The predictive effect of Indian diabetes risk score in diagnosing diabetes among medical students in a tertiary care hospital - A cross sectional study

 

 

Abstract               Background: Students studying in Medical College have a busy and stressed schedule and generally follow a sedentary life style which may predispose them to an increased risk for diabetes and related complications like cardio metabolic syndrome at a younger age group. Indian Diabetic Risk Score (IDRS) is a simple effective screening tool to evaluate the risk of Diabetes. Hence, the present study was done to assess the predictive effect of IDRS as an early marker in diagnosing diabetes mellitus among medical students. Materials and Methodology: A cross sectional study which included 150 young Undergraduate medical students were screened for the risk of developing diabetes using the Indian diabetic risk score. Criteria in the risk score like age, waist circumference, physical activity and family history were subjected on the individuals. Result: 62% of them were in the low risk group, 37% in the moderate risk and 1% in the high risk group. Nearly one third of the study group were in the moderate risk. The mean BMI was 23 in low risk group, 26 in moderate risk group and 34 in high risk group with a significance in Pearson’s correlation (P value< 0.001). Conclusion: IDRS should be considered a useful tool which can be used for predicting the risk of developing diabetes in young individuals.

Key Words: Diabetes, Medical students, Cardio metabolic syndrome, Indian Diabetic Risk Score.

 

 

INTRODUCTION

The epidemic of non-communicable diseases is the trend worldwide and will overcome the communicable disease in the developing and developed countries.¹ Diabetes mellitus [DM] which is an emerged pandemic affects people throughout the world and is associated with potentially life threatening co-morbidities and economic cost.² In India the prevalence of diabetes is so high and is directly related to environmental risk factors like life style changes and obesity which linked with genetic predisposition results in beta cell failure and insulin resistance.³ WHO projects that type 2 Diabetes is seen in all age groups and is more being identified in younger age group. Obesity is a chronic health problem of the recent trends. It is now considered as a global epidemic, affecting people worldwide irrespective of the age and sex. About 30 – 60% of the urban Indians are either overweight or obese.⁴ The relative risk of DM increases with increased BMI and this association is stronger in younger age group of the Asian population.⁵ Though the transition from early metabolic abnormalities that happen in high risk individuals to frank diabetes takes many years, majority of individuals eventually develop diabetes. The risk of developing complications related to DM is related to its duration. Hence, screening the adolescents for diabetes becomes mandatory.⁶ A strong association prevails between diabetes and hypertension. One of the postulates includes upregulation of Renin Angiotensin Aldosterone system [RAAS]. This upregulated RAAS causes increased oxidative stress which in turn explains impaired glucose tolerance.⁷ The features of RAAS and the usefulness of ACE inhibitors in the treatment of Diabetes mellitus and hypertension were studied by Sower et al.⁸ Indian Diabetic Risk Score [IDRS] is a simple effective screening tool to evaluate the risk of Diabetes. It is a simple self assessment questionnaire based score which includes four parameters namely age, family history of diabetes, waist circumference and physical activity. The IDRS was derived by a CURES [Chennai Urban Rural Epidemiological Study] study done by Mohan et al which has a sensitivity of 72.5% and specificity of 60%.⁹ A score of > 60 denotes high risk, 30 – 50 as moderate and < 30 as low risk group ¹⁰. Different studies conducted around the country have validated the IDRS as a useful tool in identifying DM ¹¹. According to a study by Mohan et al, the prevalence of hypertension and metabolic syndrome increases with the increase in the IDRS score. It is 9.4% for low risk, 22.1% for moderate risk and 38.2% for high risk individuals in case of hypertension and 1.8% for low risk, 14.6% for moderate risk and 30.3% for high risk in case of metabolic syndrome¹². Students studying in Medical College have a busy and stressed schedule and generally follow a sedentary life style which may predispose them to an increased risk for diabetes and related complications like cardio metabolic syndrome at a younger age group. Hence the present study was planned to identify the at risk individuals by a simple cost effective means like IDRS and to provide them with an awareness of risk reduction and educating them about the simple life style modifications.

 

MATERIALS AND METHODOLOGY

This is a hospital based cross sectional study and was conducted in Undergraduate medical students of Sri Venkateshwara Medical College Hospital, Ariyur, Puducherry. 150 students were included in the study. An informed consent was given to the students to be filled. Institutional Ethical Committee clearance was obtained before the commencement of the study. A self assessment questionnaire was given to the students to be filled which contained the information’s related to IDRS like age, family history of Diabetes and physical activity. Measurement of Blood Pressure, Height, weight, Body mass Index [BMI], Waist circumference. Estimation of Random blood glucose was done using standard kits in an Auto analyzer. Data were presented as arithmetic mean ± S.D., with subsequent use of Pearson’s correlation and one way ANOVA using SPSS version 23. Values P< 0.05 was considered significant.

Study setting- SVMCH and RC, Puducherry.

