International Journal of Community Medicine and Public Health

Anusuya GS et al. Int J Community Med Public Health. 2018 Dec;5(12):5200-5204

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20184790
Original Research Article

Prevalence of undiagnosed and uncontrolled diabetes mellitus

among adults in South Chennai
Ganesh S. Anusuya1, Rama Ravi2*, S. Gopalakrishnan3, A. Abiselvi3, T. Stephen3

Department of Community Medicine, 1Tagore Medical College, 3SBMCH, Chennai, Tamil Nadu, India
2
John and Jenner centre for Research, Erode, Tamil Nadu, India

Received: 28 August 2018

Accepted: 03 October 2018

*Correspondence:
Dr. Rama Ravi,
E-mail: ramangam@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Nearly 69.2 million people were living with diabetes as per 2015 WHO data. Prevalence of diabetes in
Chennai is always on the rise and it nearly around 12%. The objectives of the study were to estimate the prevalence of
undiagnosed diabetes and also to study about the uncontrolled diabetes among known case of diabetes.
Methods: A cross sectional descriptive record based study done on 1361 adult population attending medical camps in
various locations of South Chennai. The data regarding capillary blood sugar (CBG), age, gender, place, type of
treatment and duration of treatment were collected from the camp register. A RBS Glucometer value of >200 mg/dl
was defined as having diabetic. Descriptive analysis and chi square test done to see the statistical significance
between various parameters. T test was done to compare the mean RBS values between various variables.
Results: Among the study population nearly 62.9% were females. The mean age of the study population was
49.8±13.3 years. Nearly 22% were known case of diabetics and 10.3% were newly diagnosed diabetics. The mean
random blood sugar of the study population is 174.3±95.3 mg/dl. 65.4% of the known case of diabetics had
uncontrolled sugar values of >200 mg/dl. The prevalence of diabetes in age group >50 years (43.9%) and <50 years
(20.3%) [p=0.0001]. The mean blood sugar values among patients taking treatment in government (283.5 mg/dl)
versus private (249.2 mg/dl) [p=0.0001, among known diabetics (262.5 mg/dl) versus new diabetics (296.6 mg/dl)
[p=0.002].
Conclusions: The prevalence of newly diagnosed diabetes was 10.3% and uncontrolled diabetes among known case
is 65.4%. So more screening camps for early detection of diabetes and organizing health awareness programmes are
needed in this population to reduce the disease burden.

Keywords: Diabetes mellitus, Undiagnosed, South Chennai

INTRODUCTION the leading disorders in most urban populations across the

world. The slow onset of the disease, with a long pre-
India as a developing country has been facing the threat detection period and heavy influences of dietary and
of both communicable and non communicable diseases in lifestyle habits make the disease far more common in
the recent past. However, there has been a real challenge developing economies. Worldwide, there is a projected
with an increase in the burden of non communicable increase in the prevalence of diabetes mellitus to 592
diseases. A majority of the deaths today are due to million (10.1%) by 2035.1
cardiovascular causes, and they have been predisposed by
some of the other non communicable diseases like In the past few decades, India has deemed to be a diabetic
diabetes mellitus, hypertension, dyslipidemia, etc. capital of the world. With the country’s growing
Among these, type 2 diabetes mellitus has been one of urbanization, there has been an increase in the population

International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12 Page 5200
 Anusuya GS et al. Int J Community Med Public Health. 2018 Dec;5(12):5200-5204

migration which has in large disrupted the lifestyle and Sample size calculation and sampling technique
eating patterns of these people. This has indirectly
predisposed a large number of people to lifestyle diseases Based on the prevalence of 11.1% from a previous study.4
like diabetes and hypertension. Moreover, the proportions for undiagnosed diabetes mellitus, at 95% confidence
of people who remain undetected are also on the rise. limits and 16% relative precision, the sample size was
According to World Health Organization, 69.2 million calculated as 1216. Accounting 10% for non response,
(8.7%) of the global population remain undiagnosed for the final sample size was calculated as 1361. Sampling
type 2 diabetes mellitus in 2015.2 Several studies done in technique used was convenient sampling
India show alarming rates of the rise in the proportion of
population with undiagnosed diabetes mellitus. A study Study settings
done by Joshi et al showed that 7.2% of the populations
in over eight states in India were undetected with diabetes Urban and Rural areas of South Chennai patients
mellitus. In Chennai, Raja et al in 2010-11 reported a attending medical camps conducted by a private medical
prevalence of 11.1% of undetected diabetes while college.
CURES study reported a prevalence of 9.1% in Chennai
at the same time.3-5 Inclusion criteria

