Prevalence of prediabetes and diabetes among economically backward tribes, Tamilnadu, India

Geetha K*1, Kanniammal C2, Kanmani S3 1Research Scholar, Department of Community Health Nursing, SRM College of Nursing, SRM Institute of Science and Technology, Kattankulathur– 603203, Chengalpattu District, Tamilnadu, India 2Department of Medical Surgical Nursing, SRM College of Nursing, SRM Institute of Science and Technology, Kattankulathur–603203, Chengalpattu District, Tamilnadu, India 3Department of Community Medicine, SRMMedical College, SRM Institute of Science and Technology, Kattankulathur–603203, Chengalpattu District, Tamilnadu, India

Blood Sugar, Glucometer, Finger Prick Method, Substance Abuse A India has the second largest concentration of tribal population in the world. Indian tribes constitute around 8.3% of nation's total population. To assess the prevalence of Prediabetes and diabetes mellitus among tribal population of Kancheepuram district. Cross sectional study design, Multi stage cluster sampling technique was used, house to house data collection was done for 85 irula tribal people. The Irula are a Scheduled tribe that lives in northern Tamil Nadu and the Nilgiri Hills. They are sort of like a cross between tribals and ordinary southern Indians .structured questionnaire were used to assess demographic variables (gender, age, educational quali ication, marital status, family status, occupation, monthly salary and religion). Measurements taken were height, weight, and blood sugar by inger prick method with glucometer. Above 140 to 199 mg/dl considered as prediabetes and 200mg/dl is considered as diabetes. Prevalence of prediabetes and diabetes mellitus among tribes were 49.4%, 25.9%, poor literacy, poverty and substance abuse makes the tribes more prone to prediabetes and diabetes.

INTRODUCTION
Emerging trend of diabetes mellitus (DM) is observed worldwide, as by 2025, its prevalence is projected to be 6.3%, which is a 24.0% increase compared with 2003. There will be 333 million (a 72.0% increase) diabetics by 2030 in individuals of 20 to 79 years of age.
The developing world (mainly central Asia and Sub-Saharan Africa) accounted for 141 million people with diabetes (72.5% of the world total) in 2003 (Narayan et al., 2006). Environmental factors like obesity (central or general), physical inactivity, and diet (saturated fats and transfatty acids) and socioeconomic factors are responsible for development of DM (Qiao et al., 2007;Hu et al., 2003).
Diet rich in polyunsaturated fats and long chain omega-3 fatty acids reduces the risk for DM (Adler et al., 1994). The global prevalence of diabetes in 2014 was estimated to be 9% in adults aged 18+ years (World Health Organization, 2007). According to a study by Mohan et al., the overall prevalence of diabetes in India is found to be 12% (Mohan et al., 2007).

MATERIALS AND METHODS
The Irula are a Scheduled tribe that lives in northern Tamil Nadu and the Nilgiri Hills. They are sort of like a cross between tribals and ordinary southern Indians. They have many animist beliefs but have had enough contact with Hindu s to embrace many orthodox Hindu beliefs. The Irula live in villages with special "pollution hut" for menstruating women, lots of mango and jackfruit trees, and ancestral temples with stones in them that represent the dead. Many live in two-room houses with a separate room with a sacred ire. They are known as collectors of honey and hunt with nets and spears (Tribals food society, 2020). Now the scenario was entirely changed, we have done a study in Kancheepuram district. Here the people settled in plain areas but away from other villagers.
We have conducted the study in Kollam village, Anjur, karanai Puducherry and Nallambakkam. After getting consent from the participants, 85 subjects who ful illed the inclusion criteria were selected by non-probability convenient sampling technique.
Cross sectional study design was adopted for this study. Structured questionnaire was used to assess the demographic variables like age, marital status, religion, educational status, occupation, monthly salary, family status and religion. Measurements taken were height, weight, and blood sugar by inger prick method with glucometer. Above 140 to 199 mg/dl considered as prediabetes and 200mg/dl is considered as diabetes.
Weight of the subjects was measured with the help of standard weighing scale and height was measured with the help of inch tape. Two blood pressure measurements was measured with the standard digital spygmomanometer interval of 10 minutes. Random blood sugar was measured with the help of a glucometer.

Major Findings of the Study
According to the Table 1, The indings depicted that among 85 subjects most of them women (70.6%). 29.4% belongs to the age group between 30-34 Years. Most of them between the age group between 35-49 yrs. Nearly 95.3% don't have formal education, 91.8% got married. Nobody is working in Government sector. Most of them in poor socioeconomic status(94.1%). Their salary is between Rs.1500-4500.
According to the Table 2, the prevalence of prediabetes is 49.4% and diabetes is 25.9%. Table 3, the p values corresponding to the demographic variables are not signi icant since they are not less than 0.05 hence we can say that there is no signi icant association between the demographic variables and blood sugar level.

According to
From the above table, the p values corresponding to the demographic variables are not signi icant since they are not less than 0.05 hence we can say that there is no signi icant association between the demographic variables and blood sugar level.

