Skip to main content


Log in

Prevalence and clinical characteristics of individuals with newly detected lean diabetes in Tamil Nadu, South India: a community-based cross-sectional study

  • Original Article
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript


Background and objectives

Lean diabetes is an entity that has been observed to be higher in Asian populations. The estimates of the burden of lean diabetes in India are mainly from hospital-based studies. This study reports the prevalence of lean diabetes among individuals with newly detected diabetes, from Vellore, Tamil Nadu, South India.


A cross-sectional WHO STEPS survey was conducted among adults aged 30–64 years, in one rural block and 48 urban wards, in Vellore. Physical and anthropometric parameters were assessed in addition to fasting lipid profile and plasma glucose. Newly detected diabetes was defined as fasting plasma glucose ≥ 126 mg/dl and lean diabetes as non-ketotic diabetes mellitus, without clinical features to suggest pancreatic diabetes, with a body mass index (BMI) < 18.5 kg/m2.


Among 3445 rural and 2019 urban subjects, the proportion of lean diabetes among 280 subjects (146 rural, 134 urban) with newly detected diabetes was 5.5%, 95% CI: 1.7–9.3% (eight subjects) and 1.5%, 95% CI: 0–3.6% (two subjects), in the rural and urban areas respectively. The proportion of those with a normal BMI (18.5–22.9 kg/m2) was 25.3% and 18.7% in the rural and urban populations, while 69.2% and 79.9% had a BMI ≥ 23 kg/m2. Those with lean diabetes were more likely to be older, illiterate, and involved in manual labor, than those with non-lean diabetes (p < 0.05).


The prevalence of lean diabetes was low (5.5% of newly detected rural diabetes, 1.5% of newly detected urban diabetes) in Vellore, South India. Further documentation of the burden of this condition across India is needed to assess the public health implications for prevention and control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. World Health Organization. Global report on diabetes. 2016. Available at Accessed 2 Feb 2018.

  2. Jayawardena R, Ranasinghe P, Byrne NM, Soares MJ, Katulanda P, Hills AP. Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis. BMC Public Health. 2012;12:380.

    Article  Google Scholar 

  3. Coleman NJ, Miernik J, Philipson L, Fogelfeld L. Lean versus obese diabetes mellitus patients in the United States minority population. J Diabetes Complicat. 2014;28(4):500–5.

    Article  Google Scholar 

  4. George AM, Jacob AG, Fogelfeld L. Lean diabetes mellitus: an emerging entity in the era of obesity. World J Diabetes. 2015;6:613–20.

    Article  Google Scholar 

  5. Mohan V, Vijayaprabha R, Rema M, Premalatha G, Poongothai S, Deepa R, et al. Clinical profile of lean NIDDM in South India. Diabetes Res Clin Pract. 1997;38(2):101–8.

    Article  CAS  Google Scholar 

  6. Ahuja MM. Diabetes-special problems in developing countries. Bull Deliv Health Care Diabetics Devel Countries. 1980;1:5–6.

    Google Scholar 

  7. Perry JRB, Voight BF, Yengo L, Amin N, Dupuis J, Ganser M, et al. Stratifying type 2 diabetes cases by BMI identifies genetic risk variants in LAMA1 and enrichment for risk variants in lean compared to obese cases. PLoS Genet. 2012;8:e1002741.

    Article  CAS  Google Scholar 

  8. Chaudhary P, Laloo D, Salam R. Prevalence of lean type 2 diabetes mellitus in recently diagnosed type 2 diabetes mellitus patients. Indian J Endocrinol Metab. 2013;17(Suppl 1):S316–7.

    PubMed  PubMed Central  Google Scholar 

  9. World Health Organization. Noncommunicable diseases and their risk factors. STEPwise approach to surveillance (STEPS). Available at Accessed 2 May 2018.

  10. Oommen AM, Abraham VJ, George K, Jose VJ. Prevalence of risk factors for non-communicable diseases in rural and urban Tamil Nadu. Indian J Med Res. 2016;144:460–71.

    Article  Google Scholar 

  11. American Diabetes Association. Standards of medical care in diabetes 2018. Diabetes Care. 2018;41(Supplement 1):S86–S104.

    Article  Google Scholar 

  12. India State-Level Disease Burden Initiative Collaborators. Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study. Lancet. 2017;390:2437–60.

    Article  Google Scholar 

  13. Kalyani RR, Tra Y, Egan JM, Ferrucci L, Brancati F. Hyperglycemia is associated with relatively lower lean body mass in older adults. J Nutr Health Aging. 2014;18:737–43.

    Article  CAS  Google Scholar 

  14. Barma PD, Ranabir S, Prasad L, Singh TP. Clinical and biochemical profile of lean type 2 diabetes mellitus. Indian J Endocrinol Metab. 2011;15(Suppl1):S40–3.

    PubMed  PubMed Central  Google Scholar 

  15. Deepa M, Papita M, Nazir A, Anjana RM, Ali MK, Narayan KM, et al. Lean people with dysglycemia have a worse metabolic profile than centrally obese people without dysglycemia. Diabetes Technol Ther. 2014;16:91–6.

    Article  CAS  Google Scholar 

  16. Boffetta P, McLerran D, Chen Y, Inoue M, Sinha R, He J, et al. Body mass index and diabetes in Asia: a cross-sectional pooled analysis of 900,000 individuals in the Asia cohort consortium. PLoS One. 2011;6(6):e19930.

    Article  CAS  Google Scholar 

  17. Liu L, Yin X, Morrissey S. Global variability in diabetes mellitus and its association with body weight and primary healthcare support in 49 low- and middle-income developing countries. Diabet Med. 2012;29:995–1002.

    Article  CAS  Google Scholar 

  18. Oommen AM, Abraham VJ, George K, Jose VJ. Rising trend of cardiovascular risk factors between 1991–94 and 2010–12: a repeat cross-sectional survey in urban and rural Vellore. Indian Heart J. 2016;68:263–9.

    Article  Google Scholar 

Download references


The cross-sectional WHO STEPS survey was funded by the Indian Council of Medical Research (ICMR).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Anu Mary Oommen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Written informed consent was obtained from all participants in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oommen, A.M., Kapoor, N., Thomas, N. et al. Prevalence and clinical characteristics of individuals with newly detected lean diabetes in Tamil Nadu, South India: a community-based cross-sectional study. Int J Diabetes Dev Ctries 39, 680–684 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: