Diabetes is a non - communicable disease is significant public health problem the prevalence rate all the world over is raising.1 Diabetes mellitus is one of the leading cause of long – term complications and amaj or health hazard in a developing country like India.2 Indian diabetes risks core (IDRS) developed by Mohan et al. in 2005 is one of the strongest predictor of incident diabetes in India.3 It is as amplified risk score for Identifying undiagnosed diabetic subjects using four simple parameters such as age, waist circumference, family history of diabetes and physical activity. Here the minimum score is 0 and maximum are 100. A score of 60 and above is indicative of diabetes risk.3 Individuals were classified as high risk (score ≥ 60), moderate risk score (30-50) and low risk (score < 30). Recent study from the same group showed that Madras Diabetes Research Foundation (MDRF), Chennai. MDRF - IDRS not only predicted diabetes but also predicted metabolic syndrome, even in subjects who had normal glucose tolerance.4 However, the MDRF - IDRS needs to be validated in other population.3

The present study entitled was conducted in the Department of Physiology, IndexMedical College, Hospital & Research center, Malwanchal University Indore. 140 subjects in the age group range of 30 - 60 years attending the different medical OPDs were selected based on the inclusion and exclusion criteria of the study.

Inclusion Criteria

Study group:

1. Age 30 – 60
2. Fasting blood glucose (100 – 125 mg/dl).
3. With or without family history of

Control group:

1. Age and sex matched healthy asymptomatic
2. Fasting blood glucose < 100mg/dl.
3. Without family history of

Exclusion Criteria

1. Age below 30 years and above 60
2. Fasting blood glucose>126mg/dl.

IDRS

The modified risk factors were recorded using the validated questionnaire and recording method and scored the simplified IDRS was determined by adding the scores for each risk factor (Table 1).

Table1: Indian diabetes risk score =

Interpretation: Score < 30 low risk, Score30 - 50medium risk and score > 60 high risk for type 2 diabetes and cardiovascular diseases.3

FIGURENO 1:- Age Wise Classification of Study Population

The study comprised of 140 subjects aged 30 - 60 years attending the different medical OPDs IndexMedical College, Hospital & Research center, Malwanchal University Indore.

According to ADA 2007 all the subjects having fasting serum glucose <100mg/dl were included in the control groups subjects having FSG ≥100-125 mg/dl categorized into prediabetic group (Figure 1).

In the age range 30-40 years 29% men (31.2+1.5 years) and 38% women (33.5+4.3 years) were

studied, 48% men (45.1+2.9 years) and 38% women (43.5+2.7 years) were in the age range 40-50 studied. In the age range 50-60 years 23% men (54+1.4years) and 24% women (53.6+1.5years) were studies.

In pre diabetic group 29% men (34.8+3.74 years) and 38% women (34.3+2.9 years) were studied in the 30 - 40 age range 48% men (47.3 years) were in the age rage 40-50 years studied.

In the age group 50-65 years 23% men (56.7+3.5 years) and 24% women (57.4+3.5 year were studied. Maximum numbers of Prediabetic were in the age group of 40-50years.

Indian diabetic risk score (IDRS) scale was used to find out the people of the risk for development of type 2 diabetes. The scores obtained revealed that in the control group 18% subjects and in a pre – diabetic group only 7% subjects fell in to low - risk category. In medium risk group 57% control and 38% pre - diabetes could be categorized. 25% subjects in the control group and 55% subjects in a pre - diabetic group were identified as high - risk individuals.

Insulin resistance was identified by calculating Homa index. As evident from the data percentage of insulin-resistant subjects was appreciably more in moderate and high-risk category pre-diabetic subjects as compared to the control group (Figures 2).

Our study shows that IDRS consisting of variables such as age, abdominal obesity, physical activity and family history predicted diabetes mellitus with a sensitivity of 100% and specificity of 17.6% Present work was find out the incidence of pre - diabetes in the study population and association with insulin resistance and associated metabolic factors.

According to criteria of (ADA2007),5 the study comprised of 70 controls and 70 pre -diabetic subjects aged 30 - 60years with mean age 42.61+8.70 and 45.43+8.77 years, respectively.

IDRS simplified and developed by Mohan et al. (2005)3 was used to identify undiagnosed diabetic subjects, study revealed of 60 subject shaving serum glucose level < 100 mg/dl, 57% subjects (34) fell into moderate risk group (IDRS 30 - 50) and 25% (15) subjects fell into high - risk group (> 60 IDRS). of 60 subjects having FSG (> 100 - 125 mg/dl) labeled as pre - diabetic 38% subjects (23) fell into moderate risk group (IDRS 30 - 50) and 55% (33) subjects fell into high - risk group (IDRS >60).

The observation revealed that blood glucose higher than >100 - 125 mg/dl imposes greater future risk for type 2 diabetes.

Unwinn et al. wrote in their article entitled impaired glucose tolerance and impaired fasting glycemia that pre - diabetes (dysglycemia) is primarily a risk factor for the development of type 2 diabetes.6

Cardio - metabolic risk factors other than dysglycemia are also risk factors for developing type 2 diabetes

e.g. insulin resistance. The present study demonstrated that insulin resistance was present in subjects who scored >30 on IDRS scale 7% in the control group despite glycemia and 80% in a pre - diabetic group.

Recent study showed that IDRS not only predicted diabetes but also identified individuals with higher cardiovascular risk i.e., those with metabolic syndrome even at test age when

They have normal glucose tolerance.4 Now it is beyond doubt that India actually has the highest number of diabetics in the world and Government of India has rightly launched the national program for control of diabetes, cardiovascular diseases and stroke in January 2008 (Diabetes Atlas, third edition 2006).7 As the prevalence of and progression to the diabetes continue to increase, diabetes-related morbidity and mortality have emerged as major public health care issues.

Diabetes is now a global problem with devastating human and social consequence and the costs for care of diabetes, and its complications have an overwhelming economic impact globally.8

The public health burden of the disease is enormous in terms of health care expenditure. Even the lowest pre- diabetic levels have been found to be associated with increased medical costs.9 Zhang et al. studied medical claims data to estimate per capita excess health care use and medical costs to calculate national expenditures associated with pre diabetes.10 The results of the study were extrapolated to suggest the national annual medical costs of pre - diabetes exceed 25 billion dollars or an additional 443 dollars for each adult with pre-diabetes.

The diagnosis of pre – diabetes or border line diabetes is important as scientific evidence suggests that the progression to type 2 diabetes and its associated complication can be delayed or reversed. Lifestyle changes can prevent or delay the development of type 2 diabetes among persons with pre-diabetes irrespective of their age, race, and sex (diabetes prevention, programmer search group, 2002).11

The mean age of the 60 subjects included in the control group was 42.61 ± 8.70 years, and 60 pre - diabetic subjects were 45.43 ± 8.77 years. Maximum numbers of pre -diabetes were in the age group of 40 - 50 years. The results of the study will help to formulate strategies for future preventive efforts and delay the onset of type 2 diabetes.

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