DISCUSSION
The study was carried out among tribal population in Athanavoor Primary Health Centre in Yelagiri hill station of Vellore District, Tamilnadu. Individuals aged 25 to 65 years were selected for the study. Blood samples were collected to estimate Fasting Blood Sugar and Serum Cholesterol levels. Out of 104 participants, 29(27.9%) are males and 75(72.1%) are females. The proportion of participants who had diabetes mellitus is 3.8% (Nikkin and Stanly, 2016).
The study was conducted in 410 adult Katkaris (women 219) of both sexes of ≥18 years of age in three adjoining tehsils of the district. Information was obtained on socio demographic parameters, educational level, dietary pattern, and substance abuse. Prevalence of overweight, hypertension, and diabetes was measured using standard ield-based procedures and techniques. Katkaris, who are mostly landless manual laborers, subsist on a protein-poor, imbalanced diet. About half of women and one-third of men have body mass index (BMI) <18.5 kg/m 2 , an indication of undernutrition. On the other hand, about 2% of participants were obese (BMI ≥30 kg/m 2 ). The overall prevalence of hypertension and diabetes was 16.8% and 7.3%, respectively.
Subjects were recruited from ive districts of Kashmir valley using multistage cluster sampling by probability proportional to size (PPS) technique. A total of 6808 subjects were recruited in this study including 2872 (42%) men and 3936 (58%) women with mean age of 39.60 ± 20.19 years and 35.17 ± 16.70 years, respectively. About 1.26% (0.5% males and 0.9% females) had DM and 11.64% had prediabetes based on HbA1c cutoffs. Increasing age, body mass index and family history portend signi icant risk factors while smoking and sedentary lifestyle increased the risk marginally. Although the prevalence of DM among tribals of Kashmir valley is lower than general population, the higher prediabetes to DM ratio may indicate a future trend of increasing DM prevalence in this disadvantageous subpopula-  tion (Ganie et al., 2020).

Prevalence of diabetes among indigenous groups varies and it is high in some groups like New
Zealand Maori, Greenland Inuit while it is low in some traditional populations like Orang Asli of Malaysia (Roglic, 2016). Highest incidence of diabetes was reported among Pima Indians living in Arizona in United States of America (Wild et al., 2004). Prevalence of diabetes and prediabetes among tribal population of India is low when compared to the general population. The study reported that 4.6 percent of the Raica community in Rajasthan has diabetes and it was absent among camel milk 19 consuming people from the same community in 2002 (Agrawal et al., 2007). A study done in tribal population of Arunachal Pradesh in 2012 showed that the prevalence of diabetes was 8.3 percent and of impaired glucose tolerance was 21.8 percent (Yajnik, 2009). A cross sectional study done in Himachal Pradesh demonstrated that migration of traditional tribes into an urban community increases their cardiovascular risk factors. The prevalence of diabetes among urban tribals was 9.2 percent whereas among traditional tribes it was 6.7 percent (Kapoor et al., 2014). High prevalence of diabetes among tribal people of northeast India where 19.8 percent of the people had diabetes with another 12 percent pre diabetes (Zaman and Borang, 2014). A study documented that around 5  (Radhakrishnan and Ekambaram, 2015). According to a systematic review, the prevalence of diabetes in tribal India was 5.9 percent, ranging from 0.7 percent to 10.1 percent. Prevalence of impaired fasting glucose was 5.1 percent -13.5 percent and impaired glucose tolerance was 6.6 percent -12.9 percent (Oommen et al., 2016).
Prevalence of diabetes mellitus among the study population was 3.3% and prevalence of pre diabetes was 7.6%. This study showed low prevalence of diabetes mellitus among the tribal population as compared to that of general population. This may be due to less prevalence of insuf icient physical activity reported among this population (Ford et al., 1997 (Upadhyay et al., 2013).
According to this study, the prevalence of prediabetes and diabetes mellitus among tribes were 49.4%, 25.9%, it gives alarm to the society Prevalence of diabetes is almost equal among two sexes which is comparable to the study done (Kandpal et al., 2016). In this study overweight (≥23 kg/m2) and hypertension were found to be signi icantly associated with diabetes mellitus after adjusting for other factors which is similar to other studies (Zaman and Borang, 2014;Upadhyay et al., 2013).
Prevalence of diabetes mellitus and pre diabetes were 3.3% and 7.6% respectively. Overweight and hypertension were found to be signi icantly associated with diabetes mellitus (Ruban, 2017). Two stage cluster sampling method was used. Modi ied WHO STEPS instrument/Questionnaire was administered by the principal investigator. Following variable were collected.

CONCLUSION
Poor literacy rate, poverty plays a major role in developing the prediabetes and diabetes among tribals. Awareness is very poor among tribal people. Repeated awareness programmes needed to control the prediabetes and diabetes. Many people don't have formal education. Updating the health information is very dif icult among them. Effective Information education communication packages should be developed to improve awareness among irular tribes and measures to be taken to improve their educational status.

ACKNOWLEDGEMENT
We thank all the participants for their cooperation.

Competing Interest
There is no competing interest

Funding Support
No funding support from funding agency

Authors Contribution
Mr Kanmani helped in data collection; Mrs Geetha prepared the manuscript and the suggestions given by Dr.C.Kanniammal.