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Original Article
7 (
1
); 38-41
doi:
10.53553/JCH.v07i01.009

Targeted Screening for Diabetes among Women of Reproductive Age group in Kolkata: A Community Based Study

Director, GRECALTES, Kolkata
Professor & Head, Dept of Community Medicine, Malda Medical College, Malda
Corresponding Author: Dr Gitanjali Saha Director, GRECALTES, 35/1A, Old Ballygunge 1st Lane, Kolkata-19. Email: grecaltes@gmail.com
Licence
This open access article is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). http://creativecommons.org/licenses/by/4.0

How to cite this article: Saha G, Mandai NK. Targeted Screening for Diabetes among Women of Reproductive Age group in Kolkata: A Community Based Study. J Comprehensive Health 2019;7(1):38-41.

Abstract

Background:

Diabetes is increasing in alarming scale in India. Diabetic among women in reproductive age has not been explored much in community level. The present study was conducted with objective to screen for diabetic among women between 18 and 44 years.

Materials & Methods:

A descriptive observational community based study was conducted with health camp approach. At first step, women between age 18 and 44 years were screened for three risk factors: age ≥40 years, BMI ≥25 and family history of diabetes. Those who have positive history were tested for random blood sugar.

Result:

Out of 17157 women, 6386 women were tested for random sugar. 16.21% were pre-diabetic and 19.21 % were diabetic. Prevalence of diabetic was found to Increase with increase in age, BMI, and positive family history and more among Muslim women.

Conclusion:

This type of screening will enhance Yield & help In early diagnosis and prompt treatment minimising gestational problems.

Keywords

Diabetes
Gestational diabetes
Screening

Introduction:

Prevalence of diabetes Is estimated to be 366 million globally in 2030 with maximum increase in India. In 2000, India topped the world countries with highest number of diabetic patients as estimated to be 31.7 million.1,2 The International Diabetes Federation (IDF) estimated, earlyinthe 21st Century, the total number of diabetic subjects to be around 40.9 million in India and predicted that this was going to rise to 69.9 million by the year 2025.3 The earliest natioral study reported an overall prevalence of 2.1 % In urban areas and 1.5% In rural areas.4 The ICMR-INDIAAB study, a nationally representative study conducted In recent years In 15 states in India estimated overall of diabetes and pre-diabetes in India to be 7.3% and 10,3% respectively. Urban people having more prevalence than rural one (11.2% vs 5.2%)5 Environmental and lifestyle changes Including unhealthy eating habits, addiction and physical inactivity as a consequence of Industrialization and migration to urban area from rural settings may be responsible toa greater extent, for this epidemic of Type 2 diabetes in India.4 Along with the Increase in diabetes prevalence as a whole, the prevalence of gestational DM (GDM) was found to be increasing over the time. The prevalence of gestational diabetes has been reported to range from 3.8% in Kashmir6 to 41% from Lucknow.7 It is estimated that about 4 million women are affected by GDM in India, at any given time point.8 GDM has immediate effect on maternal outcome (preeclampsia, stillbirths, macro some a) and neonatal outcomes (hypoglycemia, respiratory distress). It increases the possibility of future Type 2 diabetes In mother and the baby as well \ Community based data on diabetic prevalence among women In reproductive group is grossly lacking. In this connection, the study was undertaken to assess the prevalence of diabetes a mong women between 18 to 44 years with a screeningtest.

Materials and Methods:

A descriptive observational study with cross-sectional design was undertaken in Borough 7 area of Kolkata Corporation among women between 18 to 44 years, Seriously ill persons and pregnant women were excluded from the study.

(Gestational diabetes was addressed separately, here, analysis done with non-pregnant women as a part of the total project).

