Comment on Anjana et al. Incidence of Diabetes and Prediabetes and Predictors of Progression Among Asian Indians: 10-Year Follow-up of the Chennai Urban Rural Epidemiology Study (CURES). Diabetes Care 2015;38:1441–1448

In a cohort from Chennai, India, Anjana et al. (1) recently reported one of the highest global rates of progression of prediabetes to type 2 diabetes (T2D) (78.9 per 1,000 person-years [95% CI 68.0–90.9]). One hundred seventy-six out of 299 people with prediabetes developed T2D over a median follow-up period of 9.1 years. Advancing age, positive family history of T2D, 2-h plasma glucose, low HDL cholesterol, and physical inactivity were independent predictors of progression to T2D (1). These rates are much higher than the incidence of T2D among individuals with normal glucose tolerance (22.2 per 1,000 person-years [19.4–25.4]), suggesting that significant β-cell loss is already present in prediabetes and progression to T2D is just a matter of time (1). We reported a similar conversion rate of prediabetes to T2D in a cohort of 144 individuals with prediabetes from Calcutta, India, who were followed up for a mean duration of 32 (12–48.96) months (71.52 per 1,000 person-years [56.76–97.29]) (2). In addition to the above variables, increased BMI, serum fetuin-A, triglycerides, interleukin-1β, interleukin-6, microalbuminuria, and vitamin D deficiency predicted increased progression to T2D and decreased reversal to normal glucose tolerance (2,3).

Taken together, the two Indian studies report one of the highest global rates of prediabetes progression to T2D, second only to the rates observed in Pima Indians (87.3 per 1,000 person-years) (4). This is bad news for India, where 10–14% of adults have prediabetes waiting to progress to T2D at a rapid rate (5). With a population of more than 1.25 billion having a diabetes prevalence of around 9% (5), this is an impending socioeconomic crisis of grave public health importance. Hence, there is an urgent need to initiate a national program to increase awareness regarding prediabetes and institution of aggressive diet and lifestyle changes as preventive measures to reduce the burden of new-onset T2D in India. It is time noncommunicable disease programs in India start focusing on prediabetes along with T2D. In a country with a scarcity of doctors (0.7/1,000 population), poor health infrastructure, and high out-of-pocket health expenditures, the involvement of nurses, paramedics, multipurpose social workers, teachers, and schoolchildren is critical to the mobilization of citizens and the subsequent political will and policy of the state, which are necessary for success of such programs. Simultaneous clinical and translational research focusing on development of novel lifestyle and pharmacologic interventions for diabetes prevention in India is the need of the hour.