Background There is limited data on the prevalence and outcome of prediabetes (PDM) and the incidence of type 2 diabetes mellitus (T2DM) in South Asia. We investigated these in a prospective, community-based study involving a cohort of urban adults in Sri Lanka, with a seven-year follow-up. Methods Participants were selected by age-stratified random sampling, and were initially screened in 2007 and reevaluated in 2014. To assess the participants, structured interviews, anthropometric measurements, liver ultrasound, biochemical, and serological tests were performed on both occasions. Results 2985 individuals were recruited in 2007 [54.8% women, median age (IQR) 53 (47-59)]; 737 had T2DM [baseline prevalence 24.7% (95% CI: 23.1–26.2)] and 525 had PDM [baseline prevalence 17.9% (95% CI: 16.2-19.6)]. 2148 (71.6%) attended follow-up in 2014 [57.5% women; median (IQR) 60 (54–66) years], which included 1650 who did not have T2DM in 2007. By 2014, 436/1650 (27.6%) had developed new T2DM [annual incidence 3.9% (95% CI:3.0-4.9)]. On logistic regression, PDM, central obesity, dyslipidemia, and nonalcoholic fatty liver disease (NAFLD) at baseline showed significant association with new-onset T2DM. Of 525 with PDM in 2007, 365 (69.5%) presented for follow-up in 2014; 147/365 (40.3%) remained in PDM, 201/365 (55.1%) had progressed to T2DM and 17/365 (4.6%) had reverted to normoglycemia. Annual conversion rate of PDM to T2DM was 7.9%. Increase in waist circumference and low HDL from baseline predicted progression to T2DM. Conclusions Presence of features of the metabolic syndrome at baseline predicted new-onset T2DM and conversion of PDM to T2DM. Targeted lifestyle interventions are essential for individuals with metabolic risk to prevent future T2DM.

Introduction and Objectives There are no cardiovascular risk prediction models developed in South Asian cohorts. Therefore, different risk models not validated in South Asians are being used. We aimed to compare cardiovascular risk predictions of Framingham risk score (FRS) and World health organization/International society of hypertension (WHO/ISH) charts for agreement in a sample of South Asians. Methods 10-year cardiovascular risk predictions of patients without previous cardiovascular diseases attending a non-communicable disease clinic were calculated using FRS (with BMI and with cholesterol) and WHO/ISH charts (with and without cholesterol). Patients were categorized into low(<20% ) and high(≥20%) cardiovascular risk groups on risk predictions. Agreement in risk categorisation with different prediction models was compared using Cohen’s kappa coefficient(κ). Results 169 patients (females 130(81.1%)) mean age 65 ±6.9 years were studied. 80(47.3%), 62(36.7%), 18(10.7%), and 16(9.5%) were predicted high-risk by FRS BMI-based, FRS cholesterol-based, WHO/ISH without-cholesterol and WHO/ISH with-cholesterol models, respectively. Agreement between the two FRS models (κ = 0.736, p<0.0001) and the two WHO/ISH models (κ = 0.804, p<0.0001) in stratifying patients into high and low-risk groups, were “good”. However, the agreements between, FRS BMI-based and WHO/ISH without-cholesterol models (κ = 0.234, p<0.0001) and FRS cholesterol-based and WHO/ISH with-cholesterol models (κ = 0.306, p<0.0001) were only “fair”. Conclusion Cardiovascular risk predictions of FRS were higher than WHO/ISH charts and the agreement in risk stratification was not satisfactory in Sri Lankans. Therefore, different cardiovascular risk prediction models should not be used interchangeably in the follow-up of South Asians.

Objectives To estimate the prevalence of latent iron deficiency (LID) among pregnant women, assess LID in relation to parity, age, education, and household income, and to determine correlations between LID and red cell indices, red cell distribution width (RDW), and red cell morphology. Design Cross-sectional design Setting North Colombo Teaching Hospital, Sri Lanka. Sample Participants comprised 355 pregnant women with normal haemoglobin levels seeking antenatal care within < 20 weeks of gestation. Method Data were obtained from interviews and antenatal records. Participant full blood count (FBC), serum ferritin levels, and blood films were analysed. Main Outcome Measures Prevalence of LID, demographic data (age, parity, period of gestation, gap between pregnancies, income, and education), and blood film morphology. Results LID prevalence was 54%. Statistical significance for the gap between pregnancies being < 2 years was observed but not for participant’s age, parity, income, and education. Blood film morphology depicted statistically significant presence of hypochromic microcytic red cells and pencil cells. RDW was significant in indicating the presence of LID. Among those with LID, 25% had ferritin level in the iron deficiency range. Conclusions LID is highly prevalent in early pregnancy and 25% of participants had ferritin levels in the iron deficiency range. Presence of raised RDW, hypochromic microcytic red cells, pencil cells, and <2 years’ gap between pregnancies were indicators of LID. To identify pregnant women with LID, blood film, haemoglobin, and RDW could be recommended as basic tests, and ferritin test as an affirmative one.