Association between type 2 diabetes mellitus & anthropometric measurements – a case control study in South India


Type 2 diabetes mellitus
body mass index
waist circumference
case control study


Introduction: Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). Clinical evidence indicates a stronger association of diabetes with central obesity than general obesity. The present study aimed to compare the association between type 2 diabetes mellitus and different anthropometric measurements and evaluate the usefulness of these measurements in clinical practice.

Methods: A case-control study was done among 102 individuals; of whom 51 cases included diagnosed Type 2 diabetes mellitus (≥20years age) patients attending the Medicine out-patient consultation of a tertiary care hospital and 51 controls who were screen negative for T2DM and recruited from the local community. Various anthropometric measurements were measured using standard World Health Organization (WHO) protocols. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 15. 

Results: The proportion of cases with body mass index (BMI) ≥25 kg/m2 was 55% as compared to 22% of controls and this association was statistically significant (p<0.05). The proportion of cases with high waist circumference cut-offs (WC) was 74.5% as compared to 45.1% healthy individuals and this association was also statistically significant (p<0.05, OR=3.56). A Receiver Operating Characteristic (ROC) curve for both gender revealed highest area under the curve for body mass index (area= 0.787). Body mass index had the best discriminatory power. Waist to hip ratio was not a sensitive marker especially for females.

Conclusion: A strong association between obesity indices and diabetes was identified. BMI and WC could be used in clinical practice for suggesting life style modifications.


. Rama Lakshmi G, Bandyopadhyay SS, Bhaskar LVKS, Sharma M, Rao RV. Appraisal of risk factors for diabetes mellitus type 2 in central Indian population: a case control study. Antrocom Online Journal of Anthropology 2011; 7: 103-110. Available at: Accessed on 25/07/2014.

. Ramachandran A, Snehalatha C. Current scenario of diabetes in India. J Diabetes 2009; 1:18-28. doi: 10.1111/j.1753-0407.2008.00004.x.

. Venkataraman K, Kannan AT, Mohan V. Challenges in diabetes management with particular reference to India. International Journal of Diabetes in Developing Countries. 2009; 29(3):103-109. doi:10.4103/0973-3930.54286.

. Kamath A, Shivaprakash G, Adhikari P. Body mass index and waist circumference in type 2 diabetes mellitus patients attending a diabetes clinic. Int J Biol Med Res. 2011; 2(3): 636- 638. Available at: Accessed on 20/06/ 2014.

. Spollett GR. Diabetes: treating the coming Tsunami. Diabetes Spectrum 2013; 26: 58-62. doi: 10.2337/diaspect.26.1.58.

. Unnikrishnan R, Anjana RM, Mohan V. Diabetes in South Asians: Is the phenotype different? Diabetes 2014; 63: 53–55. doi: 0.2337/db13-1592.

. The impact of chronic disease in India. Available at: Accessed on 15/01/2014.

. Padaki S, Vijayakrishna K, Dambal A, Ankad R, Manjula R, Surekharani C, Herur A, Patil S. Anthropometry and physical fitness in individuals with family history of type-2 diabetes mellitus: A comparative study. Indian Journal of Endocrinology and Metabolism 2011; 15(4): 327-330. doi: 10.4103/2230-8210.85595.

. Dagan SS, Segev S, Novikov I, Dankner R. Waist circumference vs body mass index in association with cardiorespiratory fitness in healthy men and women: a cross sectional analysis of 403 subjects. Nutrition Journal. 2013; 12: 12. doi: 10.1186/1475-2891-12-12.

. Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value. Nutrition Research Reviews 2010; 23: 247–269. doi: 10.1017/S0954422410000144.

. International Diabetes Federation: IDF Diabetes Atlas. 6th edition. Brussels, Belgium: International Diabetes Federation; 2013. Available at: Accessed on 27/07/2014.

. STEP wise approach to surveillance (STEPS)-Guide to physical measurements. World Health Organization. Available at: Accessed on 15/01/2014.

. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet 2004; 363(9403): 157-163. doi:

. Report of a WHO Expert Consultation on waist circumference and waist hip ratio. Available at: Accessed on 23/01/2014.

. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ and the National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA. 2003; 289(19): 2560-2571. doi: 10.1001/jama.289.19.2560.

. Ärnlöv J, Sundström J, Ingelsson E, Lind L. Impact of BMI and the Metabolic Syndrome on the Risk of Diabetes in Middle-Aged Men. Diabetes Care. 2011; 34(1): 61-65. doi:10.2337/dc10-0955.

. Jowitt LM, Lu LW, Rush EC. Migrant Asian Indians in New Zealand; prediction of metabolic syndrome using body weights and measures. Asia Pac J Clin Nutr 2014; 23(3): 385-393. doi: 10.6133/apjcn.2014.23.3.06.

. Freemantle N, Holmes J, Hockey A, Kumar S. How strong is the association between abdominal obesity and the incidence of type 2 diabetes? Int J Clin Pract. 2008 September; 62(9): 1391–1396. doi: 10.1111/j.1742-1241.2008.01805.x

. Mamtani M, Kulkarni H, Dyer TD, Almasy L, Mahaney MC, Duggirala R, Comuzzie AG, Blangero J, Curran JE. Waist Circumference Independently Associates with the Risk of Insulin Resistance and Type 2 Diabetes in Mexican American Families. PLoS ONE. 2013; 8(3): e59153. doi: 10.1371/journal.pone.0059153.

. MacKay MF, Haffner SM, Wagenknecht LE, D’Agostino RB, Hanley AJG. Prediction of Type 2 Diabetes Using Alternate Anthropometric Measures in a Multi-Ethnic Cohort: The Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009; 32(5): 956-958. doi: 10.2337/dc08-1663.