Assessment of risk factors, complications and treatment patterns of diabetic patients in India

Mayur Mayabhate; Nitin Kapure; Akhilesh Sharma

doi:10.18203/2319-2003.ijbcp20243836

Authors

Mayur Mayabhate Medical Affairs, Alkem Laboratories Ltd., Mumbai, Maharashtra, India
Nitin Kapure Medical Affairs, Alkem Laboratories Ltd., Mumbai, Maharashtra, India
Akhilesh Sharma Medical Affairs, Alkem Laboratories Ltd., Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20243836

Keywords:

Diabetes mellitus, Newly diagnosed, Risk factors, Prevalence, Glycemic status, India

Abstract

Background: Early identification of risk factors and comorbidities is essential for optimizing treatment strategies in diabetes. The diabetes in India (DIAB India) study aims to evaluate risk factors, glycemic status, comorbidities, and initial management choices in newly diagnosed T2DM

Methods: A retrospective, observational, multicenter study was conducted with a large cohort of 19,230 patients pan India. Data was collected from patient health records and meticulously stored into a standard format. Demographic data (age, gender, weight, height, risk factors, and blood pressure), clinical presentation (family history, complications, glycemic indices, and comorbidities), and choice of management were recorded and used for analysis.

Results: Obesity and family history were most common risk factors for T2DM and were significantly correlated with its severity (p<0.001). The most common comorbidity was neuropathy (59.8%) followed by nephropathy (27%) and CV events (25%). Obese patients have higher mean hemoglobin A1c (HbA1c) of 8.4%, fasting blood glucose (FBG) (160 mg/dL), and postprandial blood glucose (PPBG) (233.6 mg/dL) compared to non-obese. Both single and combination therapies led to significant improvements in HbA1c (Single: pre- 7.47, post-6.87; Combination: pre-8.26, post-7.13), FBG (Single: pre-138.94, post-118.89; Combination: pre-161.21, post-128.2), and PPBG (Single: pre-200.88, post-163.83; Combination: pre-235.10, post-177.87) levels after treatment, with combination therapy showing greater reductions across all markers (p<0.001). The improvement in glycemic control was greater in patients who followed dietary advice (p<0.001).

Conclusions: Obesity and family history were the most common risk factors contributing to diabetes in the newly diagnosed Indian patients. The comorbidities usually associated with diabetes are identified as neuropathy and cardiovascular conditions. While dietary measures are not widely used, significant improvement in glycemic status is reported using pharmacotherapy (monotherapy or combination). Choice of pharmacological and non-pharmacological treatments should be tailored to patient preferences, demographics, comorbidities, age, and other factors.

Metrics

Metrics Loading ...

References

Dalal N, Patel D, Chaturvedi A, Shah A. Real-world observational study to capture demographic details of newly diagnosed type 2 diabetes mellitus. Int J Res Med Sci. 2022;10(10):2251.

Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J Ophthalmol. 2021;69(11):2932-8.

Saeedi P, Petersohn I, Salpea P, Belma M, Suvi K, Nigel U, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843.

Simon D. Epidemiological features of type 2 diabetes. Rev Prat. 2010;60(4):469-473.

Magliano DJ, Boyko EJ, IDF Diabetes Atlas 10th edition scientific committee. IDF DIABETES ATLAS. 10th ed. International Diabetes Federation; 2021. Available at: http://www.ncbi.nlm.nih.gov/books/NBK581934/. Accessed on 7 September 2024.

Nanda M, Sharma R. Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey. Health Care Sci. 2023;2(5):291-305.

Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 2016;4(6):537-47.

Inzucchi SE, Bergenstal RM, Buse JB, Michaela D, Ele F, Michael N, et al. Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140-9.

Maiti S, Akhtar S, Upadhyay AK, Mohanty SK. Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: Evidence from National Family Health Survey of India (NFHS), 2019-2021. Sci Rep. 2023;13(1):2971.

Munishwar NJ, Bramhankar RB, Raju NN. A Hospital-based Observational Study of Newly diagnosed Sthula Prameha Subjects with special reference to type 2 Diabetes Mellitus from Maharashtra, India. Braz J Pharm Sci. 2023;59:e21230.

Cersosimo E, Johnson EL, Chovanes C, Skolnik N. Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach. Diabetes Obes Metab. 2018;20(3):497-507.

Anjana RM, Unnikrishnan R, Deepa M, Rajendra P, Nikhil T, Ashok KD, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol. 2023;11(7):474-89.

Sujata, Thakur R. Unequal burden of equal risk factors of diabetes between different gender in India: a cross-sectional analysis. Sci Rep. 2021;11(1):22653.

Ahola AJ, Mutter S, Forsblom C, Harjutsalo V, Groop PH. Meal timing, meal frequency, and breakfast skipping in adult individuals with type 1 diabetes-associations with glycaemic control. Sci Rep. 2019;9(1):20063.

Barbieri M. Glucose regulation and oxidative stress in healthy centenarians. Exp Gerontol. 2003;38(1-2):137-43.

Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research–INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011;54(12):3022-7.

Yan Z, Cai M, Han X, Chen Q, Lu H. The Interaction Between Age and Risk Factors for Diabetes and Prediabetes: A Community-Based Cross-Sectional Study. Diabetes Metab Syndr Obes. 2023;16:85-93.

Mitra A. Some Salient Points in Dietary and Life-Style Survey of Rural Bengal Particularly Tribal Populace in Relation to Rural Diabetes Prevalence. Stud Ethno-Med. 2008;2(1):51-6.

Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes. Transl Res. 2017;184:101-7.

Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA. 2007;298(22):2654.

Śliwińska-Mossoń M, Milnerowicz H. The impact of smoking on the development of diabetes and its complications. Diab Vasc Dis Res. 2017;14(4):265-76.

Morimoto A, Tatsumi Y, Deura K, Mizuno S, Ohno Y, Watanabe S. Impact of cigarette smoking on impaired insulin secretion and insulin resistance in J apanese men: The S aku S tudy. J Diabetes Investig. 2013;4(3):274-80.

Emdin CA, Anderson SG, Woodward M, Rahimi K. Usual Blood Pressure and Risk of New-Onset Diabetes. J Am Coll Cardiol. 2015;66(14):1552-62.

Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, et al. Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery. Obes Surg. 2014;24(1):42-55.

Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010. JAMA. 2012;307(5):491.

Dyson PA. The therapeutics of lifestyle management on obesity. Diabetes Obes Metab. 2010;12(11):941-6.

Leitner DR, Frühbeck G, Yumuk V, Karin S, Dragan M, Euan W, et al. Obesity and Type 2 Diabetes: Two Diseases with a Need for Combined Treatment Strategies-EASO Can Lead the Way. Obes Facts. 2017;10(5):483-92.

Algoblan A, Alalfi M, Khan M. Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes Targets Ther. 2014;587.

Logue J, Walker JJ, Colhoun HM, Leese GP, Lindsay RS, McKnight JA, et al. Do men develop type 2 diabetes at lower body mass indices than women? Diabetologia. 2011;54(12):3003-6.

NA. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet Lond Engl. 1998;352(9131):837-53.

Van Raalte DH, Verchere CB. Improving glycaemic control in type 2 diabetes: S timulate insulin secretion or provide beta‐cell rest? Diabetes Obes Metab. 2017;19(9):1205-13.

Xie X, Wu C, Hao Y, Shah A. Benefits and risks of drug combination therapy for diabetes mellitus and its complications: a comprehensive review. Front Endocrinol. 2023;14:1301093.