Majority of the patients with diabetes mellitus go through Patient who have attended medical camps in South
a pre diabetic phase for several years which is an Chennai region and have undergone a CBG check by
intermittent stage which increases the risk of undiagnosed glucometer.
diabetes and overt diabetes mellitus. This may also be
referred to as abnormal glucose regulation (AGR).6 It is Data collected
essential that the population is targeted at this stage with
adequate screening programme, to detect diabetes at an RBS values, age, gender, previous history of diabetes,
early stage. The American Diabetes Association (ADA) type of treatment, and place of treatment were collected
recommends that adults at normal risk for diabetes must from the camp register (1st May 2017 to 15th August
undergo every three years and adults with a positive 2017). An operational definition of RBS glucometer
family history and other risk factors should undergo values of >200 mg/dl was defined as having diabetic.
screening at one or two year interval.7 Studies have
proven that one-thirds of all the people with diabetes Justification for using RBS values >200 mg/dl for
remain undiagnosed and more than 60% of the newly diagnosing diabetes
diagnosed individuals are unaware of the condition until a
complication appears.8 We followed the Mayo Clinics, diagnostic criteria for
diabetes as using RBS values >200 mg/dl.10 Even WHO
have mentioned RBS values greater than 200 mg/dl can
There is a growing need for the early detection, due to the
be used as a screening tool for diagnosing diabetes in
nature of pathogenesis of the disease. Diabetes mellitus is
resource poor settings and practical consideration of the
bound to result in severe complications of the vascular
existing situations.11
system, affecting multiple organs. Several Indian studies
have reported about 34% prevalence of diabetic
Data analysis
retinopathy, which is a significant micro vascular
complication of the disease.9 Hence early detection is the
Data were entered and analyzed using SPSS ver.20
key to prevent the onset of complications, and reduce the
software. Descriptive analysis, Chi square test and pooled
morbidity and mortality associated with diabetes.
t test were done to see the statistical significance between
various parameters.
Objectives
Ethical clearance
 To estimate the prevalence of undiagnosed and
uncontrolled type 2 diabetes mellitus.
The ethical clearance was obtained from the Institutional
 To compare the mean blood sugar values with certain Ethical Committee and Institutional Review board of a
variables. private medical college in Chennai.
METHODS RESULTS
Type of study Baseline characteristics

Cross sectional record based study. This study was carried out among 1361 adults of South
Chennai. 62.9% of the study participants were females.
Period of study Mean age of the study participants was 49.8±13.3 years
nearly 74.9% of the participants had blood glucose levels
1st May 2017 to 15th August 2017. less than 200 mg/dl.

International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12 Page 5201
 Anusuya GS et al. Int J Community Med Public Health. 2018 Dec;5(12):5200-5204

The prevalence of undiagnosed diabetes was nearly random blood sugar among all the participants was
10.3%. Nearly 65.4% of the known case of diabetics had 174.3±95.3 mg/dl. The other baseline characteristics of
uncontrolled blood sugar values of >200 mg/dl. Mean the study participants are given in Table 1.
Table 1: Baseline characteristics (n=1361).

S. No Characteristics Frequency Percentage (%)

Male 505 37.1
1 Gender
Female 856 62.9
Newly diagnosed (undiagnosed) 140 10.3
2 Diabetic status Known diabetics (old case) 300 22
Non diabetics 921 67.7
<35 158 11.6
35-50 511 37.5
3 Age (in years)
50-65 470 34.5
>65 222 16.3
N= Numbers, % = Percentage.

Table 2: Health seeking pattern of known diabetics among the study participants (n=300).

S. No Characteristics Frequency Percentage (%)

<5 years 162 54
Duration of
1 5-10 years 67 22.3
diabetes
>10 years 71 23.7
Government 118 39.3
2 Place of treatment
Private 182 60.7
Only tablets 270 90
3 Type of treatment
Tablets and Insulin 30 10
N= Numbers, % = Percentage.

Table 3: Comparison between mean blood sugar levels and health seeking pattern among known diabetics.

