High Prevalence of Type 2 Diabetes without Traditional Risk Factors among Men Who Inject Drugs in Chennai, India

South Asians with type 2 diabetes (T2DM) are predominately normal- or underweight, due to early loss of beta cell function in addition to insulin resistance. Substances of misuse are an additional stressor on beta cells and may lead to an increased prevalence of T2DM. We determined the prevalence of T2DM and its correlates among people who inject drugs (PWID) in Chennai. We conducted a cross-sectional analysis among male PWID. T2DM was defined as fasting glucose ≥126mg/dL or a prior diagnosis. Logistic regression was used to identify correlates of T2DM. Among 1039 PWID, median age was 38.9 years (IQR 32.1, 44.9) and median BMI was 19.7 kg/m2 (IQR 17.8, 22.9). The most common injected substance was heroin (94.8%, n=998). T2DM prevalence was 8.4% (n=87), among whom 60% were underweight or normal weight and 64% had normal waist circumference. On univariable regression analysis, T2DM was not associated with greater frequency of drug use, type of drug, HIV, or Hepatitis C. On multivariable analysis, age >40 years (OR 3.0, 95% CI 1.3-6.8) and high waist circumference (OR 1.9, 95% CI 1.1-3.2) were associated with T2DM. The prevalence of T2DM among PWID is similar to India as a whole, though most cases would not be detected by screening using weight or waist circumference. Integrating universal metabolic disease screening into substance abuse treatment programs may help reduce morbidity and mortality from T2DM. Disclosure P.Chebrolu: None. S.Mehta: Research Support; Abbott Diagnostics. A.Mcfall: None. T.Brown: Advisory Panel; Merck & Co., Inc., Gilead Sciences, Inc., ViiV Healthcare, Jannsen. A.Srikrishnan: None. M.Kumar: None. H.Iqbal: None. J.S.Mathad: None. G.Lucas: None. S.S.Solomon: Research Support; Gilead Sciences, Inc., Abbott. Funding National Institute on Drug Abuse (R01DA026727); Fogarty International Center (D43TW009337); Weill Cornell Department of Medicine; National Institute of Allergy and Infectious Diseases (K24AI120834 to T.B.)