Urban-rural differences in the prevalence of foot complications in South-Indian diabetic patients.

D iabetes is recognized to be common in Asian Indians. The number of people with diabetes in the world is expected to double between 2000 and 2030. The greatest absolute increase in the number of people with diabetes will be in India (1). Regional studies from urban areas of India have shown a several-fold increase in the prevalence of diabetes in the last 2 decades (2). In a national survey reported in 2001, a concomitant increase in prevalence of impaired glucose tolerance (IGT) was noted (3). In four of six cities, the ratio of IGT to diabetes was greater than one, implying the possibility of a future conversion of IGT subjects to diabetes. An urban-rural difference in the prevalence rate was found, indicating that the environmental factors related to urbanization had a significant role in increasing the prevalence of diabetes (4). It was shown that diabetes had increased threefold over a span of 14 years in a rural population in southern India (5). The prevalence of diabetes in the urbanizing rural population was found to be midway between the rural and urban population (6). In India, diabetic foot infection is a common cause for hospital admission among diabetic patients and is caused by a number of sociocultural practices (7). The economic and emotional consequences for the patient and the family can be enormous (8). There is not much comparative data on the occurrence of foot complications between urban and rural populations. This study was therefore done in an outpatient diabetes clinic to determine the prevalence of foot complications among patients coming from urban and rural areas in South India.