Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians.

Abstract

Two recent studies on Asian Indians reported one of the highest global rates of prediabetes progression to type-2 diabetes (T2DM)1,2,3. In an observational study, we reported prediabetes to T2DM progression rate of 71.52 per 1,000 person-years (95% CI 56.76-97.29) in a cohort of 144 individuals with prediabetes, followed for 32 (12- 48.96) months from eastern India2. In an epidemiologic study, Anjana et al3 reported prediabetes to T2DM progression rate of 78.9 per 1,000 person-years; (68.0-90.9) in a cohort of 299 prediabetes individuals followed for 9.1 years, from southern India. These rates are second only to that observed in Pima Indians (87.3 per 1,000 person-years), and are much higher than that observed in Caucasians (35.0-40.0 per 1,000 person-years)3,4. In terms of annualized incidence rates, these translate to 15-19 per cent annual risk of progression to T2DM, which is much higher than 2.5 per cent observed in the Diabetes Prevention Program (DPP) study5. It must be highlighted that the incidence of T2DM among individuals with normal glucose tolerance among Asian Indian has been reported to be 22.2 per 1,000 person-years (19.4-25.4), which is much lower than the rates observed in individuals with prediabetes3, suggesting occurrence of significant beta-cell loss and disease progression by the time prediabetes develops. This may be reflective perhaps of a more aggressive diabetes pathophysiology, where progression to T2DM from prediabetes is just a matter of time.