JOURNAL CLUB PRESENTATION

Presented By Dr. Monisha Mary P

 TITLE OF THE
ARTICLE

Assessment of risk of type

2 diabetes using simplified
Indian Diabetes Risk
Score – Community-based
cross-sectional study

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 INFORMATION ON THE JOURNAL

Journal name - International Journal of Medical Science and

Public Health Online.

Open access article

Indexing - Indian Science Abstracts, Open J Gate, Index

Copernicus, HINARI, Google Scholar, Scopemed, Index Medicus

Impact factor - 3.642

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 INFORMATION ON THE ARTICLE

Received - May 16, 2016 Accepted - June 1, 2016

Volume - Vol 5 | Issue 12

DOI - 10.5455/ ijmsph.2016.16052016517

Keywords - Simplified Indian Diabetes Risk Score, Abdominal

obesity, Physical activity, Family history of diabetes.

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 INFORMATION ON THE AUTHORS
Krutarth R Brahmbhatt Department of Community Medicine, GMERS
Medical College, Junagadh, Gujarat, India.
Tamal Chakraborty

Chandana Gopal

Shwethashree M

Sajjan Madappady Department of Community Medicine, A.J.

Institute of Medical Sciences & Research
Sowndarya TA Center, Mangalore, Karnataka, India.

Bharani Kumar Anbalagan

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 SELECTED ARTICLE FOR PRESENTATION
CROSS
SECTIONAL
STUDY

DIABETES
MELLITUS

STUDY
CONDUCTED IN
KARNATAKA

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 CONTENTS

❖ BACKGROUND

❖ THE ARTICLE PRESENTATION

❖ CRITICAL APPRAISAL

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28-Apr-24
International Diabetes Federation IDF 8
 VARIABLES USED IN IDRS

Abdominal Physical
obesity activity

Age Family history

IDRS
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 IDRS
❖ Simplified Indian Diabetes Risk Score (IDRS).

❖ IDRS has been validated by various studies conducted in

different parts of India. (3-6)

IDRS is useful for

• Undiagnosed diabetic subjects

• Cost-effective
• Effective tool for mass screening.

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 IDRS

Optimum Optimum
sensitivity specificity

High High
positive negative
predictive predictive
value value

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PREVALENCE OF DM IN INDIA

13.5% 12.4% 16.6% 11.6% 11.7%

CHENNAI BANGALORE HYDERABAD NEW DELHI KOLKATTA
MUMBAI 9.3%

Prevalence in the southern part of India is higher

Source- National Urban Diabetes Survey (NUDS)

 INTRODUCTION

The study
As the The majority
was
prevalence of of the
conducted to
diabetes subjects
find out the
mellitus is remain
high-risk
higher in South undiagnosed
people for
India. for diabetes.
diabetes.

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 02

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 OBJECTIVES

To assess risk for type 2

diabetes amongst study To estimate the prevalence of
participants using simplified abdominal obesity and physical
version of Indian diabetes risk activity among males and
score. females.

To find out proportion of To study association of socio-

positive family history for demographic variables with
diabetes in study participants. diabetes.

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 03METHODOLOGY

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 STUDY DESIGN AND PARTICIPANTS

Study Design - A community-based cross-sectional study.

Study setting - Urban field practice area of the institute.

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 STUDY DURATION

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
l
YEAR 2015

JANUARY TO APRIL
2015

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 SAMPLE SIZE CALCULATION
• With reference to the study conducted by Ramachandran A,
et al, in India titled “High Prevalence of Diabetes and
impaired glucose tolerance in India: National Urban Diabetes
Survey (7).
• Sample size was derived by formula: 4 pq/L2,
where p = 10%,
q = 90%,
Absolute precision: 5%
=144.

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 The minimum sample size for the study was concluded to be
144

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 SAMPLING METHOD

Was used to select the

participants from the registers
available at UHC.

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 INCLUSION CRITERIA

Selected participants aged 20 years and above, not

diagnosed cases of diabetes were included in the study.

Written informed consent was obtained from

all the participants.

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 EXCLUSION CRITERIA

If the particular participant was not available at the time

of the visit, a second visit was done the very next day.

If the person was not available after two visits one more
participant was selected randomly from the list.

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 STUDY TOOL

PART A PART B

Sociodemographic Simplified Diabetes

Information Risk Score

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 STUDY TOOL
• Questionnaire was validated for use in local language

➢ Translation from English to Kannada

➢ And back translation from Kannada to English.

