Earlier vs. Early Screening of Covert Diabetes in The Innocent 30's

IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 2 Ver. VI (Feb. 2016), PP 21-23
www.iosrjournals.org
Earlier vs. Early Screening of Covert Diabetes in the Innocent

30’s
M Mohamed Fawaz1, Vithiavathi S2
1
(Postgraduate, Department of General Medicine, Aarupadai Veedu Medical College and Hospital ,India)
2
(Professor, Department of General Medicine, Aarupadai Veedu Medical College and Hospital ,India)
Abstract : Increased prevalence and susceptibly to diabetes in the Indian phenotype, has warranted early
screening for diabetes, for detection and prevention of complication among the Asian Indians. Currently the
screening guidelines used are ADA 2015 guidelines and Indian Diabetes Risk Score system to identify
asymptomatic type 2 diabetics for the prevalence of diabetes. ADA guidelines recommends screening as early as
45 years of age and Indian Diabetic Risk score system considers 35 years of age along with presence other
parameters as a risk for diabetes. Our study shows, a much earlier ( 30 years of age onwards ) screening for
diabetes, , irrespective of any normal or abnormal clinical and biochemical parameters is necessary for the
Indian phenotype group, for earlier detection of this Covert Diabetes in these innocent 30's.
Keywords: Earlier screening, 30 years, Covert Diabetes, Indian Phenotype, Screening Guidelines
I. Introduction
Increased prevalence of Diabetes in India, making India the Diabetic capital [1] has already led to wake
up calls among the health fraternity to fortify efforts to control the prevalence as well as progression of Diabetes
to its complications. To aid this effort, early screening tools for diagnosis and identification of high risk
population tools are widely used for early detection and treatment. The American Diabetes Association 2015
recommendations [2] and the Indian Diabetic Risk Scoring [3] method are widely accepted and is in common
practice in India. Indians as compared to the rest of the world along with their south Asian counterparts exhibit a
salient phenotype which makes them, both an earlier as well as a delicate prey for the disease[4]. By far, the so
called early screening tools and methods recommend early screening from 45 years onwards, Diabetes risk score
is given from 35 years on wards and to those whose BMI or Waist circumference fall in the overweight
category or above.
Though these tools are efficient enough for early screening, the Indian phenotype warrants a much
earlier screening due to the covert nature of Diabetes in them. This study is undertaken to emphasis on the need
for a much earlier and inquisitive screening approach for all adults from 30 years of age irrespective of, BMI
and lipid profile being normal.
II. Aim
1. To study the Diabetes pattern in the Indian phenotype along with age, sex, Hba1c, Lipid profile, BMI.
2. To use TMT as a mean to detect presence of silent diabetic complications in the them in the form of
inducible ischemia/coronary artery disease.
III. Materials And Methods

All patients (n=50) after informed consent, fulfilling both inclusion and exclusion criteria have been
recruited for the study. A detailed clinical examination including history taking was performed and recorded,
Bedside tests for autonomic dysfunction along with the following investigations were carried out : CBC, FBS,
PPBS, HbA1c, resting ECG, serum Lipid profile, urea, Creatinine, urine for microalbuminuria and fundus
examination and Tread Mill Test.
1.Inclusion criteria:
1.1 Diagnosed cases of Diabetes as per ADA guidelines of 2013 asymptomatic for ischemic heart disease age
2.Exclusion criteria:
2.1 Typical angina
2.2 Resting Electrocardiographic signs of myocardial ischemia
2.3 Severe and poor prognosis systemic disease
2.4 Age >70 years
2.5 Claudication observed at <400m
2.6 Left bundle branch block on resting ECG
DOI: 10.9790/0853-15262123 www.iosrjournals.org 21 | Page

Earlier vs. Early Screening of Covert Diabetes in the Innocent 30’s
3.TMT Was Aborted When One Of The Following End Points Were Reached:
3.1 Target heart rate 85% of predicted heart rate ( 220 beats/ min minus age in years )
3.2 Severe fatigue
3.3 Systolic blood pressure reduction
3.4 Hypertensive response (systolic pressure increase >250 mmHg and / or diastolic >115mmHg )
IV. Observations And Inferences

Table 1: Prevelance Of Diabetes In Different Age Groups
Age Group 30-34 Years 35-40 Years 41-50 Years 51-60 Years 61-70 Years
Total /50 5 9 13 11 12
% 10% 18% 26% 22% 24%
28%
10% of the patients diagnosed for diabetes belonged to 30 - 34 years age group , while 28% constituted 30 - 40
years age group.
TABLE 2: Hba1c IN 30-40 YEARS AGE GROUP
Age 32 33 33 33 34 35 35 36 36 36 37 38 38 38
Hba1c 9.3 8.8 9.4 8.7 9 7.7 9.8 8.7 9 8.8 8.4 9.3 9 8
All the 30 to 40 years age group , patients who were diagnosed to have diabetes, had deranged Hba1c
levels.
Table 3 : Fasting Lipid Profile In 30-40 Years Age Group Diabetics

