WHAT IS DRIVING THE DIABETES

EPIDEMIC IN INDIA?

WHAT IS DRIVING THE DIABETES

EPIDEMIC IN INDIA?

MADRAS DIABETES RESEARCH FOUNDATION,

Gopalapuram, Chennai

CHAIRMAN & CHIEF OF DIABETOLOGY

Dr.Mohan’s DIABETES SPECIALITIES CENTRE

DIRECTOR

MADRAS DIABETES RESEARCH FOUNDATION

DIRECTOR

MADRAS DIABETES RESEARCH FOUNDATION

Dr. Mohan’s DIABETES SPECIALITIES CENTRE,

Anna Nagar, Chennai

Dr. Mohan’s DIABETES SPECIALITIES CENTRE, Gopalapuram, Chennai

Dr. Mohan’s DIABETES SPECIALITIES CENTRE, Jubilee Hills, Hyderabad

&

India

Chennai (Formerly Madras)Hyderabad

Dr.V.Mohan., M.D., F.R.C.P (UK)., F.R.C.P (Glasg)., Ph.D., D.Sc., FNASc.,

DIABETES: TOP 10 COUNTRIES

2000 2030Country Persons

(millions)Country Persons

(millions)

1. India 31.7 India 79.4

2. China 20.8 China 42.3

3. USA 17.7 USA 30.3

4. Indonesia 8.4 Indonesia 21.3

5. Japan 6.8 Pakistan 13.9

6. Pakistan 5.2 Brazil 11.3

7. Russia 4.6 Bangladesh 11.1

8. Brazil 4.6 Japan 8.9

9. Italy 4.3 Philippines 7.8

10. Bangladesh 3.2 Egypt 6.7

Wild S et al, WHO Report, Diabetes Care, 2004

Environmental [Diet / physical activity]

factors?

IS THIS DIABETES EPIDEMIC DUE TO…

Genetic factors?

OR

Gene – Environment Interaction?

PPAR- GENE: PRO12ALA POLYMORPHISM

0

5

10

15

20

25

PR

OP

OR

TIO

N O

F P

RO

12A

LA

P

OL

YM

OR

PH

ISM

[%]

Non-diabetics

Diabetics

South Indians in Chennai

South Asians in Dallas

Caucasians in Dallas

p=0.006

Radha V et al, Diabetes Care, 2006 [in press]

Demographic transition

Epidemiological transition

Rapid Urbanization

Industrialization

Increasing income levels

Changing lifestyles, values and culture

CHANGING FACE OF INDIA

DEMOGRAPHIC TRANSITION IN INDIA

Expectation of life at birth in the year : 1951 – 41 years; 2000 – 64 years

URBANIZATION IN INDIA      Number of metropolitan cities

1901 1

1951 5

1991 23

2001 40

URBANIZATION AND ECONOMIC GROWTH

Source:http//urbanindia.nic/scene.htm

In 15 years from now > 50% of Indians will be in Urban cities

0

10

20

30

40

Per

cen

tag

e

1951 1961 1991 2001

VISIBLE FAT CONSUMPTION AND PREVALENCE OF NEWLY DIAGNOSED DIABETES AND IGT

0123456789

PR

EV

AL

EN

CE

[%

]

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

VISIBLE FAT CONSUMPTION

DIABETES

IGT

* p<0.05 for the trend

**

Saroja Raghavan et al, Chennai Urban Population Study, 2006

5.6%

9.7%

17.0%

0

5

10

15

20

Heavy Moderate Light

Physical activity grades

Pre

va

len

ce

of

dia

be

tes

[%

]PREVALENCE OF DIABETES IN RELATION

TO PHYSICAL ACTIVITY

Mohan V et al, Diabet Med. 2005,22:1206-11

0 0.5 1 1.5 2 2.5 3 3.5 4

Odds ratio

Reference

2.5 times higher risk

SYNERGISTIC EFFECT OF HERITABILITY AND PHYSICAL ACTIVITY ON GLUCOSE INTOLERANCE

Mohan V et al, J Assoc Physicians India, 51:771-777, 2003

Family history negative + Physical active

Family history positive + Physical active

Family history negative + Sedentary

Family history Positive + Sedentary

2.0 times higher risk

3.0 times higher risk

Chennai Urban Population Study