The impact of the diabetes epidemic in India: Establishing the prevalence and clinical profile of Metabolic Syndrome in Type 1 Diabetes patients in Chennai, India
Location: Chennai, India
Alumni: Amy Billow
Faculty: Edwin Michael
The lifestyle shift that is taking place in India has introduced type 2 diabetes mellitus (T2DM), obesity and the metabolic syndrome (MS) in epidemic proportions. While the connection between MS and TD2M is well studied, the connection between type 1 diabetes mellitus (T1DM) and MS is less understood. Although lifestyle choices do not influence onset of T1DM, increasing obesity may be a key player in the evolution of insulin resistance and “double diabetes.” This study sought to establish the prevalence of MS in T1DM and investigate how presence of MS affects prevalence of diabetes complications using a T1DM cohort at Dr. Mohan’s Diabetes Specialty Center in Chennai, India. A retrospective analysis using an electronic medical record system was done on 491 T1DM patients. Relevant clinical and biochemical data from patient first visit was collected and MS was diagnosed according to International Diabetes Federation (IDF) criteria. MS risk factors and macrovascular and microvascular complications data was analyzed for association with MS using t-test, chi-square and logistic regression.
Prevalence of MS was 7.9% overall. MS positive people had longer duration of T1DM, were overweight or obese, showed a family history of DM, showed signs of insulin resistance and had higher cholesterol. Presence of MS was not associated with poor glycemic control. MS positive patients had higher prevalence of microvascular complications but not macrovascular complications, with a strong association between MS and presence of nephropathy even after adjusting for confounding variables. In general, the prevalence of microvascular but not macrovascular complications rose with number of MS components present. This study has established a baseline prevalence of MS in a T1DM cohort in Southern India. There is a clear association between certain risk factors such as duration of DM and obesity and presence of metabolic syndrome. Presence of MS at first visit increases the odds that patients have microvascular complications such as retinopathy, neuropathy and especially nephropathy at first visit, although further study is needed to determine a causal relationship between presence of MS and development of complications.