Study design- Hospital based cross sectional study

Study population: II^nd Professional Year Medical students of SVMCH and RC who were willing to participate in the study

Study Variable: Blood Pressure, Height, Weight, BMI, Waist circumference and Random blood glucose

Sample size calculation: Sample size was by convenience sampling of 150

Data collection period: Data was be collected from August 2018 to October 2018.

  

Score ≥60:High Risk, 30-50:Medium,<30: Low Risk

 

 

Table: 1 Distribution of students among various risk groups

 

Table 2: Distribution of subjects in relation to various criteria’s of IDRS

 

Table 3: Comparison of various parameters among the different groups

 

Table 4: Correlation between risk score and various parameters

DISCUSSION

The present study aims in diagnosing the at risk individuals for type 2 diabetes using a simple cost effective risk assessment score called Indian diabetic risk score [IDRS]. According to our study, out of the 150 undergraduate medical students, 62% of them were in the low risk group, 37% in the moderate risk and 1% in the high risk group. Nearly one third of the study group were in the moderate risk which is in consistent with a study conducted by Anand Vardhan et al ¹³. Since the subjects were less than 35 years of age we excluded age from the risk group. But as the age advances the subjects with moderate risk can progress to high risk group and hence monitoring such individuals becomes a mainstay. The increased risk is mainly attributed to decreased physical activity [78%], increased waist circumference [26%] and family history [28%]. In the present study, there was an increase in BMI with the increase in risk score. The mean BMI was 23 in low risk group, 26 in moderate risk group and 34 in high risk group with a significance in Pearson’s correlation. BMI is an independent risk factor for diabetes and its complication like cardio metabolic syndrome. This finding is correlating with the findings of a study done by Kumar et al in 2016 14. Similarly 28% of the subjects had a family history of diabetes. According to a study done by Pranita et al, 45% – 80% of younger individuals who developed diabetes had a family history of diabetes ¹⁵. Hence, IDRS may be considered one of the useful tools which can be used for predicting the risk of developing metabolic syndrome [a prediabetic state]. Indentifying the individuals at risk and prevent their progression into frank diabetes by simple health education and life style modifications can be made possible by a simple cost effective tool. In country like India which forms the capital for diabetes IDRS could be a better option to screen mass of individuals in a cost effective way. So, we conclude that Indian Diabetic risk score has a positive predictive effect in diagnosing at risk young individuals.

 

REFERENCES

• Shashank R Joshi. Indian Diabetic Risk Score. JAPI 2005, Vol 53: 755 – 57
• WHO Technical Series Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization Technical Report Series, 2000; 894: 1-253.
• Ramlo Halsted BA, Edelman SV. The natural history of type 2 Diabetes: Implications for clinical practice. Prim care, 1999; 26: 771 – 789
• Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metabolism 2008; 93[11 Suppl1]:S9-30.
• Ni Mhurchu, C., et al. Body mass index and risk of diabetes mellitus in the Asia-Pacific region. Asia Pacific Journal of Clinical Nutrition, 2006; 15: 127-133.
• Tuomilehoto J, Lindstorm I, Eriksson JG, Valli TT, Hamalainen H, Ilanne – Parikka P, Keinanen – kiukaannieni S, Loakso M, Louheranto A, Rastas M, Salminen V, Uusituup a M, The Finnish Diabetes Prevention Study Goup: Prevention of type 2 diabetes mellitus by changes in life style among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343 – 1350.
• Gurushankar S, Sowers JR, Stump CS. Hypertension and Diabetes. European Cardiovascular Disease. 2006; 2[1]: 1-7
• Sowers JR. Hypertension in type 2 Diabetes mellitus – Update on therapy. J Clin Hypertens. 1999; 1[1]: 41 – 47
• Radha R, Srividya J. Assessment of the risk of type 2 diabetes mellitus among rural population in Karnataka using IDRS. Int J Community Med Public Health. 2017 Apr;4[4]:1056-1059
• Sumit G, Jagadamba A, Vinutha S, Karthiyanee K. Risk of Type 2 Diabetes in medical students. Int J of Comprehensive Med Physiol and Res. 2014; 1[1]: 6-9
• Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects. J Assoc Physicians India 2005;53:759-63.
• Mohan V, Anbalagan VP. Expanding role of Madras Diabetes Research Foundation – Indian Diabetic Risk Score in clinical practice. Indian J Endocrinol Metab. 2013; 17 [1]: 31-36.
• Anand V, Adhikari PMR, Kotiyan SM, Nithya S,et al. Values of Indian diabetic risk score among medical students and its correlation with fasting plasma glucose, blood pressure and lipid profile. Journal of clinical and diagnostic research. 2012; 6[9]: 1528-30
• Kumar R, Kumar A. study of type 2 diabetes mellitus risk assessment in medical students of Davangere district, Karnataka, India, using Indian diabetic risk score. Int J Community Med Public Health. 2016 ; 3[12]: 3320 -24.
• Pranita A, Phadke AV, Kharache JS, Balsubramaniam B, Joshi AR. Screening of young adults for future risk of type2 diabetes mellitus- a big concern for society and nation. Journal of clinical and diagnostic research. 2012 November: vol-6[9]: 1610-11.