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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 4  |  Page : 472-479

Research on type 2 diabetes in India during 1982 to 2019: A comprehensive bibliometric assessment


1 Department of Pediatrics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
2 CSIR-National Institute of Science, Technology and Development Studies, New Delhi, India
3 Department of Endocrinology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
4 CSIR-National Physical Laboratory, New Delhi, India

Date of Submission30-Apr-2021
Date of Decision24-May-2021
Date of Acceptance27-May-2021
Date of Web Publication12-Jan-2022

Correspondence Address:
Dr. Devi Dayal
Endocrinology and Diabetes Unit, Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education & Research, Chandigarh 160012.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jod.jod_53_21

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  Abstract 

Background: India has an enormous burden of type 2 diabetes mellitus (T2DM), and this plays an important role in global T2DM research. However, the quantity and quality of Indian T2DM research remain largely unexplored. Objective: To provide a detailed analysis of Indian T2DM research output during 1982–2019 using select bibliometric indicators. Materials and Methods: Data on T2DM publications were retrieved from the Scopus database. The analysis focused on the quantitative output of Indian authors and organizations. The qualitative performance was assessed in terms of relative citation index, citations per paper, and highly cited papers. Results: Globally, 157 countries participated in T2DM research, producing 208902 publications during 1982–2019. India ranks in the ninth place in global output, with 7844 publications (3.75% share). Only 19.06% of papers had international collaboration, whereas 12% received funding. The leading productive organizations were the Madras Diabetes Research Foundation, Chennai, All India Institute of Medical Sciences (AIIMS), New Delhi, and Post Graduate Institute of Medical Education & Research, Chandigarh; whereas King Edward Memorial Hospital, Pune, AIIMS, New Delhi, and Fortis Healthcare, Gurgaon were the most impactful. The most productive authors were V. Mohan, S. Kalra, and A. Ramachandran. Journal of the Association of Physicians of India, Diabetes and Metabolic Syndrome Clinical Research and Reviews, and Journal of Clinical and Diagnostic Research were the leading productive journals. Only 2.23% of publications were highly cited. Conclusions: Considering the burden of T2DM, India’s research is lagging behind. Increasing national and international collaborations, active involvement of national and international funding agencies, and prioritizing research on youth with T2DM is the need of the hour.

Keywords: Bibliometrics, diabetes research, India, scientometrics, type 2 diabetes


How to cite this article:
Dayal D, Gupta BM, Raviteja K V, Pal R, Dhawan SM. Research on type 2 diabetes in India during 1982 to 2019: A comprehensive bibliometric assessment. J Diabetol 2021;12:472-9

How to cite this URL:
Dayal D, Gupta BM, Raviteja K V, Pal R, Dhawan SM. Research on type 2 diabetes in India during 1982 to 2019: A comprehensive bibliometric assessment. J Diabetol [serial online] 2021 [cited 2022 Jan 27];12:472-9. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/4/472/335594




  Introduction Top


Type 2 diabetes mellitus (T2DM) is a global epidemic, with an estimated 463 million adults affected worldwide.[1],[2] The number is estimated to rise to 700 million by 2045.[2] More than 60% of the global T2DM burden is contributed by the Asian continent. India has an estimated 77 million patient population affected by T2DM, second only to that of China.[2] The huge burden of T2DM in India is contributed by ethnic factors, a carbohydrate-rich diet combined with lifestyle changes associated with urbanization. Asian Indian patients with T2DM tend to have truncal obesity with a relatively low body mass index, which predisposes them to T2DM at a younger age.[3] Taking these into consideration, many research organizations such as The Research Society for Study of Diabetes in India and the Endocrine Society of India have formulated their own guidelines regarding the management of T2DM as the predominantly Western guidelines might not be appropriate for the Indian population with T2DM.[4] Substantial research is still needed to improve basic diabetes care, education, and awareness in the Indian population with T2DM, especially for those residing in resource-limited settings such as rural areas (where 70%–80% of the Indian population resides). Despite a huge disease burden, an assessment of the Indian contribution to T2DM research is largely unexplored.

Bibliometrics is a useful method that is used to evaluate trends in research activity over time, comparing the contributions of scholars, journals, institutes, and countries and for dictating future policies.[5],[6],[7] It enables researchers to extract essential information to identify the gaps as well as hotspots in research, thereby assisting them in their work on certain areas of interest. Findings from bibliometric studies have played a fundamental role in decision making regarding policy formation, development of clinical practice guidelines, and the prioritization of resources for public health challenges.[7],[8]

The previous bibliometric studies on T2DM research focused on individual regions and countries.[9],[10],[11],[12],[13] Two studies have examined the global research output for T2DM: One of these was a detailed analysis of publications during 1951–2012, whereas the other examined 1845 highly cited papers (HCPs) on T2DM.[14],[15] The available bibliometric studies that have examined the Indian output in T2DM are limited in number. Moreover, the data analyzed have spanned over a maximum period of only nine years, making it impossible to analyze trends in the quantity and quality of publications. Moreover, there has not been an analysis of the Indian T2DM research after 2012.[9],[10],[11] Therefore, we aimed at providing a detailed evaluation of the T2DM research output from India over a period of 37 years during 1982–2019 using appropriate bibliometrics.


