The prevalence of diabetes is rapidly rising all over

the globe at an alarming rate.1 Over the past 30 years,

the status of diabetes has changed from being considered

a mild disorder of the elderly, to one of the major causes

of morbidity and mortality affecting the youth and middle

aged. It is important to note that the rise in prevalence is

seen in all six inhabited continents of the globe.2 The major

driver of the epidemic is the more common form of diabetes

namely type 2 diabetes, which accounts more than 90% of

all diabetic cases

Chandramohan, P

Mohan, V

Eprints @MDRF

© JAPI • VOL. 56 • NOVEMBER 2008 www.japi.org 837
Editorial
High Prevalence of Diabetes and Metabolic Syndrome 
Among Policemen
P Chandramohan, V Mohan
in the rural population while the prevalence of diabetes 
according to the WHO criteria was 5.6 and 2.7 per cent 
among urban and rural areas respectively.9,10 In National 
Urban Diabetes Survey (NUDS),15 based on WHO criteria, 
the age standardized prevalence of type 2 diabetes was 
12.1 per cent. This study also revealed that the prevalence 
in the southern part of India to be higher-13.5 per cent in 
Chennai, 12.4 per cent in Bangalore, and 16.6 per cent in 
Hyderabad; compared to eastern India (Kolkata), 11.7 per 
cent; northern India (New Delhi), 11.6 per cent; and western 
India (Mumbai), 9.3 per cent. Thus it is clear that different 
studies has shown different results and what is needed is a 
truly national study to determine the exact prevalence of 
diabetes in urban and rural areas in India .
In this issue of JAPI , two interesting studies, one 
from Kolkata11 and the other from Chennai,20 report on 
the prevalence of diabetes and metabolic syndrome 
respectively among police personnel in these two cities.
In the Kolkata-policemen study, S Kumar et al11 estimated 
the prevalence of diabetes and IFG in a population of 
policemen and evaluated the influence of risk factors 
such as body mass index (BMI), waist circumference (WC), 
waist-hip ratio (WHR), waist-height ratio (WHtR) and 
family history of diabetes on prevalence of diabetes. The 
study was conducted in men in the middle income group 
and used capillary blood (glucometer) for measuring the 
fasting blood glucose level. This study reports the diabetic 
prevalence to be 11.5% of which 10.4% were known 
diabetic and 1.1% were newly diagnosed. Additionally, 
6.2 % had impaired fasting glucose (IFG). The study also 
shows that the prevalence of diabetes increases with age, 
parental history, waist circumference, WHR and WHtR were 
significantly greater in IFG and diabetes groups compared 
to the normoglycaemic group. However there was no 
statistically significant difference in BMI between the three 
groups studied .
While the overall prevalence of diabetes in this study is 
consistent with data from Kolkata in NUDS, the prevalence 
of newly diagnosed diabetes in this study is considerably 
lower than reported in Kolkata in NUDS,15 or Chennai in 
CUPS12 or CURES.13,14 One of the reasons for this could be 
that fasting blood glucose was used for diagnosis rather 
than the 2 hour blood glucose value. It has been proved 
in earlier studies that 2-hr value has better sensitivity in 
detecting type 2 diabetic patients than fasting blood 
Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes 
Specialities Centre, WHO Collaborating Centre for Noncommunicable 
Diseases, Prevention and Control, Chennai, India.
The prevalence of diabetes is rapidly rising all over the globe at an alarming rate.1 Over the past 30 years, 
the status of diabetes has changed from being considered 
a mild disorder of the elderly, to one of the major causes 
of morbidity and mortality affecting the youth and middle 
aged. It is important to note that the rise in prevalence is 
seen in all six inhabited continents of the globe.2 The major 
driver of the epidemic is the more common form of diabetes 
namely type 2 diabetes, which accounts more than 90% of 
all diabetic cases.
India leads the world with largest number of diabetic 
subjects thus earning it the dubious distinction of being 
termed the “Diabetes capital of the world”. According to the 
Diabetes Atlas 2006 published by the International Diabetes 
Federation, the number of people with diabetes in India is 
currently around 40 million and this number is expected to 
rise to 70 million by 2025, unless urgent preventive steps 
are taken.3 The so called “Asian Indian Phenotype” refers to 
certain unique clinical and biochemical abnormalities in 
Indians which include increased insulin resistance, greater 
abdominal adiposity i.e., higher waist circumference despite 
lower body mass index, lower adiponectin and higher high 
