Prevalence, Awareness and Control of Diabetes Mellitus in the Southern Cone of Latin America

RUBINSTEIN, ADOLFO; IRAZOLA, V.; POGGIO, R; LANAS, F; CALANDRELLI, M; OLIVERA, H; PONZO, J; SERON, P; GUTIERREZ, L; BAZZANO, L; HE, J

CIRCULATION

LIPPINCOTT WILLIAMS & WILKINS

Lugar: Philadelphia; Año: 2013 p. 1 - 30

0009-7322

Objective: Diabetes Mellitus (DM) is a common chronic illness and a preventable risk factor for cardiovascular morbidity and mortality worldwide. Almost two-thirds of these deaths occurred in low-middle-income countries. In Argentina, Chile and Uruguay, only the prevalence of self-reported diagnosed DM are available. We conducted a population-based cross-sectional study in a multistage-probabilistic sample of around 8,000 subjects aged 35-74 years old from 4 cities: Bariloche and Marcos Paz in Argentina and Temuco in Chile and Canelones in Uruguay, to estimate the prevalence and distribution of diagnosed and undiagnosed diabetes and pre-diabetes, as well as the level of glycemic control. Methods: Data on history of diagnosed DM and use of antidiabetic drugs were obtained using a standard questionnaire. An overnight-fasting blood sample was drawn to measure plasma glucose (FPG). DM was defined by self-reported history of DM or a FPG ≥126 mg/dl (7.0 mmol/l), while pre-diabetes was defined as FPG 100-125 mg/dl (5.6-6.9 mmol/l). Prevalence of DM was calculated by weighting sampling factors derived from population census data for each city. FPG ≤ 130 (≤7.2 mmol/l) was considered a proxy for good glycemic control and FPG ≥200 mg/dl (11 mmol/l) for very poor control. Results: In our study, 11.9 % (11.0% in men and 13.1% in women) had DM and 4.6% had prediabetes (6.1% in men and 2.9% in women). The age-specific prevalence of DM was 4.3%, 10.9%, 17.5%, and 24.2% for ages 35-44, 45-54, 55-64 and 65-74 yrs, respectively. In addition, DM prevalence decreased with the levels of education (15.1%, 10.8% and 9.1% for primary, secondary and tertiary/university education, respectively). Overall, 20.3% of subjects with DM were not aware of their condition (230% in men and 17.6% in women) with age-specific rates of 32.2%, 27.8%, 17.2%, and 11.7% for ages 35-44, 45-54, 55-64, and 65-74 yrs, respectively. The overall rate of good glycemic control in diabetics was 46.1%, and the rate of very poor control of DM was 16,4%, with variation across sites (25,5 % in Marcos Paz, 22,4% in Temuco, 16,4% in Bariloche, and 11,6% in Canelones) but no variation by sex, age, education level or health coverage. Conclusion: DM appears as an increasingly challenging public health issue as the Southern Cone of Latin America is completing the demographic, epidemiological and nutritional transition. We found a prevalence of DM higher than was observed in previous studies for the region with dismal rates of unknown DM, also varying by age, gender, and level of education. It is a matter of concern the striking variability shown in the rates of very poorly controlled DM across sites, not associated with socio-demographic factors, which might reflect distinct characteristics related to the sites that need to be explored in further analysis. These data provide a basis for targeting public health policies to reduce the prevalence of DM in the region.