  Materials and Methods Top


Data for the current study were retrieved up to January 2, 2020, from the Scopus international multidisciplinary abstract and citation database (http://www.scopus.com).

With the use of Boolean operators “OR,” “AND,” and “NOT,” the following search query was developed. Keywords for the search included “Type 2 Diabetes” or “Diabetes, Type 2” or “Type II Diabetes” or “Diabetes, Type II” or “Non-Insulin Dependent Diabetes Mellitus.” These keywords were suffixed to “Key” (keyword) and “Title” (title of paper) tags, and the search output was refined by the period “1982–2019.” The main search strategy yielded a global output of 20,8902 records, which was further refined by countries (including India) to identify the top 15 most productive countries in T2DM research. The “India” search string yielded 7844 records, which were further analyzed.

The analysis focused on the quantitative output of Indian authors and organizations and their collaborative interlinkages. The qualitative performance was assessed in terms of citations per paper (CPP), relative citation index (RCI), HCPs, and H-index (HI), besides identifying the important subjects and keywords, media of communication, and characteristics of highly cited publications. The CPP was defined as the total number of citations divided by the total number of papers. The RCI is calculated by dividing the number of citations a paper received by the average number of citations an article usually receives in that field. That number is then benchmarked against the median Relative Citation Ratio for all National Institute of Health (NIH)–funded papers.[16] HI, also known as the Hirsch index, is defined as the maximum value of h such that the given author/journal has published h papers that have each been cited at least h times.


  Results Top


Overall publication output and growth

During 1982–2019, 157 countries contributed to the overall publication output of 208902. The United States contributed toward 27.34% of the overall output, followed by other countries. India ranked ninth, with the total publications numbering 7844. The global and India’s cumulative publications increased from 24842 and 344 during 1982–2000 to 184060 and 7500 publications during 2001–2019, respectively [Table 1]. India’s cumulative research output registered 2080.23% growth compared with 640.92% growth of the world output between 1982–2000 and 2001–2019. Eleven countries, namely the United States, China, India, Canada, South Korea, Australia, Spain, Netherlands, Germany, Denmark, and the United Kingdom, showed an increase in the publication share as against a decrease in four countries, namely Sweden, Italy, France, and Japan [Table 1].
Table 1: Leading countries by number of type 2 diabetes mellitus publications during 1982–2019

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India’s 7844 publications received 126564 citations, averaging 16.14 CPP during 1982–2019. However, CPP decreased from 23.80 during 1982–2000 to 15.78 during 2001–2019 [Table 2]. A majority (5923 papers, 75.51%) of Indian data were published as original articles, 14.53% (1140) as reviews, 4.08% (320) as letters, 1.87% (147) as editorials, 1.57% (123) as notes, 1.40% (110) as conference papers, and <1% as miscellaneous (book chapters = 0.45%, short surveys = 0.32%, erratum = 0.17%, book, data paper, and retracted = 0.01% each, and undefined = 0.06%).
Table 2: Global and India’s publication output and citation count in type 2 diabetes mellitus research during 1982–2019

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The medium of research communication

Of the total Indian T2DM research output, 99.74% (7745) appeared in 1292 journals. All other source types were less than 1.0%. The leading journals were Journal of the Association of Physicians of India (206 papers), Diabetes and Metabolic Syndrome Clinical Research and Reviews (199 papers), Journal of Clinical and Diagnostic Research (196 papers), and Diabetes Research and Clinical Practice (170 papers) [Table 3].
Table 3: Leading productive and impactful journals in India’s type 2 diabetes mellitus research during 1982–2019

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Research focus according to the age of the patient population

A major proportion of Indian T2D research was conducted on adults and the middle-aged population (45.39% and 26.40%, respectively), followed by the elderly (18.19%), adolescents (3.49%), and children (2.63%). During the study period, the research focus increased in the elderly from 9.88% to 18.57%, whereas it decreased in all other age groups.

Research on diabetes complications

The literature on the complications of T2DM accounted for a significant share of India’s publication output. The largest number of papers were found on cardiovascular complications and hypertension (15.15% and 11.54% shares, respectively), followed by hyperglycemia (9.37%), diabetic retinopathy (7.57%), hypoglycemia (7.09%), diabetic neuropathy (5.60%), diabetic foot (1.68%), and depression (1.73%). The share of other complications such as stroke, skin infections, and oral hygiene was less than 1.0% each.

