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What Population Has the Fastest Progression to Diabetes?

May 8, 2015

Asian Indians with prediabetes have one of the highest incidence rates for diabetes, despite being younger and having a much lower average BMI than other high-risk populations…


There is little data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian Indians. Researchers led by Ranjit Mohan Anjana, MD, vice president of Madras Diabetes Research Foundation in Chennai, India, examined the incidence of diabetes and prediabetes and the predictors of progression in a population-based Asian Indian cohort.

The south Indian researchers used data on progression to diabetes and prediabetes from 1,376 individuals, a subset of 2,207 of the Chennai Urban Rural Epidemiology Study (CURES) cohort with normal glucose tolerance (NGT) or prediabetes at baseline, who were followed for a median of 9.1 years (11,629 person-years). During follow-up, 534 died and 1,077 with NGT and 299 with prediabetes at baseline were reinvestigated in a 10-year follow-up study. Diabetes and prediabetes were diagnosed based on the American Diabetes Association criteria. Incidence rates were calculated and predictors of progression to prediabetes and/or diabetes were estimated using the Cox proportional hazards model.

The incidence of diabetes, prediabetes, and “any dysglycemia” were 22.2, 29.5, and 51.7 per 1,000 person-years, respectively. Among those with NGT, 19.4% converted to diabetes and 25.7% to prediabetes, giving an overall conversion rate to dysglycemia of 45.1%. Among those with prediabetes, 58.9% converted to diabetes. Predictors of progression to dysglycemia were advancing age, family history of diabetes, 2-h plasma glucose, glycated hemoglobin (HbA1c), low HDL cholesterol, and physical inactivity.

The researchers concluded that, “Asian Indians have one of the highest incidence rates of diabetes, with rapid conversion from normoglycemia to dysglycemia. Public health interventions should target modifiable risk factors to slow down the diabetes epidemic in this population.”


“Part of this could be explained by the high prevalence of family history [of diabetes] in our population,” they wrote. “It also represents rapid epidemiological transition in our population.”

Practice Pearl:

  • Among participants with normal glucose tolerance at baseline, 19.4% developed diabetes and 25.7% developed prediabetes.
  • Among participants with existing prediabetes, 58.9% went on to develop diabetes.
  • The incidence rate for prediabetes for the cohort was 78.9 per 1,000 person-years

Anjana RM, et al. Diabetes Care. 2015;doi:10.2337/dc14-2814. Incidence of Diabetes and Prediabetes and Predictors of Progression Among Asian Indians: 10-Year Follow-up of the Chennai Urban Rural Epidemiology Study (CURES).