Prevalence of type 2 diabetes mellitus and risk of hypertension and coronary artery disease in rural and urban population with low rates of obesity

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Abstract

Objective: To compare the prevalence of type 2 diabetes mellitus (DM) and coronary artery disease (CAD) and hypertension in DM in the rural and urban populations of north India. Design and methods: Two populations of the same ethnic background were randomly selected for this cross sectional survey. There were 1769 rural (894 men, 875 women) and 1806 urban subjects (904 men, 902 women) between 25–64 years of age. The survey methods included fasting and 2 h blood glucose and electro-cardiogram and blood pressure measurement of all subjects. Results: Using the criteria of World Health Organization, the prevalence of diabetes mellitus (6.0 vs 2.8%) hypertension (24.0 vs 17.0%) and CAD (9.0 vs 3.2%) was significantly (P<0.001) higher in urban compared to rural subjects. Hypertension and CAD were significantly more frequent among subjects with diabetes compared to nondiabetes. The association of CAD and hypertension with diabetes was greater in urban than rural subjects. Excess body weight and obesity, central obesity, sedentary lifestyle, higher visible fat intake (>25 g/day), and social class 1–3 (higher and middle) were significantly associated with diabetes. Multivariate logistic regression analysis showed that after adjustment of age and sex, body mass index, central obesity, sedentary lifestyle and higher visible fat intake and alcohol intake in men were significant risk factors of diabetes among all the sub-groups. Conclusions: The study showed a high prevalence of diabetes in urban north Indian population compared to rural subjects in the same ethnic group. CAD and hypertension were significantly associated with diabetes more in urban than rural subjects. The findings suggest that higher body mass index, waist–hip ratio and visible fat intake and sedentary lifestyle were risk factors of diabetes.

Introduction

In the early 1970s, the prevalence of type 2 diabetes mellitus (type 2 DM) was 1.5% in rural and 2.3% in urban population of India [1]. The prevalence of type 2 DM has almost doubled in rural areas and has increased three fold in urban areas in the last two decades 1, 2, 3. However only in two recent small studies 2, 3, was the prevalence of diabetes compared in rural and urban areas using similar methods of sample selection and criteria of diagnosis. There are no large scale studies with an adequate sample size to demonstrate the differences in prevalence and pattern of risk factors in the rural and urban populations of India. No study has examined the associations of hypertension and coronary artery disease (CAD) in persons with type 2 DM although they are most common in Indian immigrants. The rural–urban differences in the prevalence of type 2 DM indicate that differences in diet and lifestyle characteristics and risk factors may be important 1, 2, 3, 4, 5, 6, 7, 8. The associations of these characteristics and coronary artery disease and hypertension with type 2 DM may be easily demonstrated when two populations with different diet and lifestyle are compared using similar methods of sample selection and similar criteria of diagnosis. In the present study, we describe the prevalence of type 2 DM and risk of hypertension and coronary artery disease (CAD) among random samples of rural and urban population with low rates of obesity.

Section snippets

Subjects and methods

The details of subjects and methods regarding both rural and urban samples [9]have been described. Briefly, the sampling frame for urban subjects consisted of the final population of the city of Moradabad which is roughly 0.43 million based on a 1991 census [10]. After excluding 16 suburban streets, 20 out of the remaining 180 streets were randomly selected by persons unconnected with the study. They blindly selected 20 cards in sealed envelopes from 180 envelopes each representing a street.

Criteria

Body mass index was calculated and obesity was defined as a body mass index >27 kg/m2 and overweight when body mass index >25 kg/m2. Figures for criteria according to the Indian consensus group [13]for overweight (>23 kg/m2), were also calculated. Central obesity was considered when waist–hip ratio >0.88 in males and >0.85 in females as suggested in previous studies [3].

Diabetes mellitus was diagnosed in presence of fasting blood glucose >7.7 mmol/l (>140 mg/dl) and postprandial 2 h after 75 g

Results

Our study includes 1769 rural (899 men, 875 women) and 1806 urban (904 men and 902 women) subjects between 25–64 years of age inclusive. The age and sex groups were consistent with the population in this state. The overall prevalence of diabetes was significantly (P<0.001) higher in urban compared to rural subjects (6.0 vs. 2.9%). The prevalence rates were approximately two times higher in urban compared to rural subjects in both men (6.9 vs. 3.0%) and women (5.0 vs. 2.7%) and the rates

Discussion

In this study, we examined two population groups which were homogenous with respect to ethnic background but significantly different in socioeconomic status. The urban subjects were affluent, educated and the majority had sedentary lifestyle whereas the rural subjects were poor and majority were illiterate and unskilled labourers. The prevalence of diabetes mellitus as well as CAD and hypertension were significantly higher in urban and were strikingly different in the two socioeconomic groups

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