S. No Characteristics Mean sugar Mean difference T value P value

Government 283.5
1 Place of treatment 34.4 2.5 0.016*
Private 249.2
<5 years 262.8
2 Duration of treatment 0.6 0.046 0.631
>5 years 262.2
Insulin/tablets 318
3 Type of treatment 60.9 2.6 0.0001*
Tablets only 257
(*statistically significant).

Health seeking pattern of known diabetics among the significant lower mean blood sugar values (249.2 mg/dl)
study participants compared to those taking treatment in government
hospitals (283.5 mg/dl) and this difference was
The known case of diabetics were 300 (22%) in number. statistically significant (p=0.016).
The duration of diabetes was over 10 years for 23.7% of
the known diabetics. Moreover, 60.7% of them undertook The mean blood sugar values of patients taking both
treatment from private hospitals, and 90% of known Insulin and tablets (318 mg/dl) were high when compared
diabetics were only on oral hypoglycemic drugs. The with those taking only tablets (257 mg/dl) and the
health seeking pattern of known diabetics is given in difference was statistically significant.
Table 2.
Mean RBS among known diabetics was 262.5±114.5
Comparison between mean blood sugar levels and mg/dl. Mean RBS among newly detected diabetes was
health seeking pattern among known diabetics 296.6±89.6 mg/dl. The mean blood sugar value among
the newly diagnosed diabetics were comparatively higher
It was observed that place and type of treatment were than known case of diabetics and the findings were also
significant predictors of mean blood sugar values. statistically significant (p=0.002). The comparison
Patients obtaining care in private hospitals had a between the mean blood sugar values and the health

International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12 Page 5202
 Anusuya GS et al. Int J Community Med Public Health. 2018 Dec;5(12):5200-5204

seeking pattern among known diabetics is given in Table diagnosed diabetics when compared with known cases of
3. diabetics. This finding shows the importance of early
diagnosis and bringing the patients into care at an early
DISCUSSION stage. The mean RBS values were also high among
patients taking treatment from government hospitals and
This community based study was carried out to measure those who were on both insulin and tablets type of
the burden of undetected diabetes mellitus in the treatment. The patients on insulin should be reviewed
population. Our study reported a prevalence of 10.3% of frequently and their insulin dosages should be upgraded
undiagnosed diabetes mellitus. A study done by Joshi et depending on the CBG values.
al reported a prevalence of 7.2% while a study done by
Raja et al reported a prevalence of 11.1% in Chennai Limitations
city.3,4 The above findings are similar to our study
findings. This study also reported the prevalence of The prevalence of diabetes mellitus in this study was
uncontrolled blood sugar levels among known diabetics, estimated from the first level screening test which may
which was found to be 65.4%. In a study done by not be a confirmatory diagnostic measure. Therefore
Mahapatra et al, the prevalence of uncontrolled diabetes there is a need for a follow up measurement of fasting
was 46.43%, which was lesser than our findings.12 In and post prandial blood sugar values for confirming their
another study done by Kanungo et al the prevalence of diabetic status in newly diagnosed diabetics.
uncontrolled diabetes was 47%, which was also lesser
when compared with our study findings.13 The difference Funding: No funding sources
in prevalence of uncontrolled diabetes can be attributed to Conflict of interest: None declared
different study settings, different criteria for uncontrolled Ethical approval: The study was approved by the
diabetes and different geographical locations. Institutional Ethics Committee

