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Indian Journal of Community Medicine

Prevalence of Impaired Glucose Tolerance in Young Non-Diabetic Patients with Ischaemic Heart Disease (Below 50 Years)

Author(s): M.K. Jain, P.K. Baghel, P. Vasudeva

Vol. 30, No. 1 (2005-03 - 2005-03)

Introduction

As the civilization continues to conquer the contagious causes the ischaemic heart disease and diabetes mellitus are fast emerging as the numero uno casue for morbidity and mortality. The personnel and public health problems of diabetes which have assumed already vast proportions continue to grow despite exciting advances in the past few years in virtually every field of diabetes including new researches and patient care. Thus it is one of the worst cripplers among chronic diseases.

The complex interplay of metabolic abnormalities and risk factors that underlie the ischaemic event are greatly enhanced with co-existence of glucose intolerance/diabetes. The effects of risk factors both modifiable like tobacco, hypertension, central obesity, hypercholesterolemia, urban life culture and unmodifiable like age, sex and a positive family history are increased many folds in presence of diabetes.

Urban India has seen an epidemic increase in the number of cases with impaired glucose tolerance as well as diabetes mellitus. The state of impaired glucose tolerance is defined as a glycaemic response to a standard glucose challenge intermediate between normal and diabetic and can therefore only be detemined by an oral glucose tolerance test. The lack of self-concern, absence of awareness, long latent period before symptomatic manifestation among the youth underlies the reason for late detection of glucose intolerance/diabetes. The paucity of dramatic and typical symptomatology among diabetics with ischaemic heart disease cause a delayed diagnosis.

Material and Methods

The study was carried out in Department of medicine, S.S. Medical College, Associated S.G.M.H. and G.M.H. Rewa, over a period of one year from April, 2001 to August, 2002 in 150 subjects with definite electrocardiographic ischaemic events. The study group contained 150 subjects below the age of 50 years who were having ischaemic heart disease and were not diagnosed cases of diabetes mellitus. Patients selected for the study were asked about the symptoms pertaining to the diabetes mellitus. A complete general and systemic examinaiton was carried out including relevant anthropometric measurements such as height, weight, BMI and waist hip ratio. Patients were then subjected to oral glucose tolerance test. Each patient was advised to take an unresticted diet (>150 gm carbohydrate daily) and do usual physical activities for three days before the test. The patients were advised an overnight fast preceding to test and in the morning glucose tolerance test was carried out using 75 gm of glucose with collection of blood and urine samples at 0, 1, 2 hour interval.

Results

Out of 150 Subjects who participated in the study 64 (42.6%) had abnormal glucose tolerance (30.6% IGT and 12% had newly detected diabetes) As depicted in table-I, prevalence of abnormal glucose tolerance was minimum (25%) in age group 20-29 years and maximum 55% in 40-50 years age group. Correlation between abnormal glucose tolerance and age was statistically significant. Prevalence of abnormal glucose tolerance was 45.1% in males and 37.5% in females.

Table I : Relationship of IGT with Non modifiable Risk Factor

Risk Factor No. of
Subjects
Abnormal OGTT
Merge cells
Age Group
20-29 4 1 (25%)
30-39 83 28 (33.7%)
40-50 63 35 (55.5%)
Sex
Male 102 46 (45.1%)
Female 48 18 (37.5%)
Total 150 64 (42.6%)
x2 = 6.7, P<0.05 Significant (AGE)
x2 = 0.17 P>0.05 Insignificant (SEX)

Table II : Relationship of IGT with Modifiable Risk Factors

Risk Factor N No. of
cases
Abnormal
OGTT
Urban 59 36 61%
Sedentary life style 34 21 61.7%
Non-vegetarian 99 51 51.5%
Addiction to tobacco 43 23 53.4%
Past history of hypertension
a) Males 32 14 43.7%
b) Females 28 18 64.2%
Persons with central obesity
a) Males 17 12 70.5%
b) Females 14 18 40.9%
Hypercholesterolemia 91 48 52.7%

Discussion

Out of 150 subjects 64 (42.6%) were positive for abnormal glucose tolerance (30.6%) IGT and 12% newly detected Prevalence of IGT in Young Non-Diabetics Indian Journal of Community Medicine Vol. 30, No. 1, January-March, 2005 diabetes). This was significantly more than the prevalence of IGT in general population. The prevalence of IGT in recently reported in national urban diabetes survey showed age adjusted prevalence of diabetes and impaired glucose tolerance to be 12% to 14.4% respectively. By WHO criteria prevalence of diabetes in India in adults is 2.4%. Prevalence of diabetes varies from 4% in rural areas to 11.5% in urban areas and of IGT varies from 3.6% to 9.1%.

