European Journal of Cardiovascular Medicine

Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by insulin resistance, impaired insulin secretion, and elevated blood glucose levels. It is the most prevalent metabolic disorder globally and poses significant health and socioeconomic challenges (1-3). T2DM accounts for over 90% of diabetes cases worldwide (4) and contributes to approximately 9% of global mortality, resulting in four million deaths annually. Due to its subtle onset, diagnosis is often delayed by 3–5 years, during which complications such as microvascular and macrovascular damage may already develop (5). Ignorance or inaccessibility to care can exacerbate the disease, leading to severe outcomes such as limb amputation, blindness, kidney failure, and neuropathy. Moreover, T2DM significantly increases the risk of cardiovascular events and doubles the likelihood of cardiovascular-related deaths (5-7).

The prevalence of T2DM has been increasing globally, affecting over 180 million individuals, with developing nations experiencing the highest burden (8-9). India and China are predicted to contribute more than 75% of diabetes cases by 2025 (4). Rapid epidemiological transitions, urbanization, and lifestyle changes in India have significantly influenced the disease's prevalence, making it a critical public health concern. Studies indicate a three-fold rise in diabetes prevalence in urban areas (5–15%) and rural areas (2–6%) in India (10-11). India leads globally in the number of T2DM cases, with an estimated 31.7 million individuals affected (3,12). The growing obesity epidemic further compounds the problem, increasing the economic and health burden of diabetes (13).

Effective prevention strategies focusing on lifestyle modification, such as diet and physical activity, are essential to mitigate this epidemic. Additionally, increasing public awareness about risk factors and early intervention is crucial for controlling T2DM (14). Despite these challenges, limited data exist from Odisha to support culturally and socioeconomically relevant prevention strategies. Understanding the profile of diabetic patients is vital for developing targeted interventions.

This paper presents the demographic, clinical, and biochemical profile of T2DM patients in Burla, Odisha, India.

This hospital-based observational study was conducted from September 2022 to February 2023 in Burla, Odisha, known for its tertiary care facilities, attracting patients from neighboring states and beyond. The study population included newly diagnosed T2DM patients (diagnosed within the past six months) attending the OPD. Patients willing to participate in the study were included.

A sample size of 800 was determined based on department records indicating approximately 100 new cases monthly, resulting in 3,000 cases during the study period. Twenty percent of these cases were randomly selected, and the sample size was inflated by 10% to account for dropouts.

After obtaining informed consent, 783 participants were enrolled using a simple random sampling method. A semi-structured questionnaire collected demographic data, lifestyle habits, medical history, and clinical information. Physical examinations were conducted, and clinical tests, including blood and urine analyses, were performed.

Anthropometric, clinical, and biochemical measurements
Standardized methods were used for anthropometric measurements, while clinical tests included urinalysis, blood glucose levels, HbA1c, renal function tests, and lipid profiles. Hypertension was defined according to JNC-VII criteria (16-17), and diabetes was diagnosed based on ADA guidelines (18). Dyslipidaemia was defined using NCEP criteria (19), and BMI classifications followed Indian Council of Medical Research standards (20).

Data were analyzed using R software. Quantitative variables were expressed as means and standard deviations, while categorical data were presented as frequencies and percentages. Statistical tests included the Student’s t-test for continuous variables and Chi-square tests for categorical variables, with significance set at p < 0.05.

A sample of 796 diabetic subjects was enrolled. Of these, 783 subjects were confirmed to have type 2 diabetes mellitus (T2DM). Further analysis was performed on this cohort.

The sociodemographic characteristics of the study subjects are summarized in Table 1. The mean age of T2DM subjects was 47.70±10.94 years, distributed across four quartiles: 26.9% (211) were aged ≤40 years, 27.1% (212) were 41–48 years, 23.8% (186) were 49–55 years, and 22.2% (174) were >55 years.

Of the study population (n=783), 472 (60.3%) were male, and 311 (39.7%) were female. Most subjects (86.6%, n=678) identified as Hindu, while smaller proportions followed Islam (6.1%), Christianity (4.3%), or other religions (2.9%). Nearly all participants (98.6%) were literate, with 62.8% attaining college-level education and 14.3% holding professional degrees. Regarding occupation levels, 44.4% (n=276) had high-level occupations.

Classic diabetic symptoms were common among the subjects (Table 2). The most frequently reported symptoms were weakness (59.3%, n=464), nocturia (44.4%, n=348), and weight loss (26.7%, n=209). Other complaints included leg pain (25.3%, n=198), tingling (22.3%, n=175), and polydipsia (23.1%, n=181). Vision impairment was observed in 9.1% (n=71) of subjects, while 10.3% (n=81) reported skin complaints.

Behavioral data indicated that 28% of participants had at least one lifestyle-related habit. Smoking was reported by 8.8% (n=69), tobacco chewing by 20.3% (n=159), and alcohol consumption by 8.4% (n=66). Sedentary lifestyles were prevalent among 84% of subjects (Table 3).

