title: Burden and Socio-Behavioral Correlates of Uncontrolled Abnormal Glucose Metabolism in an Urban Population of India.
abstract: BACKGROUND
  Progressive burden of diabetes mellitus is a major concern in India. Data on the predictors of poor glycemic control among diabetics are scanty. A population-based cross-sectional study nested in an urban cohort was thus conducted in West Bengal, India to determine the burden and correlates of total and uncontrolled abnormalities in glucose metabolism (AGM) in a representative population.
  
  
  METHODS
  From 9046 adult cohort-members, 269 randomly selected consenting subjects (non-response = 7.24%) were interviewed, examined [blood pressure (BP), anthropometry], tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C). Those having pre-diagnosed diabetes or FPG ≥126 or HbA1c≥6.5 were defined as diabetic. Among non-diabetics, subjects with FPG (mg/dl) = 100-125 or HbA1C(%) = 5.7-6.4 were defined as pre-diabetic. Pre-diagnosed cases with current FPG ≥126 were defined as uncontrolled AGM. Descriptive and regression analyses were conducted using SAS-9.3.2.
  
  
  RESULTS
  Among participants, 28.62% [95% Confidence Interval (95%CI) = 23.19-34.06)] were overweight [body mass index(BMI) = (25-29.99)kg/meter2], 7.81% (4.58-11.03) were obese(BMI≥30kg/meter2), 20.82% (15.93-25.70) were current smokers, 12.64% (8.64-16.64) were current alcohol-drinkers and 46.32% of responders (39.16-53.47) had family history of diabetes. 17.84% (13.24-22.45) had stage-I [140≤average systolic BP (AvSBP in mm of mercury)<160 or 90≤average diastolic BP (AvDBP)<100] and 12.64% (8.64-16.64) had stage-II (AvSBP≥160 or AvDBP≥160) hypertension. Based on FPG and HbA1c, 10.41% (6.74-14.08) were diabetic and 27.88% (22.49-33.27) were pre-diabetic. Overall prevalence of diabetes was 15.61% (11.25-19.98). Among pre-diagnosed cases, 46.43% (26.74-66.12) had uncontrolled AGM. With one year increase in age [Odds Ratio(OR) = 1.05(1.03-1.07)], retired subjects [OR = 9.14(1.72-48.66)], overweight[OR = 2.78(1.37-5.64)], ex-drinkers [OR = 4.66(1.35-16.12)] and hypertensives [ORStage I = 3.75(1.42-9.94); ORStage II = 4.69(1.67-13.17)] had higher odds of diabetes. Relatively older subjects [OR = 1.06(1.02-1.10)], unemployed [OR = 19.68(18.64-20.78)], business-owners [OR = 25.53(24.91-16.18)], retired [OR = 46.53(45.38-47.72)], ex-smokers [OR = 4.75(1.09-20.78)], ex-drinkers [OR = 22.43(4.62-108.81)] and hypertensives [ORStage II = 13.17(1.29-134.03)] were more likely to have uncontrolled AGM.
  
  
  CONCLUSIONS
  Burden of uncontrolled AGM was high among participants. Efforts to curb the diabetes epidemic in urban India should include interventions targeting appropriate diabetic control among relatively older persons, unemployed, business-owners, retired, ex-smokers, ex-drinkers and hypertensives.
authors.affiliation: Barrackpore Population Health Research Foundation, Kolkata, 700123, India.|Mission Arogya Health and Information Technology Research Foundation, Kolkata, 700010, India.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.affiliation: Barrackpore Population Health Research Foundation, Kolkata, 700123, India.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Chakraborty
authors.affiliation: Mission Arogya Health and Information Technology Research Foundation, Kolkata, 700010, India.
authors.forename: Sanchita
authors.initials: S
authors.lastname: Mahapatra
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical, Education and Research, Kolkata, 700020, India.
authors.forename: Umakanta
authors.initials: U
authors.lastname: Mahapatra
authors.affiliation: Mediland Diagnostic Institute, Kolkata, Kolkata, 700014, India.
authors.forename: Naren
authors.initials: N
authors.lastname: Pandey
authors.affiliation: Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thomson
authors.affiliation: Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia.|School of Population Health, University of Western Australia, Perth, 6009, Australia.
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Musk
authors.affiliation: Barrackpore Population Health Research Foundation, Kolkata, 700123, India.|Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia.
authors.forename: Ramendra N
authors.initials: RN
authors.lastname: Mitra
mesh_terms: D000328:Adult; D000368:Aged; D001519:Behavior / Q000502:physiology*; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D014505:Urban Population
chemical_list: D001786:Blood Glucose; D005947:Glucose; D006442:Glycated Hemoglobin