a short communication, Singh and Bhattarai found the rates to be 14.6 and 9.1% in urban areas, and 2.5 and 1.3% in rural areas. This phenomena appears to have been influenced more by rapid urbanization and changes in lifestyles after the ongoing democratic movements that have taken place since 1990 in Nepal. Moreover, our new analysis of the data provide baseline features for the planning of health care policy and establishment of medical priorities in modern day Nepal.

Introduction

Diabetes is recognized as a major global epidemic, with the prevalence of diabetes rapidly increasing in many developed and/or developing Asian countries [1], [2], [3], [4], [5], [6], [7]. No pertinent literature has been available to date showing an accurate prevalence of diabetes in developing countries like Nepal. We read with great interest in short communication by Singh and Bhattarai [8] on the high prevalence of diabetes and impaired fasting glucose/glycaemia (IFG) in the first population-based urban and rural Nepal survey using the new diagnostic criteria of ADA-1997 [9] and WHO-1998 which do not required on oral glucose tolerance test (O-GTT) [10], [11]. Recently, Karki and coworkers [12], [13] have also reported a high prevalence of Type 2 diabetes in urban areas of eastern Nepal in a hospital-based study of a heterogeneous Nepalese population using modified WHO-1985 criteria [12]. Some of the subjects were tested with O-GTT and had glycated hemoglobin [13]. Therefore, we reanalyzed a previous survey area of Kathmandu that was studied in 1990, a suburban area, Bhadrakali, and a rural village, Kotyang, representative of different lifestyle currently seen in Nepal [14], [15], [16]. The purpose of the present paper was to reanalyze and update the data based on the WHO-1985 criteria and adopt them to the newly revised ADH/WHO-criteria [9], [10], [11] for comparison purposes with the current literature [8]. At the time of our original study, it was very difficult to perform O-GTTs in such a developing country like Nepal.