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METHOD OF DATA COLLECTION

DATA
APPROVAL INFORMATION WRITTEN INFORMED COLLECTION
SHEETS CONSENT
Approved by the Visiting the houses of
Explained to all the Obtained from the selected
Institutional Ethics
participants all participants participants.
Committee
Data was collected by post-graduate students by interview method in the local language
 OPERATIONAL DEFINITIONS

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 PARTICIPANTS
WITH IDRS

I
≥60 <60 D
30- <60
R
S

HIGH RISK INTERMEDIATE RISK LOW RISK FOR DIABETES MELLITUS

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 OPERATIONAL DEFINITIONS
Family history of diabetes- If either or both of a participant’s
parents had diabetes, they were considered to have a
positive family history.

Physical activity- Grading was done as per WHO STEPS

definitions of
• sedentary
• mild
• moderate
• or vigorous physically active.

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 OPERATIONAL DEFINITIONS
Abdominal obesity-

• Waist circumference (cm) was measured using a non-

stretchable measuring tape.

• Waist circumference was measured at the smallest

horizontal girth between the costal margins and the iliac
crest at the end of expiration.

• Abdominal obesity (AO) was defined as a waist

circumference (WC) ≥ 90 cm for men and ≥ 80 cm for
women.
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 STATISTICAL ANALYSIS

Frequency,and Pearson’s Chi-square

Data were entered was used as a test of
into Microsoft excel percentages
significance. P-value <
sheet and analysed (descriptive statistics)
were calculated. 0.05 was considered
using SPSS version statistically significant.
17.0 software.

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 04 RESULTS

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 RESULTS

In total, 145 persons participated in the

study. Sociodemographic profile of
participants is described in Table 1.

Assessment results for all the parameters of

“Simplified Indian Diabetes Risk Score” are
mentioned in Table 2.

Association of gender with IDRS parameters

is described in Table 3.

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 DISCUSSION

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 THE PREVALENCE OF PEOPLE AT HIGH RISK
OF DIABETES WAS 34%

THE PREVALENCE THE PREVALENCE THE PREVALENCE OF

OF ABDOMINAL OF PHYSICAL POSITIVE FAMILY
OBESITY ACTIVITY HISTORY

IN EITHER
MALES FEMALES BOTH
FEMALES MALES PARENT
44% 49% PARENT
84% 64% 22%
22%

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THE PREVALENCE OF PEOPLE AT
HIGH RISK OF DIABETES WAS 34%.

01 02 03 04
MEDICAL
URBAN AREA URBAN SLUM OF URBAN OPDS OF A
OF PUNE, AREA OF MEDICAL
PUDUCHERRY MAHARASHTRA JAMNAGAR, COLLEGE
31% 37% GUJARAT HOSPITAL
29% 25%

THE PREVALENCE OF DIABETES IS HIGHER IN SOUTH INDIA THAN OTHER PARTS OF THE
COUNTRY.
THE PREVALENCE OF ABDOMINAL OBESITY WAS 44% AND 84%
AMONG MALES AND FEMALES

01 02
NORTH INDIA USING SOUTH INDIA 31% AND
THE SAME CUT-OFF 66% AMONG MALES
VALUES OF 62% AND AND FEMALES
75% AMONG MALES
AND FEMALES
PREVALENCE OF PHYSICAL ACTIVITY AMONG MALES AND
FEMALES WAS 64% AND 49%

01 02
ICMR REPORTED
PHYSICAL AHMEDABAD, GUJARAT
PHYSICAL ACTIVITY IN
ACTIVITYIN
MALES AND FEMALES
MALES AND UP TO 68% AND 32%,
FEMALES AS 60%
AND 40%
PREVALENCE OF POSITIVE FAMILY HISTORY (IN EITHER PARENT
OR BOTH PARENTS) WAS 22%

01 02
URBAN AREA
PUNE, JAMNAGAR, GUJARAT
MAHARASHTRA PREVALENCE OF
REPORTED IT AS 23% POSITIVE FAMILY
HISTORY OF DIABETES
UP TO 18%
STRENGTH OF THE STUDY
A COMMUNITY-BASED STUDY

A VALIDATED QUESTIONNAIRE
(IDRS) WAS USED.
 LIMITATIONS

RECALL BIAS MIGHT HAVE

PLAYED ROLE IN
REPORTING OF FAMILY
HISTORY BY PARTICIPANTS.
 CONCLUSIONS
❖ One-third of the participants were at
high risk for diabetes.
❖ IDRS is a simple and easy-to-use tool
to assess the risk of diabetes in the
community.
❖ It should be used routinely in
community-based screening to find out
high risk people for diabetes.
 REFERENCE
1. http://www.idf.org/membership/sea/india (last accessed on December 5,
2015).