International collaboration

The international collaborative publications (ICPs) were 1495 (19.06%), involving collaboration with 160 countries. The share of ICP increased from 14.24% during 1982–2000 to 19.28% during 2001–2019 [Table 2]. The ICPs were cited 52,598 times, with a CPP of 35.21. The largest collaborator was the United States (641 papers, 42.88%), followed by the United Kingdom (339 papers, 22.68%), Australia (148 papers, 9.90%), Saudi Arabia (126 papers, 8.43%), Canada (122 papers, 8.16%), China (99 papers, 6.62%), and Germany (96 papers, 6.42%).

Research funding

Approximately 12% (937) of India’s publications received financial support from 156 Indian and foreign agencies. These publications received 24088 citations with a CPP of 25.71. The funded publications increased from just 10 during 1982–2000 to 927 during 2001–2019. Among Indian agencies, the largest number of papers (162) was funded by the Indian Council of Medical Research, followed by the University Grants Commission (139 papers), Department of Biotechnology, Government of West Bengal (87 papers), Department of Science and Technology, Government of Kerala (65 papers), and Council of Scientific and Industrial Research (CSIR; 59 papers). The Bangladesh CSIR (82 papers), National Institute of Health, the United States (67 papers), Novo Nordisk (46 papers), Eli Lilly and Company (43 papers), Sanofi (32 papers), Wellcome Trust, the United Kingdom (32 papers), and the Medical Research Council, the United Kingdom (28 papers) were the major foreign funding agencies.

Top research organizations

Of the 1782 organizations that contributed to India’s T2DM research, 778 published only one paper each; whereas 31, five, and two organizations published 51–100 papers, 101–200, and 201–335 papers each, respectively. The productivity of the top 30 most productive organizations varied from 58 to 335 publications per organization; together, they contributed 39.84% (3125) and 52.36% (66,273) of the publications and citations share, respectively. A significant association was observed between the research funding of organizations and their quantity and quality of publications, with correlation coefficients of 0.88 and 0.65, respectively [Table 4].
Table 4: Publication profile of top 10 most productive and top 10 most impactful organizations in type 2 diabetes mellitus research during 1982–2019

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Collaboration between the Indian organizations

Four organizations that showed high institutional collaboration were Manipal Academy of Higher Education (128 linkages with four organizations), Kasturba Medical College, Manipal (91 linkages with five organizations), All India Institute of Medical Sciences (AIIMS), New Delhi, and M. Vishwanathan Hospital for Diabetes (MVHFD), Chennai (91 linkages with 13 and four organizations). The largest number of collaborative linkages (75) was between the Diabetes Research Center (DRC), Chennai, and MVHFD, Chennai.

Productive and impactful authors

A large number (3425) of authors participated in T2DM research. The top 10 most productive authors published 59 to 356 publications each; together, they contributed 16.12% (1265) and 30.41% (126,564) of publications and citations share, respectively [Table 5]. Three authors registered their publications output above the group average of 126.50, whereas two registered their CPP and RCI above the group average of 67.96 and 4.21, respectively [Table 5].
Table 5: Publication profile of top 10 most productive and most impactful authors in type 2 diabetes mellitus research during 1982–2019

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Highly cited papers

Only 175 (2.23%) of the 7844 publications received 100 to 5363 CPP (assumed highly cited), averaging 280.95. Sixty-five of the 175 HCPs had no collaboration, whereas 110 had collaboration between two or more organizations per paper. The Madras Diabetes Research Foundation, Chennai contributed the largest number of HCPs (21 papers), followed by AIIMS, New Delhi (14 papers), King Edward Memorial Hospital, Pune (13 papers), DRC, Chennai (10 papers), Fortis Healthcare, Gurgaon (nine papers), MVHFD, Chennai (eight papers), and Banaras Hindu University, Varanasi (four papers). Among the authors, V. Mohan contributed the largest number of HCPs (22 papers), followed by A. Ramachandran (19 papers), C. Snehalatha (12 papers), and A. Misra and C.S. Yajnik (11 papers each).


  Discussion Top


To the best of our knowledge, this is the largest bibliometric analysis of T2DM research in India, spanning over a period of 37 years (1982–2019). India’s publications numbered 7844 and ranked ninth globally in terms of overall output, with a CPP of 16.14. The ICPs accounted for 19.06% of the total publications, and 12% of the publications received funding from Indian/foreign agencies. Besides, HCPs comprised 2.23% of the country’s research output. Although these figures appear noteworthy, these do not commensurate with the country’s T2DM disease burden.