sensitive C-reactive protein levels.4 This phenotype makes 
Asian Indians more prone to diabetes and premature 
coronary artery disease.5
Urban rural differences in the prevalence of diabetes 
have been consistently reported from India. While the ICMR 
study in the 1970’s reported that the prevalence was 2.1 per 
cent in urban and 1.5 per cent in rural areas,6 a more recent 
WHO-ICMR study based on NCD risk factor surveillance 
showed that the prevalence of self-reported diabetes was 
7.3% in urban, 3.2% in periurban, and 3.1% in rural areas.7 
A study done in southern Kerala looked at the variations 
in the prevalence of type 2 diabetes among different 
geographic divisions within a region.8 The prevalence of 
diabetes was highest in the urban (12.4%) areas, followed 
by the midland (8.1%), highland (5.8%) and coastal division 
(2.5%). In Prevalence Of Diabetes in India Study (PODIS), 
based on the ADA criteria, the prevalence of diabetes was 
4.7 per cent in the urban compared to the 2.0 per cent 
838 www.japi.org © JAPI • VOL. 56 • NOVEMBER 2008
glucose.16 Alternatively it might be because policemen may 
be undergoing periodic testing and hence the undiagnosed 
diabetes is low.
In the recent years, it has become clear that visceral, 
rather than subcutaneous fat, is associated with insulin 
resistance.17 This study confirms earlier observations that 
the waist circumference (WC) is an important predictor of 
diabetes. This study also shows the importance of waist 
height ratio (WHtR) in increasing risk of type 2 diabetes. This 
is a novel index not reported so far in India, although some 
earlier studies in other countries have shown that WHtR is a 
useful index to assess risk of type 2 diabetes.18-19
Another study reported in this issue by Vijay Viswanathan 
and colleagues from Chennai,20 compares the prevalence 
of diabetes among policemen and general population 
(GP) in Chennai. This study reports a very high prevalence 
of diabetes among policemen (32%) compared to the GP 
(20%). This study also reports the  prevalence of metabolic 
syndrome (MS) among policemen to be 57% and that in GP 
to be 28%. This figures appears to be much higher than the 
prevalence of MS reported in a representative population 
of Chennai where the prevalence of MS was found to 
be 23.2% using WHO criteria 18.3% using NCEP-ATP III 
criteria and 25.8% using IDF criteria.21 In the study by Vijay 
et al,  policemen also had a higher mean of biochemical 
parameters and anthropometric measurements. This report 
thus suggests that policemen are at high risk of developing 
diabetes and cardiometabolic risk factors. The possible 
reason for high prevalence could be due to poor physical 
activity, altered sleep cycle, improper food habits and the 
tremendous work pressure and stress.
Thus it is clear from both Kolkata and Chennai studies 
that policemen should be targeted for therapeutic life 
style changes to keep themselves healthy and to prevent 
diabetes and metabolic syndrome as they are the law 
keepers of the nation. Such a program could be linked with 
the National Program for Prevention and Control of Diabetes 
/ Cardiovascular Disease and Stroke recently launched by 
the Government of India.22
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Diabetes Metabolism Research Review 2007;23:127-34.
22. National Program for Prevention and Control of Diabetes / 
Cardiovascular Disease and Stroke (NPDCS) - http://www.
igovernment.in/site/pilot-project-to- fight-diabetes-cardio-vascular-
diseases-launched/. Accessed on September 13, 2008.
© JAPI • VOL. 56 • NOVEMBER 2008 www.japi.org 839
Announcement
8th International Symposium on Diabetes
Venue: Mumbai        Date: 24th & 25th January 2009
Theme : Diabetes Update 2009
Course Directors: Prof. K. Sreekumaran Nair, David Murdock Dole Professor and Professor of Medicine,  
 Divis ion of  Endocr inology,  Mayo Cl inic,  200 First  Street  S .W.  Rochester,  
 MN 55905 USA.
 Dr. AK Das, Additional Director of Health Services and Director, Department of Medicine 
 JIPMER, Pondicherry.
CME credits will be awarded
For further details contact: Dr. Shashank R Joshi, Organising Secretary, Joshi Clinic, 12, Golden Palace, Turner 
Road, Bandra (W), Mumbai – 400 050.
Tel: 91-22-26402769; Fax: 91-22-26443572    Email: srjoshi@vsnl.com
Advance Registration: Rs. 4,000/- Before 30th November 2008
The Demand Draft should be in favour of ‘Events in Mumbai’ payable at Mumbai.
Reserve early as we have limited Registrations


High Prevalence of Diabetes and Metabolic Syndrome

Among Policemen

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High Prevalence of Diabetes and Metabolic Syndrome Among Policemen

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