A targeted screening10 was performed in a sub-group of subjects who were at relatively high risk for diabetes. One hundred and fifty six (156) health camps were arranged with the help of local clubs scattered throughout Borough 7 of Kolkata Corporation during a period of one years starting from February 2016 to 31st January 2017. Community living around the clubs were sensitised about the camp beforehand and eligible members of the family i.e women between age group 18 to 44 years were asked to attend the camp for health check up. In the Camp trained workers of Grecaltes screened the women with any or more of the following criteria

a. Women having family history of diabetes

b. Women with BMI >=25, and

c. Women of age 40-44 years

Total 17157 women were examined initially during the study period; those who fulfilled any one or more of above criteria were counselled for blood testing. Verbal consent was taken after briefing up the project. Capillary blood was drawn from willing candidates through finger prick and tested for random sugar with the helpof a Gluco-meter. Those who were having sugar level 200 mg/dl or more was taken as positive and sent to diabetes clinic of Government Hospital for further evaluation and management

Result:

Total 17157 women between 18 to 44 years were initially screened. About 43% belonged to age group 25 to 34 years, 63.62% were Hindu, and most of them were housewives. About 10% participants had family history of diabetes. Twenty-three percent was overweight and 8% were obese (Table-1).

Table 1: Demographic characteristics of study subjects (n = 17157)
Demographic Characteristics Frequency Percentage (%)
Age (yrs)
18-19 971 5.66
20-24 2626 15.31
25-29 3518 20.50
30-34 3886 22.65
35-39 3269 19.05
40-44 2887 16.83
Religion
Christian 3 0.02
Hindu 10916 63.62
Muslim 6238 36.36
Occupation
Housemaid 2157 12.57
Housewife 13563 79.05
Other 340 1.98
Service 87 0.51
Student 1010 5.89
Family history
Blood related 277 1.61
Both 155 0.90
Father 754 4.39
Mother 687 4.00
None 15284 89.08
BMI
Under weight 1356 7.90
Normal Weight 10421 60.74
Overweight 3965 23.11
Obese 1414 8.24

Out of 17157 women, 6386 fulfilled the criteria prefixed for blood test for random sugar. Eight percent women was from 40 to 44 years of age, 10.3% had family history of diabetes mellitus and 29.54% had BMI ≥25 (Table 2).

Table 2 Study subjects fulfilling criteria for sugar testing (N=17157)
Criteria No %
Age 40 years & above 1376 8.02
Family history of diabetes 1768 10.30
BMI =25 5068 29.54
Total* 6386 37.22

*Criteria were not mutually exclusive

Blood for random sugar was tested on the spot with the help of a standard Glucometer. From initial screening, More than 60% (64.58%) had normal sugar, 16.21% were pre-diabetic (Blood sugar between 140 & 199 mg/dl) and 19.21% were diabetic (Blood sugar ≥200 mg/dl). Prevalence of diabetic were found to increase with increase In age, lowest was found in 18-19 years (4.58%) and highest among 40-44 years (30.89%)(p=0.0000). Muslim women have more prevalence than their Hindu counterpart (20.50% versus 17.92%). Prevalence of diabetes among students (10%) was less than other occupational groups; higher prevalence was found among In-service women (21.05%) & others groups (23.10%). Relation between BMI & Diabetics prevalence was found to be directly proportional, lowest prevalence was found among under-weights (9.30%) and highest among obese group (30.31%) (P=0.0000). About 35% of 153 study subjects from diabetic parents (both), showed high blood sugar. Food habit and physical exercise showed no relation with the prevalence of diabetes in the present study (Table 3).