2. 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.

3. Chaurasia H, Chaurasia RS. To find out the diabetic risk in study population by
subjecting them to Indian diabetic risk scale. Int J Med Sci Res Pract
2015;2(1):37–40.

4. Taksande B, Ambade M, Joshi R. External validation of Indian diabetes risk

score in a rural community of central India. J Diabet Mellitus 2012;2:109–13.

28-Apr-24 49
 5. Patel DN, Shah MC, Ahir GN, Amin DV, Singh MP. A study on validity of
Indian diabetes risk score (MDRF) for screening of diabetes mellitus among the
high risk group (policemen) of diabetes mellitus of Bhavnagar city. Innovative J
Med Health Sci 2012;2:109–11.

6. Adhikari P, Pathak R, Kotian S. Validation of the MDRF-Indian Diabetes Risk

Score (IDRS) in another south Indian population through the Boloor Diabetes
Study (BDS). J Assoc Physicians India 2010;58:434–6.

7. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, et al.

Diabetes Epidemiology Study Group in India (DESI). High prevalence of
diabetes and impaired glucose tolerance in India: National Urban Diabetes
Survey. Diabetologia 2001;44:1094–101

28-Apr-24 50
 8. Shah B. Development of Sentinel Health Monitoring Centers for Surveillance of
Risk Factors of Non-communicable Diseases in India (April 2003 to March 2005).
Collated Results of Six Centers. New Delhi: Division of Non-communicable
Diseases, Indian Council of Medical Research, 2005. Available at: http://
www.who.int/chp/steps/IndiaSTEPSReport_6Centers.pdf (last accessed on March
10, 2016).

9. Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, et al.
Prevalence of generalized & abdominal obesity in urban & rural India – the ICMR –
INDIAB Study (Phase-I) [ICMR – INDIAB-3]. Indian J Med Res 2015;142(2):139–
50.

10. Gupta SK, Singh Z, Purty AJ, Vishwanathan M. Diabetes prevalence and its
risk factors in urban Pondicherry. Int J Diabet Dev Ctries 2009;29(4):166–9.

28-Apr-24 51
 11. Patil RS, Gothankar JS. Assessment of risk of type 2 diabetes using the
Indian Diabetes Risk Score in an urban slum of Pune, Maharashtra, India: A
cross-sectional study. WHO South-East Asia J Public Health 2016;5(1):53–
61.

12. Khandhedia SA, Chaudhary AI, Unadkat S, Parmar D. A study on

assessment of risk of developing diabetes using IDRS (Indian Diabetes Risk
Score) in the urban area of Jamnagar city. Sch J Appl Med Sci
2015;3(6C):2358–60.

13. Bhardwaj S, Misra A, Misra R, Goel K, Bhatt SP, Rastogi K, et al. High
prevalence of abdominal, intra-abdominal and subcutaneous adiposity and
clustering of risk factors among urban Asian Indians in North India. PLoS
ONE 2011;6(9):e24362. doi:10.1371/journal.pone.0024362.

28-Apr-24 52
 14. Chauhan RC, Chauhan NS, Mani Kandan, Purty AJ, Mishra AK, Singh Z.
Obesity among adult population of a rural coastal area in South India. Int J
Sci Rep 2015;1(3):155–8.

15. Anjana RM, Pradeepa R, Das AK, Deepa M, Bhansali A, Joshi SR, et al.
Physical activity and inactivity patterns in India – Results from the ICMR-
INDIAB study (Phase-1) [ICMRINDIAB-5]. Int J Behav Nutr Phys Activ
2014;11:26.

16. Nayak H, Gadhavi R, Vyas S, Kapoor R, Brahmbhatt K. Epidemiological

determinants of the physical activity among the urban community of
Ahmedabad, India: A cross sectional study. GJMEDPH 2013;2(6):1–6.

28-Apr-24 53
 CRITICAL APPRAISAL

Appraisal tool for Cross-Sectional Studies (AXIS)

JC - 1
28-Apr-24 54
 WERE THE AIMS AND OBJECTIVES OF THE
STUDY CLEAR

4 objectives.

The purpose of the study is clearly stated.

The aim is stated both at the beginning of the

abstract and at the end of the introduction.

JC - 1
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 WAS THE STUDY DESIGN APPROPRIATE FOR
THE STATED AIMS

STUDY DESIGN -Assessment of risk of type 2

diabetes/cross-sectional study

STUDY SETTING -The relevant information on the

location is present.