Age 32 33 33 33 34 35 35 36 36 36 37 38 38 38
LDL 138 133 96 146 80 87 91 108 83 145 84 129 154 148
HDL 33 39 33 37 35 37 36 37 32 35 37 36 39 37
All the diabetic patients who belonged to 30- 40 years age group had 57% of them had optimal/near
optimal LDL levels and all of them had lower HDL levels.
TABLE 4 : Inducible ISCHEMIA IN 30-40 YEARS AGE GROUP DIABETICS

Age 32 33 33 33 34 35 35 36 36 36 37 38 38 38
TMT -ve -ve -ve -ve -ve +ve -ve -ve -ve -ve -ve -ve -ve -ve
There was one case positive for inducible ischemia within the 30 - 40 years age group diabetics.
Table 5 : Bmi In 30-40 Years Age Group Diabetics

Age 32 33 33 33 34 35 35 36 36 36 37 38 38 38
BMI 28 22.9 24 25 22 28.3 32.6 25 19.9 35.9 28 30 20.8 23
42.8% of diabetic patients belonging to 30 to 40 years age group had normal BMI
V. Results And Analysis

1. Out of 50 diagnosed diabetes patients,5 belonged to the age group of 30 – 34 years and 14 belonged to 30 –
40 years of age respectively, which accounts for 10% of patients that would be missed by ADA screening
methods and 28% of patients who would be given nil score for the age of the patient in the Indian Diabetes
Risk Score calculation system.
2. All the patients including the 30 – 40 years age group 57% of them had near optimal LDL levels in spite of
having elevated HbA1c levels , all of them had low HDL levels probably secondary to type 2 diabetes.[5]
3. 7.14% of the patients belong to 30 – 40 years of age were positive for inducible, which can be attributed as
a cardiovascular complication of diabetes.
4. 42.8% of patients belonging to 30 – 40 years of age had normal BMI and in spite of having deranged
Hba1c, hence these patients would escape screening for diabetes according to the ADA 2015 guidelines.
VI. Conclusion
Our study was initially aimed at studying the clinical, biochemical and TMT parameters of diabetic
patients in the Indian phenotype belonging to 30 to70 year’s age group. Notably, a considerable number of
patients were diagnosed to have diabetes in the 30 to 40 years age group itself out of which one patient was
positive for inducible ischemia by the Tread Mill Test. The prevalence of diabetes in this age group inspite of
normal BMI, normal HDL levels and more than half of them having optimal/near optimal LDL levels was also
significantly interesting. Though the American Diabetes Association recommends screening for diabetes for
those with overweight BMI and those above 45 years of age and the Indian diabetes scoring system considers
Earlier vs. Early Screening of Covert Diabetes in the Innocent 30’s
below 35 years age as no risk for diabetes, we recommend screening for diabetes for Indians from the age of 30
years onwards itself in spite of normal clinical and biochemical parameters, based on our study and
observations.
References
[1] Joshi SR, Parikh RM. India--diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India. 2007
May;55:323-4.
[2] American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015;38(suppl 1):S1-S93
[3] Mohan, V. ; Deepa, R. ; Deepa, M. ; Somannavar, S. ; Datta, M. A simplified Indian diabetes risk score for screening for
undiagnosed diabetic subjects Journal of the Association of Physicians of India, 2005Sep; 53. pp. 759-763. ISSN 0004-5772
[4] Ram1, C. Snehalatha1, A. Nanditha1, S. Selvam1, S. A. Shetty1, I. F. Godsland2, D. G. Johnston2 and A. Ramachandran1,*
Hypertriglyceridaemic waist phenotype as a simple predictive marker of incident diabetes in Asian-Indian men with prediabetes
Diabetic Medicine Volume 31, Issue 12, pages 1542–1549, December 2014
[5] Bitzur R1, Cohen H, Kamari Y, Shaish A, Harats D. Triglycerides and HDL cholesterol: stars or second leads in diabetes? Diabetes
Care. 2009 Nov;32 Suppl 2:S373-7

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IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

Earlier vs. Early Screening of Covert Diabetes in the Innocent

III. Materials And Methods

DOI: 10.9790/0853-15262123 www.iosrjournals.org 21 | Page

IV. Observations And Inferences

TABLE 2: Hba1c IN 30-40 YEARS AGE GROUP

Table 3 : Fasting Lipid Profile In 30-40 Years Age Group Diabetics

TABLE 4 : Inducible ISCHEMIA IN 30-40 YEARS AGE GROUP DIABETICS

Table 5 : Bmi In 30-40 Years Age Group Diabetics

V. Results And Analysis

DOI: 10.9790/0853-15262123 www.iosrjournals.org 23 | Page

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