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A Multiethnic Study of Pre-Diabetes and Diabetes in LMIC

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dc.contributor.author Shen, Jia
dc.contributor.author Kondal, Dimple
dc.contributor.author Rubinstein, Adolfo
dc.contributor.author Irazola, Vilma
dc.contributor.author Gutierrez, Laura
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Bernabé Ortiz, Antonio
dc.contributor.author Lazo Porras, María de los Ángeles
dc.contributor.author Levitt, Naomi
dc.contributor.author Steyn, Krisela
dc.contributor.author Bobrow, Kirsten
dc.contributor.author Ali, Mohammed-K.
dc.contributor.author Prabhakaran, Dorairaj
dc.contributor.author Tandon, Nikhil
dc.date.accessioned 2019-02-06T14:45:59Z
dc.date.available 2019-02-06T14:45:59Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5162
dc.description.abstract BACKGROUND: Diabetes 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. OBJECTIVES: We 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: The 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. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Global Heart
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Developing Countries en_US
dc.subject Health Knowledge, Attitudes, Practice en_US
dc.subject Adult en_US
dc.subject Aged en_US
dc.subject Argentina/epidemiology en_US
dc.subject Chile/epidemiology en_US
dc.subject Cohort Studies en_US
dc.subject Cross-Sectional Studies en_US
dc.subject Diabetes Mellitus/drug therapy/epidemiology en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Hypoglycemic Agents/therapeutic use en_US
dc.subject India/epidemiology en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.subject Obesity/epidemiology en_US
dc.subject Overweight/epidemiology en_US
dc.subject Pakistan/epidemiology en_US
dc.subject Peru/epidemiology en_US
dc.subject Prediabetic State/epidemiology/therapy en_US
dc.subject Prevalence en_US
dc.subject Risk Factors en_US
dc.subject South Africa/epidemiology en_US
dc.subject Uruguay/epidemiology en_US
dc.title A Multiethnic Study of Pre-Diabetes and Diabetes in LMIC en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.gheart.2015.12.015
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.04
dc.relation.issn 2211-8179


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