title: High burden of prediabetes and diabetes in three large cities in South Asia: The Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study.
abstract: OBJECTIVE
  To estimate the prevalence of, and assess factors associated with, diabetes and prediabetes in three South Asian cities.
  
  
  METHODS
  Using a multi-stage cluster random sample representative of each city, 16,288 subjects aged ≥20 years (Chennai: 6906, Delhi: 5365 and Karachi: 4017) were recruited to the Centre for cArdio-metabolic Risk Reduction in South-Asia (CARRS) Study. Fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) were measured in 13720 subjects. Prediabetes was defined as FPG 100-125 mg/dl (5.6-6.9 mmol/l) and/or HbA1c 5.7-6.4% (39-46 mmol/mol) and diabetes as self-report and/or drug treatment for diabetes and/or FPG≥126 mg/dl (≥7.0 mmol/l) and/or HbA1c≥6.5% (48 mmol/mol). We assessed factors associated with diabetes and prediabetes using polytomous logistic regression models.
  
  
  RESULTS
  Overall 47.3-73.1% of the population had either diabetes or prediabetes: Chennai 60.7% [95%CI: 59.0-62.4%] (diabetes - 22.8% [21.5-24.1%], prediabetes - 37.9% [36.1-39.7%]); Delhi 72.7% [70.6-74.9%] (diabetes - 25.2% [23.6-26.8%], prediabetes - 47.6% [45.6-49.5%]); and Karachi 47.4% [45.7-49.1%]; (diabetes - 16.3% [15.2-17.3%], prediabetes - 31.1% [29.5-32.8%], respectively). Proportions of self-reported diabetes were 55.1%, 39.0%, and 48.0% in Chennai, Delhi, and Karachi, respectively. City, age, family history of diabetes, generalized obesity, abdominal obesity, body fat, high cholesterol, high triglyceride, and low HDL cholesterol levels were each independently associated with prediabetes, while the same factors plus waist-to-height ratio and hypertension were associated with diabetes.
  
  
  CONCLUSIONS
  Six in ten adults in large South Asian cities have either diabetes or prediabetes. These data call for urgent action to prevent diabetes in South Asia.
authors.affiliation: Madras Diabetes Research Foundation (MDRF), Chennai, India. Electronic address: deepa.mohan1@gmail.com.
authors.forename: Mohan
authors.initials: M
authors.lastname: Deepa
authors.affiliation: Public Health Foundation of India (PHFI) & Centre for Chronic Disease Control (CCDC), New Delhi, India.
authors.forename: Mundu
authors.initials: M
authors.lastname: Grace
authors.affiliation: National Institute of Mental Health and Neuro Sciences, Bangalore, India.
authors.forename: Bhaskarapillai
authors.initials: B
authors.lastname: Binukumar
authors.affiliation: Madras Diabetes Research Foundation (MDRF), Chennai, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Pradeepa
authors.affiliation: Public Health Foundation of India (PHFI) & Centre for Chronic Disease Control (CCDC), New Delhi, India.
authors.forename: Shivashankar
authors.initials: S
authors.lastname: Roopa
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Hassan M
authors.initials: HM
authors.lastname: Khan
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Fatmi
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Kadir
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Imran
authors.initials: I
authors.lastname: Naeem
authors.affiliation: Public Health Foundation of India (PHFI) & Centre for Chronic Disease Control (CCDC), New Delhi, India.
authors.forename: Vamadevan S
authors.initials: VS
authors.lastname: Ajay
authors.affiliation: Madras Diabetes Research Foundation (MDRF), Chennai, India.
authors.forename: Ranjit Mohan
authors.initials: RM
authors.lastname: Anjana
authors.affiliation: Emory University, Atlanta, USA.
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.affiliation: Public Health Foundation of India (PHFI) & Centre for Chronic Disease Control (CCDC), New Delhi, India.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Madras Diabetes Research Foundation (MDRF), Chennai, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Emory University, Atlanta, USA.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
mesh_terms: D000328:Adult; D000368:Aged; D002947:Cities; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D014505:Urban Population
keywords: CARRS Surveillance; Diabetes; Dysglycemia; Prediabetes; South Asians; Urban