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      Prevalence and Awareness of Stroke and Other Comorbidities Associated with Diabetes in Northwest India

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          Abstract

          Objectives  The main purpose of this study is to investigate the prevalence of comorbid conditions in diabetic, prediabetic, and nondiabetic individuals. Additionally, the current study examines the levels of awareness of those comorbidities among North Indian population.

          Methods  As a part of a national study (Niyantrit Madhumeh Bharat [NMB] screening program), different comorbidity parameters were screened in the northern part of India between April and September 2017. There were 1,215 participants recruited in this study. Biochemical analyses of hemoglobin A1c (HbA1c) were conducted on the study subjects. Subsequently, the study subjects were divided into diabetic, prediabetic, and nondiabetic groups based on their HbA1c results.

          Results  The study analysis reveals a higher prevalence of peripheral vascular disease (21.2%), ocular diseases (18%), and hypertension (13.4%) in diabetics with other comorbidities. Furthermore, the study found that a vast majority of the participants were unaware of the presence of hypertension (67.2%), dyslipidemia (84.5%), kidney disease (95.2%), peripheral vascular disease (34.5%), and stroke (95.1%).

          Conclusion  The study concluded that in the northern India, the prevalence of multiple comorbid conditions, such as peripheral vascular disease and hypertension, is higher among diabetic population. Also, the level of awareness of diabetic comorbidities is surprisingly low, which has implications for policymakers, health practitioners, and educators of alternate medicine to increase awareness about diabetes, comorbid conditions, health risk, and possible solution at community and rural level, such as periodic screening programs in this population.

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          Most cited references23

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          Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection.

          Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance. Thus, hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications. These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease. Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy. The familial predisposition to diabetes and hypertension appears to be polygenic in origin, which militates against the feasibility of a "gene therapy" approach to the control or prevention of these conditions. On the other hand, the shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for nonpharmacologic intervention. Thus, the initial approach to the management of both diabetes and hypertension must emphasize weight control, physical activity, and dietary modification. Interestingly, lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders. In addition to lifestyle modification, most patients will require specific medications to achieve national treatment goals for hypertension and diabetes. Management of hyperglycemia, hypertension, dyslipidemia, and the underlying hypercoagulable and proinflammatory states requires the use of multiple medications in combination. © 2011 Wiley Periodicals, Inc.
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            Diabetes mellitus and its complications in India.

            India is one of the epicentres of the global diabetes mellitus pandemic. Rapid socioeconomic development and demographic changes, along with increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of diabetes mellitus in India over the past four decades. Type 2 diabetes mellitus in Asian Indian people is characterized by a young age of onset and occurrence at low levels of BMI. Available data also suggest that the susceptibility of Asian Indian people to the complications of diabetes mellitus differs from that of white populations. Management of this disease in India faces multiple challenges, such as low levels of awareness, paucity of trained medical and paramedical staff and unaffordability of medications and services. Novel interventions using readily available resources and technology promise to revolutionise the care of patients with diabetes mellitus in India. As many of these challenges are common to most developing countries of the world, the lessons learnt from India's experience with diabetes mellitus are likely to be of immense global relevance. In this Review, we discuss the epidemiology of diabetes mellitus and its complications in India and outline the advances made in the country to ensure adequate care. We make specific references to novel, cost-effective interventions, which might be of relevance to other low-income and middle-income countries of the world.
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              The current state of diabetes mellitus in India.

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                Author and article information

                Journal
                J Neurosci Rural Pract
                J Neurosci Rural Pract
                10.1055/s-00043281
                Journal of Neurosciences in Rural Practice
                Thieme Medical and Scientific Publishers Private Ltd. (A-12, Second Floor, Sector -2, NOIDA -201301, India )
                0976-3147
                0976-3155
                July 2020
                04 June 2020
                : 11
                : 3
                : 467-473
                Affiliations
                [1 ]Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
                [2 ]Department of Social Work, University of Kentucky, Lexington, Kentucky, United States
                [3 ]Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
                [4 ]Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
                [5 ]Department of General Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna-Avutapalli, Krishna, Andhra Pradesh, India
                [6 ]Department of Physical Education, Panjab University, Chandigarh, India
                [7 ]Department of Yoga, Dev Samaj College of Education, Panjab University, Chandigarh, India
                Author notes
                Address for correspondence Akshay Anand, PhD Department of Neurology, PGIMER Chandigarh, 160014India akshay1anand@ 123456rediffmail.com
                Article
                JNRP1900386
                10.1055/s-0040-1709369
                7394624
                efef3d68-2ed6-460c-ae53-340e1084880e

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                Funding
                Funded by: Ministry of AYUSH, Government of India
                Award ID: 16-63/2016-17/CCRYN/RES/Y&D/MCT/ dated 15.12.2016
                Funding This research work was supported by Ministry of AYUSH, Government of India (grant number: 16-63/2016-17/CCRYN/RES/Y&D/MCT/ dated 15.12.2016).
                Categories
                Brief Report

                Neurosciences
                diabetes mellitus,comorbidity,awareness,north india,policy change
                Neurosciences
                diabetes mellitus, comorbidity, awareness, north india, policy change

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