STUDY DURATION-The period of recruitment is

mentioned.

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 WAS THE SAMPLE SIZE JUSTIFIED

The reference article has been mentioned.

Sample size was derived by formula: 4 pq/L2

where p = 10%, q = 90%, absolute precision:
5%, = 144.

JC - 1
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 WAS THE INCLUSION/EXCLUSION CRITERIA
MENTIONED

The inclusion and exclusion criteria have been

given.

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 WAS THE TARGET/REFERENCE POPULATION
CLEARLY DEFINED

The target population is not mentioned

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 WAS THE SAMPLE FRAME TAKEN FROM AN
APPROPRIATE POPULATION BASE

Participants were taken from the registers

available at UHC.

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 WAS THE SELECTION PROCESS LIKELY TO
SELECT SUBJECTS/PARTICIPANTS THAT WERE
REPRESENTATIVES OF THE TARGET POPULATION
UNDER INVESTIGATION

Yes, Simple random sampling.

Participants were taken from the registers

available at UHC.

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 WERE MEASURES UNDERTAKEN TO ADDRESS
AND CATEGORISE NON RESPONDERS

Yes , mentioned in the exclusion criteria .

If the person was not available after two visits

one more participant was selected randomly
from the list.

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 WERE THE RISK FACTOR AND OUTCOME
VARIABLES MEASURED APPROPRIATE TO THE
STUDY

The study estimates the prevalence of abdominal

obesity and physical activity among males and
females.

They have found out the proportion of positive

family history for diabetes in study participants.

They have not studied the association of certain

socio-demographic variables with diabetes.

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 WERE THE RISK FACTOR AND OUTCOME
VARIABLES MEASURED CORRECTLY USING
INSTRUMENTS/MEASUREMENTS THAT HAD BEEN
TRIALED,PILOTED, OR PUBLISHED PREVIOUSLY

WHO step guidelines for NCD have been

used.

IDRS tool.

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 IS IT CLEAR WHAT WAS USED TO DETERMINE
STATISTICAL SIGNIFICANCE ?

Software package – SPSS version 17.

The statistical significance levels are clearly stated.

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28-Apr-24 66
 WERE THE METHODS (INCLUDING STATISTICAL
METHODS) SUFFICIENTLY DESCRIBED TO
ENABLE THEM TO BE REPEATED?)

Frequency and percentages (descriptive

statistics) were calculated.

Pearson’s Chi-square was used as a test of

significance. P-value < 0.05 was considered
statistically significant.

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 WERE THE BASIC DATA ADEQUATELY
DESCRIBED?

Basic data is mentioned .

But the description is limited.

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 DOES THE RESPONSE RATE RAISE CONCERNS
ABOUT NON-RESPONSE BIAS?, IF APPROPRIATE
INFORMATION ABOUT NON-RESPONDERS
DESCRIBED?
Not mentioned and not described

There has been no attempt made to quantify

the level of non-response by the researchers.

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 WERE THE RESULTS INTERNALLY
CONSISTENT?

The study recruited 145 participants.

The tables and the text included data from about

145 participants.

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 WERE THE RESULTS FOR THE ANALYSES
DESCRIBED IN THE METHODS, PRESENTED?

The results have been described in the

methodology.

The results from all analyses are described.

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 WERE THE AUTHORS’ DISCUSSIONS AND
CONCLUSIONS JUSTIFIED BY THE RESULTS?

The study summarised the key results of the study

objectives.

Overall interpretation of the results.

Addressed both significant and nonsignificant

findings.
.
Made comparisons with other research, citing
their sources.
JC - 1
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 WERE THE LIMITATIONS OF THE STUDY
DISCUSSED?

An understanding of the limitations has been

involved in the study.

Recall bias – family history.

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 WERE THERE ANY FUNDING SOURCES OR
CONFLICTS OF INTEREST THAT MAY AFFECT THE
AUTHORS’ INTERPRETATION OF THE RESULTS?

None declared.

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 WAS ETHICAL APPROVAL OR CONSENT OF
PARTICIPANTS ATTAINED?

Ethical committee clearance was

obtained.

Written consent was taken from the

participants of the study.

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 WAS THE REFERENCE OF THE STUDY
APPROPRIATE?
Webpage Last accessed

1. http://www.idf.org/membership/sea/india (last
accessed on December 5, 2015).

Author Title of Place of Year of original

/Organisation
. webpage publication: publication OR
[Internet] Publisher Year of Copyright

16 REFERENCES

JC - 1
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Thank you