Studies conducted in western countries have also shown high prevalence of abnormal glucose tolerance of 52.3% (36.1% IGT and 16.2% type II diabetes) in patients of young ischaemic heart disease. The prevalence of diabetes was 16% in IHD2 which was much higher than in general population i.e. 2-4%. In study of Japanese population (2001) with IHD, the prevalence of disturbances of glucose metabolism was very high 67.7% (IGT 32.3% and type II diabetes 35.4%)3.

Prevalence of abnormal glucose tolerance was maximum 55% in 40-50 years of age goup. This observation was similar to that of Costa et al, (1998)4, Stewart et al (1995)5 i.e. increasing risk of IGT or to develop diabetes mellitus increases with increasing age of subjects was mainly due to altered insulin sensitivity. Other explanation is the absence of awareness, lack of self concern and long latent period before symptomatic manifestation among youth underlies the reason for late detection of diabetes.The paucity of dramatic and typical symptomatology among abnormal glucose tolerance with IHD causes a delayed diagnosis of coronary events.

Statistically significant (P<0.001) number of subjects were positive for IGT belonging to urban area (61.1%) highlighting the fact that higher incidence is a consequence of urban life culture, awareness, and easy availability of diagnostic approaches for detection of glucose intolerance.

In this study sedentary life style was a statistically significant (P<0.05) risk factor (61.1%) in patients of young IHD with abnormal glucose tolerance. Non-vegetarian diet was a statistically significant (P<0.05) risk factor in IGT population with IHD. It may be due to increased dietary intake of saturated fats and decreased intake of dietary fibres leading to blunted insulin sensitivity. Addiction to tobacco in either chewing or smoking form was significantly (P<0.001) more in abnormal glucose tolerance with IHD. Central obesity was significantly (P<0.05) more prevalent in abnormal glucose tolerance (70.5% male and 40.9% female), revealing that it is not obesity, but the distribution of body fat which is risk factor for ischaemic heart disease in abnormal glucose tolerance.

Past history of hypertension was significantly (P<0.05) more in abnormal glucose tolerant population providing their prevalent coexistence and causal importance. Hypercholesterolemia was significantly (P<0.005) more prevalent in impaired glucose tolerance than normal glucose tolerance.

Conclusion

Non-diabetic patients with ischemic heart disease are at increased risk of developing impaired glucose tolerance compared to general population. Testing for impaired glucose tolerance at younger age should be carried out frequently in individuals who are obese, hypertensive, have hypercholesterolemia, have history of habitual addiction have non-vegetarian dietary habits, have history of urban life style and are leading a sedentary life.

References

  1. Ramchandra A, Snehlata C, Kapur A, Vijay, Mohan V, Das A.K. High prevalence of diabetes and impaired glucose tolerance in India, National Urban diabetes survey. Diabetologia 2001, (44): 1084-1101.
  2. Irina, Jolanta P, Kinalskal I. Disturbance of glucose metabolism in men referred for coronary arteriography. Postload glycemia as a predictor for coronary atherosclerosis. Diabetes care, 2001; 24 : 897-901.
  3. Fujiwara R, Kutsumi Y. Yayashi T, Nishio H, Koshino Y, Shimada Y, Nakai T, Miyabo S, Relation of angiographically defined coronary artery disease and plasma concentration of insulin, lipid and apolipoprotein in normolipidemic subjects with varying degrees of glucose tolerance. Am J Cardiol 1995; 75: 122-126.
  4. Costa A, Rios M., Diabetes research and clinical practice, 1998; 41:191-196.
  5. Stewart M.W. Berrish T.S., 1995, Feature of syndrome X in 1O relative of NIDDM patients. Diabetes Care, 1995; 18. 1020- 1022.

Dept. of Medicine, SSMC, Rewa (M.P.)-486001

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