There are several factors which could be attributed to the REFERENCES

existing scenario of diabetes care and burden as observed
in our study. The key focus in diabetes management is 1. Forouhi NG, Wareham NJ. Epidemiology of
early detection and adequate control. Studies have Diabetes. Medicine (Abingdon). 2014;42(12):698-
reported that diabetes control worsens with increase in 70.
the duration of the disease beyond 10 years.14 It is a well 2. World Health Organization. India. Available at:
known fact that poor glycemic control increases the risk http://www.searo.who.int/india/mediacentre/events/
for micro and macro vascular complications. However, 2016/en/. Accessed on 3 August 2018.
achievement of glycemic control poses a significant 3. Joshi SR, Saboo B, Vadivale M, Dani SI, Mithal A,
challenge to not only the patients, but also to the Kaul U, et al. Prevalence of diagnosed and
physicians. Our study reported that care in private undiagnosed diabetes and hypertension in India--
hospitals significantly reduced the mean glucose levels results from the Screening India's Twin Epidemic
compared to patients taking treatment in government (SITE) study. Diabetes Technol Ther. 2012;14(1):8-
hospitals. This is well substantiated by the fact that the 15.
availability of resources to monitor the blood glucose 4. Subramani R, Devi U, Shankar U, Rama,
levels like HbA1c is lacking in certain government Rajalakshmi, Ganesh, et al. Prevalence of
infrastructure. Moreover, there has been a reported ‘lack Undiagnosed Type 2 Diabetes and its Associated
of inertia’ in initiating insulin therapy from both the Risk Factors in Rural Population of Tamil Nadu.
doctors and patients side.15,16 There is also a possibility World J Med Sci. 2014;11(2):222-7.
that the doctor patient ratio may not be similar in 5. Deepa M, Pradeepa R, Rema M, Mohan A, Deepa
government and private sectors. Since the case load is R, Shanthirani S, et al. The Chennai Urban Rural
very high in government settings when compared to the Epidemiology Study (CURES)--study design and
private hospitals, there is also a possibility the doctors methodology (urban component) (CURES-I). J
may not be able to spend more time with the patients in Assoc Physicians India. 2003;51:863-70.
government hospitals. Our study also showed that 6. Meme N, Amwayi S, Nganga Z, Buregyeya E.
patients taking both insulin and tablets had high mean Prevalence of undiagnosed diabetes and pre-
RBS values than those who were only on tablets. This diabetes among hypertensive patients attending
finding can be attributed to possibility of more severely Kiambu district hospital, Kenya: A cross sectional
diabetic patients were in the category of taking both study. Pan Afr Med J. 2015;22:286.
insulin and tablets. 7. Pétursson P. Aspects of Abnormal Glucose
Regulation in Various Manifestations of Coronary
CONCLUSION Artery Disease. 2012.
8. WHO. WHO Global status report on non
The prevalence of undiagnosed diabetes is 10.3%. communicable diseases; 2010. Available
Prevalence of uncontrolled diabetes among known case is from:http://www.cabdirect.org/abstracts/201131688
65.4%. The mean RBS values were high among newly 08.html. Accessed on 3 August 2018.

International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12 Page 5203
 Anusuya GS et al. Int J Community Med Public Health. 2018 Dec;5(12):5200-5204

9. Vaz NC, Ferreira AM, Kulkarni MS, Vaz FS, Pinto for restructuring health care delivery services.
NR. Prevalence of diabetic complications in rural Epidemiol. 2016;6:224.
Goa, India. Indian J Community Med. 14. Mohan V, Shah S, Saboo B. Current glycemic status
2011;36(4):283-286. and diabetes related complications among type 2
10. Mayo clinic. Type 2 Diabetes. Diagnosis. Available diabetes patients in India: data from the A1chieve
at: http://www.mayoclinic.org/diseases-conditions/ study. J Assoc Physicians India. 2013;61(1):12-5.
type-2-diabetes/basics/tests-diagnosis/con- 15. Kumar A. Insulin guidelines: taking it forward.
20031902. Accessed on 3 May 2018. Medicine Update (API India). 2010;20:127–30.
11. Screening for Type 2 diabetes. Report of a world 16. Unnikrishnan RI, Anjana RM, Mohan V.
Health Organization and International Diabetes Importance of controlling diabetes early--the
Federation meeting 2003. Available at: concept of metabolic memory, legacy effect and the
http://www.who.int/diabetes/publications/en/screeni case for early insulinisation. J Assoc Physicians
ng_mnc03.pdf. Accessed on 3 May 2018. India. 2011;59:8-12.
12. Mahapatra T, Chakraborty K, Mahapatra S,
Mahapatra U, Pandey N, Thomson PL et al. Burden
and socio behavioural correlates of uncontrolled Cite this article as: Anusuya GS, Ravi R,
abnormal glucose metabolism in urban population Gopalakrishnan S, Abiselvi A, Stephen T. Prevalence
of India. PLoS ONE. 2006;11(10):e0163891. of undiagnosed and uncontrolled diabetes mellitus
13. Kanungo S, Mahapatra T, Bhowmik K, Mahapatra among adults in South Chennai. Int J Community Med
S, Saha J, Pal D, et al. Diabetes scenario in Public Health 2018;5:5200-4.
backward rural district population of India and need

International Journal of Community Medicine and Public Health | December 2018 | Vol 5 | Issue 12 Page 5204