Glycaemic control was poor in most participants, with only 6.8% achieving good control (HbA1c <7%). The mean HbA1c level was 10.01±1.53. Dyslipidaemia was identified in 78.2% (n=612), and hypertension was present in 51.2% (n=401). The mean BMI was 27.06±4.57, with 68.1% classified as obese and only 15.8% having normal weight. Microalbuminuria was observed in 10.1% (n=79).

Significant differences (p<0.05) were observed between males and females in terms of BMI (male=25.98±4.28 vs. female=27.03±4.66), waist circumference (male=94.23±10.52 cm vs. female=87.84±9.46 cm), hip circumference (male=97.58±8.79 cm vs. female=102.72±12.49 cm), and LDL cholesterol levels (male=121.19±30.01 mg/dL vs. female=126.89±39.21 mg/dL) (Table 4).

BMI was significantly associated with hypertension (p<0.001). Among hypertensive subjects, 279 (76.8%) were obese (BMI ≥25 kg/m²). Positive family history of diabetes was also significantly associated with hypertension (p=0.049) (Table 5).

Diabetes mellitus is a significant global public health issue, with its prevalence increasing rapidly, particularly in developing nations like India. India is on track to becoming the diabetes capital of the world. Individuals with type 2 diabetes mellitus (T2DM) require urgent attention as they are at high risk for complications, necessitating timely evaluation and intervention to mitigate disease progression.

This study analyzed observational data from a substantial  diabetic patients attending the OPD. To our knowledge, no comparable data profiles have been reported specifically from Burla, although literature on diabetes prevalence in South and North India exists (22–24). The primary aim of this analysis was to assess risk profiles to help reduce the burden of T2DM in Odisha.

The findings indicate that T2DM represents a significant health burden in Odisha, aligning with earlier studies (4). Key findings include that only 6.8% of the population had good glycaemic control (HbA1c ≤7%), around 70% of T2DM subjects were obese, and body mass index (BMI) was significantly (p<0.001) associated with hypertension. Most subjects were literate, reflecting the urban and tertiary-care hospital setting from which the sample was drawn.

Achieving optimal glycaemic control in T2DM patients remains a challenge for healthcare providers. Studies have shown that effective self-care practices among individuals with T2DM improve glycaemic control and reduce complications (25–26). However, only 6.8% of the participants in this study achieved good glycaemic control, a figure considerably lower than in other studies. For instance, a Swedish survey reported 34% of T2DM patients achieved good glycaemic control (27), while Al-Maskari et al. found this to be 38% (28), and Al-Kaabi et al. reported 31% (21). This discrepancy may stem from our sample comprising predominantly newly diagnosed T2DM patients from a tertiary-care hospital, where non-adherence to treatment plans may have contributed to poorer control (29).

Our findings also highlight that a significant proportion of subjects presented with complications, such as renal dysfunction in around 9% and vision impairment in around 10%, suggesting a long duration of undiagnosed diabetes in many cases. The high prevalence of obesity (around 70%) among T2DM subjects aligns with observations from other studies (30–33). Obesity was linked to a family history of diabetes within the Indian population (34). Dyslipidaemia and hypertension were similarly associated with family history, mediated through BMI (32,35). The role of BMI as a predictor of hypertension is well-documented (36), and our study corroborates this among T2DM patients.

Interestingly, no significant associations were observed between physical activity, dyslipidaemia, or controlled glycaemic status with hypertension in the study population. However, age and a family history of diabetes showed marginal significance. Only 17% of participants reported being on diet therapy, despite dietary management being a cornerstone of T2DM care.

Limitations

This study has some limitations. First, its cross-sectional design prevents establishing causality or temporal relationships between variables. However, it provides a valuable snapshot of the current scenario, offering insights for improving T2DM management and guiding future research. Second, as a hospital-based study in an urban setting, its findings may not be generalizable to the broader population. Nevertheless, it offers a reliable estimate of the risk profile for T2DM in Burla. Third, while we aimed to include newly diagnosed T2DM patients, some participants may have had undiagnosed diabetes for an extended period, as our data relied on self-reports.

This study aimed to profile T2DM patients in Burla, Odisha, India, and highlights sociocultural and individual factors influencing diabetes management outcomes. The findings underscore the prevalence of significant factors, including obesity, family history, dyslipidaemia, poor glycaemic control, sedentary habits, and hypertension, which collectively indicate an increased risk for diabetes-related complications.

Based on the results, the following recommendations are proposed to enhance diabetes care:

• Address uncontrolled glycaemic levels, dyslipidaemia, and vision issues through early complication screenings, regular monitoring, and timely follow-ups.
• Emphasize prevention through lifestyle modifications, including dietary interventions and physical activity, to manage body weight effectively.

This study provides a foundation for refining diabetes control strategies and preventive measures tailored to the regional context.

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