A Multiethnic Study of Pre-Diabetes and Diabetes in LMIC |
| |
| Institution: | 1. Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA;2. Public Health Foundation of India & Center for Chronic Disease Control, New Delhi, India;3. South American Center for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina;4. CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru;6. School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru;5. Chronic Diseases Initiative for Africa, University of Cape Town, Cape Town, South Africa;7. All India Institute of Medical Sciences, New Delhi, India;1. Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA;2. Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA;3. Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA;4. Fogarty International Center, National Institutes of Health, Bethesda, MD, USA;1. Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa;2. Medical Research Council/University of Witwatersrand, Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;1. CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru;2. University of Washington, Seattle, WA, USA;3. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;4. Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru;6. Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, MD, USA;5. Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru;1. Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;2. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA;3. Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. The George Institute for Global Health, University of Oxford, Oxford, UK;5. University of Sydney, Sydney, NSW, Australia;1. Centro de Excelencia en Salud Cardiovascular para el Cono Sur, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina;2. Duke Clinical Research Institute, Durham, NC, USA;3. CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru;4. Public Health Foundation of India, Gurgaon, India;6. Centre for Chronic Disease Control, Gurgaon, India;5. Division of Cardiovascular Medicine, Brigham & Women''s Hospital, Boston, MA, USA;7. Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;11. Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;12. Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru;8. The George Institute for Global Health at Peking University Health Science Center, Beijing, China;10. Peking University Clinical Research Institute, Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China;9. St. John''s Medical College and Research Institute, St. John''s National Academy of Health Sciences, Bangalore, India;71. Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA |
| |
| Abstract: | BackgroundDiabetes mellitus is one of the leading causes of death and disability worldwide. Approximately three-quarters of people with diabetes live in low- and middle-income countries, and these countries are projected to experience the greatest increase in diabetes burden.ObjectivesWe sought to compare the prevalence, awareness, treatment, and control of diabetes in 3 urban and periurban regions: the Southern Cone of Latin America and Peru, South Asia, and South Africa. In addition, we examined the relationship between diabetes and pre-diabetes with known cardiovascular and metabolic risk factors.MethodsA total of 26,680 participants (mean age, 47.7 ± 14.0 years; 45.9% male) were enrolled in 4 sites (Southern Cone of Latin America = 7,524; Peru = 3,601; South Asia = 11,907; South Africa = 1,099). Detailed demographic, anthropometric, and biochemical data were collected. Diabetes and pre-diabetes were defined as a fasting plasma glucose ≥126 mg/dl and 100 to 125 mg/dl, respectively. Diabetes control was defined as fasting plasma glucose <130 mg/dl.ResultsThe prevalence of diabetes and pre-diabetes was 14.0% (95% confidence interval CI]: 13.2% to 14.8%) and 17.8% (95% CI: 17.0% to 18.7%) in the Southern Cone of Latin America, 9.8% (95% CI: 8.8% to 10.9%) and 17.1% (95% CI: 15.9% to 18.5%) in Peru, 19.0% (95% CI: 18.4% to 19.8%) and 24.0% (95% CI: 23.2% to 24.7%) in South Asia, and 13.8% (95% CI: 11.9% to 16.0%) and 9.9% (95% CI: 8.3% to 11.8%) in South Africa. The age- and sex-specific prevalence of diabetes and pre-diabetes for all countries increased with age (p < 0.001). In the Southern Cone of Latin America, Peru, and South Africa the prevalence of pre-diabetes rose sharply at 35 to 44 years. In South Asia, the sharpest rise in pre-diabetes prevalence occurred younger at 25 to 34 years. The prevalence of diabetes rose sharply at 45 to 54 years in the Southern Cone of Latin America, Peru, and South Africa, and at 35 to 44 years in South Asia. Diabetes and pre-diabetes prevalence increased with body mass index. South Asians had the highest prevalence of diabetes and pre-diabetes for any body mass index and normal-weight South Asians had a higher prevalence of diabetes and pre-diabetes than overweight and obese individuals from other regions. Across all regions, only 79.8% of persons with diabetes were aware of their diagnosis, of these only 78.2% were receiving treatment, and only 36.6% were able to attain glycemic control.ConclusionsThe prevalence of diabetes and pre-diabetes is alarmingly high among urban and periurban populations in Latin America, South Asia, and South Africa. Even more alarming is the propensity for South Asians to develop diabetes and pre-diabetes at a younger age and lower body mass index compared with individuals from other low and middle income countries. It is concerning that one-fifth of all people with diabetes were unaware of their diagnosis and that only two-thirds of those under treatment were able to attain glycemic control. Health systems and policy makers must make concerted efforts to improve diabetes prevention, detection, and control to prevent long-term consequences. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
