India leads the world with largest number of diabetic
subjects, earning the dubious distinction of being termed the
‘‘diabetes capital of the world’’. The International
Diabetes Federation (IDF) estimates the total number of diabetic subjects
to be around 40.9 million in India and this is further set to rise to 69.9
million by the year 2025 [13,14]. Diabetes develops at a younger age in
Indians, that is at least a decade or two earlier than in the Western
In our study, the prevalence of diabetes was 0.6%. In a
study done by Asha Bai, et al.  in 1982 on 3515 children
aged 5-15 years with oral glucose tolerance test, no cases of diabetes
were found. In a population based study of physician diagnosed diabetes in
US youth <20 years, the prevalence of undiagnosed type 2 diabetes was 0.4
% . In Taiwan, in children aged 6-18 years, the rate of newly
diagnosed diabetes in screening programme was 0.9 and 1.53% in boys and
girls, respectively .
The prevalence of prediabetes in our study was 3.7%.
There are hardly any population based studies done in children aged 5-10
years to compare the data from this study. According to the National Urban
Diabetes Survey done in adults above 20 years, the prevalence of impaired
glucose tolerance was 16.8% in Chennai, 14.9% in Bengaluru, 29.8% in
Hyderabad, 10% in Kolkatta, 10.8% in Mumbai and 8.6% in New Delhi .
The Amrita Diabetes and Endocrine Population Survey done in Kerala showed
that 11.2 % of the subjects had either impaired fasting glucose or
impaired glucose tolerance . Prevalence of prediabetes was 19.2% in
280 overweight Japanese children .
There are very few publications on the natural history
of type 2 diabetes in children. Several case series suggests that children
also have an asymptomatic phase similar to adults, during which the
disease can be diagnosed . The rate of progression is influenced by
various factors like high BMI, hypercholesterolemia, high blood pressure,
positive family history etc. In adults, the likely duration of diabetes
prior to clinical diagnosis has been estimated as 4-7 years. The duration
of ‘asymptomatic’ diabetes in children has not been estimated .
Several studies have confirmed that lifestyle modification and treatment
with pharmaco-logical agents like metformin can prevent or delay the onset
of diabetes in patients with impaired fasting glucose . Several
studies have shown that these prediabetic states are also high risk stages
for cardiovascular disease [13,15,16].
The prevalence of overweight and obesity in our study
was 11% and 5%, respectively in concordance with other school based data
in India, which demonstrated prevalence of obesity in the range of 5.6% to
24% among children and adolescents [20-23]. A positive association between
overweight and obesity and risk of type 2 diabetes has been established
repeatedly in many cross-sectional and prospective studies . Increasing
prevalence of type 2 diabetes among children in India and other countries
has been attributed to epidemic of obesity and overweight among children
. In our study no association was found between prediabetes/diabetes
with overweight or obesity. This can be explained by the fact that insulin
resistance is a common feature even in nonobese Asian–Indian subjects
[3,7]. It was also not possible to establish any association with known
major risk factors related with type 2 diabetes.
The present study has certain limitations for
generalizability. The data utilized in the study was drawn from a research
project which is basically a study on the changes in blood pressure over a
period of time in school going children. The lipid profile and blood sugar
estimation was carried out as a part of the study. The sample size was
calculated based on the main study. Hence sample size for estimation of
prevalence of prediabetes and for studying the association of risk factors
may not be adequate. Classification of diabetes was also not feasible in
this study. This study has brought out important points for further
studies with sufficiently larger samples to confirm the epidemiological
consistency of the observations made in this study.
Prevalence of type 2 diabetes and prediabetes in Indian
children is not known at present. Efforts must be made to recognize type 2
diabetes in the asymptomatic prediabetes state. Early identification of
at-risk individuals using simple screening tools and appropriate lifestyle
intervention would greatly help in preventing or postponing both the onset
of diabetes and its related cardiovascular and micro- vascular
complications thereby reducing the burden on the community and the nation
as a whole.
Acknowledgments: We acknowledge the assistance
provided by co-investigators Dr Sudarshan Murthy KA, Professor and HOD,
Department of Medicine, JSS Medical college, Dr Renuka, Associate
Professor, Depart-ment of Community Medicine, Senior research fellows: Dr
Ravikumar, Dr Purushottam V, Dr Purushottam DR and Medical Social Workers:
Smt Sharada and Smt Prakruti; and, CFTRI for providing Annapoorna
software for nutritional assessment.
Competing interests: None stated.
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