Table 3: Prevalence of Diabetes with re spect to different pertinent variables (n=6386)
Age Group Normal No (%) Pre-diabetic No (%) Diabetic No (%) TOTAL No (%) X2 P
<20 107 (81.68) 18 (13.74) 6(4.58) 131 (100.00) 286.89
0.0000
20-29 1300 (74.28) 307 (17.54) 143 (8.17) 1750 (100.00)
30-39 1687 (62.69) 437 (16.67) 567 (21.63) 2691 (100.00)
>=40 757 (55.01) 194(14.10) 425 (30.89) 1376 (100.00)
Total 3851 956 1141 5948
Religion
Christian* 0 (0.00) 1 (100.00) 0 (0.00) 1 (100.00) 14.94
0.00057
Hindu 2696 (66.19) 647 (15.89) 730 (17.92) 4073 (100.00)
Muslim 1428 (61.76) 387 (16.74) 497 (20.50) 2312 (100.00)
Total 4124 (64.58) 1035 (16.21) 1227 (19.21 6386 (100.00)
Occupation
Housemaid 455 (70.87) 76 (11.84) 111 (17.29) 642 (100.00) 63.4995
0.0001
Housewife 3414 (63.74) 886 (16.54) 1056 (19.72) 5356 (100.00)
Other 73 (56.15) 27 (20.77) 30(23.10) 130 (100.00)
Service 21(55.26) 9 (23.68) 8 (21.05) 38 (100.00)
Studen t 161(73.18) 37 (16.82) 22 (10.00) 220 (100.00)
Total 4124 1035 1227 6386
BMI
Underweight 70 (81.40) 8 (9.30) 8 (9.30) 86 (100.00) 308.9636
0.0000
Normal Weight 966 (78.47) 120(9.75) 145 (11.78) 1231 (100.00)
Overweight 2444 (66.07) 596 (16.11) 659 (17.82) 3699 (100.00)
Obese 643 (46.97) 311(22.72) 415 (30.31) 1369 (100.00)
Total 4123 1035 1227 6385
Family history
Blood related 165 (62.98) 34 (12.98) 63 (24.05) 262 (100.00) 63.4995
0.0000
Both 63 (41.18) 37 (24.18) 53 (34.64) 153 (100.00)
Father 509 (72.51) 92 (13.11) 101 (14.39) 702 (100.00)
Mother 427 (65.59) 102 (15.67) 122 (18.74) 651 (100.00)
None 2960 (64.10) 770(16.67) 888 (19.23) 4618 (100.00)
Total 4124 1035 1227 6386
Food habit
Both 343 (60.39) 98 (17.25) 127 (22.36) 568 (100.00) 5.941
0.2036
Homemade food 3748 (64.95) 931 (16.13) 1092 (18.92) 5771 (100.00)
Junk food 33 (70.21) 6 (12.77) 8 (17.02) 47 (100.00)

*not included in test of significance

Discussion:

From 17157 women attending 156 health camps organised between 1st February 2016 and 31st January 2017, 6386 women were screened out based on three pre-fixed criteria, age 40-44 years, and or, BMI ≥ 25, and or family history of diabetes. This was done to get better yield so that chance of case detection will bemorewith the screening test.

Overall prevalence of pre-diabetic and diabetic were 16.21% and 19.21% respectively. Similar finding (20% prevalence) was noted In another study among urban adults. Overall prevalence of pre-diabetes and diabetes in a recent study done in 15 states was 10.3% and 7.3% respectively, whereas diabetes in urban area was found higher (11.2%) .5 In South- East Asia region adult diabetes was estimated to be 8.6%11 The difference in the findings was probably due to different population groups, different geographic location and Targeted screening. Diabetes as revealed from this screening test in the Present study showed that with advancement of age, prevalence of diabetics was increasing. The ICMR-INDAB study showed same trend, They showed take off of diabetics in the group of 25-34 years. Present study was corroborating the findings of studies done elsewhere reflecting that BMI was strongly and independently associated with the risk of being diagnosed with diabetes.12,13 Women with positive family history, particularly when both parents are diabetics, are more prone to developing diabetes. Similarfindings were also shown in different study done elsewhere in India & abroad.14

Conclusion:

Age, positive family history, over-weight and obesity were found to be associated with diabetes in women in reproductive age. Targeted screening among women could enhance yield and would help in early detection and management of diabetes to avert future complication.

Limitation:

Prevalence of diabetes was calculated on screening data based on testing with Glucometer at field condition. Random sugar might be influenced on time of food intake, type of food, physical exercise, and illness and so on. As it was targeted screening, prevalence appeared to be high.

Sources of support:

World Diabetic Foundation

Acknowledgement:

We are indebted to the Department of Health & Family Welfare, Governmentt of West Bengal and Kolkata Corporation for giving permission to conduct this study. We are equally thankful to all dubs for necessary support to organize the camps. We specially thankful to all staffs of GRECALTE5 (Goutam Das, Tapan Bagchi, Sanat Dutta, Dilruba Begum, Dipti Chackraborty, Kasturl Ghosh, Sraboni Ghosh, Deepa Roy, Pal la bi Lai, Salma Ara and Suvasish Banerjee) for their tireless effort to complete the project timely and successfully.

Conflict of interest:

None declared

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