Diabetes mellitus is a complex, chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control(1,2). Given the burden of type 2 diabetes and dreading complications, much attention to prevention is the key to reduction of the proportion of diabetes(3,4). Type 2 diabetes is preceded by a latent and symptomatic phase called prediabetes. This condition includes the dysglycaemic disorders of both fasting and post prandial glucose namely impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) respectively(5). Recognition of pre-diabetes is critical, assuming the risk of progression to diabetes. Identifying individuals with pre-diabetes offers the opportunity to modify their risk prior to development of a significant sequel(5–7). Therefore, we aimed to study the prevalence of pre- diabetes among individuals with metabolic risk and to categorize patients into IFG, impaired GTT, both abnormal, and both normal and to compare anthropometric measures and metabolic parameters in four groups.

An observational cross-sectional study was conducted among the patients with metabolic risks attending the department of medicine at a tertiary care centre in Maharashtra. The study was conducted for a period of 2 years after taking clearance from the institutional ethics committee. The patients with prior history of diabetes mellitus, use of drugs that interfere with glucose metabolism such as angiotensin converting enzyme inhibitors, angiotensin receptor inhibitors and thiazide diuretics and the patients using lipid lowering drugs were excluded from the study. After taking written informed consent from the patients, they were interviewed using a questionnaire. The questionnaire had details of demographics, detailed clinical history and physical examination. Weight, height, waist circumference and hip circumference were measured using standard guidelines. Body mass index was calculated and categorised into groups based on WHO classification for South East Asian individuals. Waist to hip was calculated. Blood pressure was measured using mercury sphygmomanometer on two difference settings and average blood pressure was noted. Lipid profile, fasting blood sugar and oral GTT were conducted using standard guidelines and the reports were noted.

Glucose tolerance test was performed for all the patients and results were calculated and the patients were divided into four groups:

• Group 1- FPG and GTT both normal
• Group 2- normal FPG but abnormal GTT
• Group 3- abnormal FPG but normal GTT
• Group 4- FPG and GTT both abnormal

Statistical Analysis

The data was collected and compiled using Epi info 7.2. The qualitative variables were expressed in terms of proportions and the difference between the two proportions was tested by Chi square or Fisher exact test. The quantative variables were either categorised and expressed in percentages or expressed in terms of mean and standard deviation. The difference between two means was tested by t test and more than 2 groups by ANOVA. All analysis was two tailed and the significance level was set at 0.05.

We included 150 patients in the present study.

Table 1: Demographic particulars of the sample

The mean age of the study subjects was 43.01 ± 10.41 years with female preponderance.

Table 2: Distribution based on the anthropometric parameters

The mean body mass index was 27.47 ± 2.36 kg/m², the mean waist circumference was 90.23 ± 5.67 cms and mean waist to hip ratio was 0.94 ± 0.03.

Table 4a: Distribution of the risk factors based on different groups

@-Median value, $-classified based on 130/90 as the cut off

Table 4b: Distribution of the lipid profile based on different groups

In Group 1, all the patients were having BMI >22.99, 45 subjects (93.75%) had abnormal waist circumference, 22 subjects (45.83) were hypertensive and 26 were non hypertensive (54.17%), 37 subjects (77.08%) had hypertriglyceridemia and 44 subjects (91.67%) had low HDL.

In Group 2, all the patients were having BMI >22.99, 17 subjects (94.44%) had abnormal waist circumference, 9 subjects (50%) were hypertensive and 9 were non hypertensive (50%), 15 subjects (83.33%) had hypertriglyceridemia and 16 subjects (88.89%) had low HDL.

In Group 3, all the patients were having BMI >22.99, 24 subjects (92.31%) had abnormal waist circumference, 13 subjects (50%) were hypertensive and 13 were non hypertensive (50%), 20 subjects (76.92%) had hypertriglyceridemia and 25 subjects (96.15%) had low HDL.

In Group 4, all the patients were having BMI >22.99, 55 subjects (94.83%) had abnormal waist circumference, 34 subjects (58.62%) were hypertensive and 24 were non hypertensive (41.38%), 44 subjects (75.86%) had hypertriglyceridemia and 55 subjects (94.83%) had low HDL.

Asymptomatic hyperglycemias before the onset of Type 2 diabetes mellitus is called as pre diabetic state. Asian Indians are more prone for diabetes and its complications at the time of diagnosis(8–11). This study has been done to highlight the prevalence of abnormal intolerance in our population. A total of 150 cases were included in the present study who had metabolic risks and were attending our outpatient and inpatient department.

The mean age of our study was 43.01 ± 10.41 years with female preponderance. Studies conducted by Matos LN et al(12), Moriel G et al(13), Xu Y et al(14) and Li C et al(15) reported the age to be higher when compared to our study. This highlights that Indian population is at higher risk of getting metabolic risks at an earlier age when compared to other countries.

The mean waist circumference of our study population was comparable to that of Xu Y et al(14) study. Several studies indicate that waist circumference or waist-to-hip ratio may be a better indicator of the risk of developing diabetes than BMI. Such data suggest that the distribution of body fat is an important determinant of risk as these measures reflect abdominal or visceral obesity. In this study, 149 subjects (99.33%) had normal waist to hip ratio and 1 subject (0.67%) had abnormal waist to hip ratio. The high mean of WHR was suggestive of central obesity in this population. Study by Matos LN et al(12) had mean WHR of 0.90 (0.8-0.9) which was concordant with our study.

In this study out of 150 subjects, 48 reported normal Fasting Plasma Glucose and normal Glucose Tolerance Test (32.0%), 17 subjects i.e.12 % were reported with normal fasting plasma glucose and abnormal glucose tolerance test were included in Group 2, 26 subjects i.e. 17.33 % were reported with abnormal fasting plasma glucose but normal glucose tolerance test were included in Group 3. While in group 4 i.e. both fasting plasma glucose and GTT were abnormal was reported by 58 patients (38.67%). Matos LN et al(12) study reported similar results in their study.

Among the individuals who had normal FPG, the prevalence of glucose intolerance was 27.70%, as demonstrated by an abnormal GTT in the present study. In a prospective study, Gabir MM et al(16) observed that the cumulative incidence of diabetes mellitus over five years, among those who had normal FPG and glucose intolerance was 5.5 times higher than among those whose FPG and GTT were both normal. Study by Torquato MT et al(17) had result similar results of abnormal GTT and T2DM prevalence. This concluded that among patients who present at least one condition relating to increased risk of developing diabetes mellitus, performing the GTT is highly recommendable, even among individuals who have already been found to present normal FPG. This is because the GTT is a low-cost test that is simple to implement, easy to under-stand and widely available at all levels of healthcare complexity.

The study had some limitations. This study was done in a tertiary care hospital. Being a hospital-based study; the prevalence of the certain findings may be high, due to reporting of the population at a late stage, therefore, the study may not reflect the whole picture of the problem in the community. The sample size was relatively small. A bigger sample size and comparing the difference between the prevalence of pre-diabetes in a hospital-based and community-based study in our population would be worthwhile.

In the sample studied, the prevalence of abnormal glucose metabolism was as high as 68.0%. These glucose metabolism abnormalities could be described as 12.0% for normal FPG but abnormal GTT, 17.33 % for abnormal FPG but normal GTT, and 38.67% for elevation in both FPG and GTT. The patients with metabolic risk factors had high prevalence of pre-diabetes. There was higher proportion impaired FPG, impaired GTT among patients having obesity, hypertension, dyslipidemia.

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