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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