India is home to 77 million people with T2DM, with an overall prevalence of 7.3%.[2],[17] The number is expected to reach a mammoth 134 million by the year 2045.[2] The T2DM burden in India is contributed by genetic/ethnic factors combined with lifestyle changes; age-adjusted prevalence rates of T2DM among Indians are higher at lower BMI thresholds compared with Caucasians.[3] Moreover, T2DM in the Indian population tends to occur almost at least a decade earlier than in Europeans.[18] Due to the sheer numbers, the economic burden imposed by T2DM on India is among the highest in the world.[19] However, the disease’s real burden is due to the inherent micro- and macro-vascular complications that contribute to morbidity and mortality. The overall prevalence of retinopathy among Indians with T2DM ranges from 7.3% to 34.1%, and that of microalbuminuria, overt nephropathy, peripheral neuropathy, coronary artery disease, and peripheral vascular disease is 26.9%, 2.2%, 26.1%, 21.4%, and 6.3%, respectively.[19],[20],[21],[22],[23],[24] Besides, nearly half of the people with T2DM remain undetected, accounting for florid complications even at diagnosis. Moreover, the glycemic control of T2DM is suboptimal in Indian patients with a mean glycated hemoglobin of 9%, which is at least 2% higher than that suggested by international organizations.[19] Early diagnosis, low-cost pharmacotherapy, and effective screening for micro- and macro-vascular complications are the need of the hour. Herein lies the need for extensive and quality research in the field of T2DM.

In this bibliometric analysis, we found that India ranked ninth, contributing to 3.74% of the global output, whereas the United States ranked first, accounting for 27.34% of the global yield. According to the latest estimates, the United States is home to only 31 million people with T2DM, as opposed to 77 million people residing in India. Even in China, the diabetes capital of the world with nearly 116 million affected people, publications on T2DM numbered 15118, which is almost twice as that of India. Thus, considering the magnitude of the disease burden in India, publications on T2DM are lagging behind. India’s cumulative research output registered a 2080.23% growth between 1982–2000 and 2001–2019, whereas China recorded a massive growth of 6316.37%, coinciding with the country’s surge in the number of cases with T2DM.

India’s overall T2DM research achieved 126564 citations with a CPP of 16.14. However, CPP showed a marked dip from 23.80 during 1982–2000 to 15.78 during 2001–2019, implying that with an increase in quantity, the quality of T2D research in India has taken a backseat. Although ICPs and funded research showed an increasing trend from 1982–2000 to 2001–2019, overall, they comprised only 19.06% and 12% of the 37-year research output. We also observed a disparity in the distribution of funding of research organizations; the research output and impact of organizations that received higher funding were better than those who received little or no financial support. It is well known that research sponsorship and international collaboration do improve research citation impact.[25],[26] In a bibliometric analysis conducted by Geaney, et al. on global T2DM research yield between 1951 and 2012, India did not feature in the top 15 collaborating nations.[14] Even Iran, a developing nation that had contributed only 4425 papers on diabetes research between 1968 and 2014, collaborated with 84 other countries on 932 papers (21%).[27] Besides, we noted a dearth of adequate collaboration between the Indian institutions, with the major collaborating institutes being located in South India. Similarly, on an individual-to-individual basis, the largest number of collaborative linkages was between researchers belonging to the Southern part of the country. Collaboration between institutions and authors belonging to other parts of the country needs to be strengthened.

A major issue is a relative scarcity of research on children and adolescents with T2DM as compared with type 1 diabetes.[28],[29],[30] The prevalence of T2DM in Indian youth is on the rise.[31] The occurrence of T2DM among young individuals bears major public health consequences, as they are likely to manifest the florid complications of diabetes, including retinopathy, nephropathy, neuropathy, and cardiovascular disease, at a time that should be the most active and productive of their lives.[32] Data from the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study suggest an early and rapid decline in β-cell function in youth compared with adults with newly diagnosed T2DM.[33] Hence, youth with T2DM need to be treated early and aggressively. Extensive research on youth with T2DM in India is, therefore, vital.


  Conclusions Top


India’s T2DM research has witnessed remarkable growth over the past two decades. However, the country’s quantity and quality of research are still lagging behind, considering the massive burden of T2DM. Increasing national and international collaborations, active involvement of national and international funding agencies, and intensifying research on youth with T2DM are urgently needed.

Contributors’ list

B.M.G: concept and design of the study, and acquisition, analysis, and interpretation of data; K.V.R and R.P: data analysis and preparation of the article; S.M.D: critical revision of the article for important intellectual content; D.D: article preparation and critical revision for important intellectual content. All authors approved the final version of the article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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