1. A Multiethnic Study of Pre-Diabetes and Diabetes in LMIC

JIA SHEN; ADOLFO RUBINSTEIN

GLOBAL HEART

Elsevier

Año: 2016

Background: Diabetes mellitus is one of the leading causes of death and disability worldwide. Approximatelythree-quarters of people with diabetes live in low- and middle-income countries, and these countries areprojected to experience the greatest increase in diabetes burden.Objectives: We sought to compare the prevalence, awareness, treatment, and control of diabetes in 3 urban andperiurban regions: the Southern Cone of Latin America and Peru, South Asia, and South Africa. In addition, weexamined the relationship between diabetes and pre-diabeteswith known cardiovascular andmetabolic 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 ¼ 7,524; Peru ¼ 3,601; South Asia ¼ 11,907; South Africa ¼ 1,099).Detailed demographic, anthropometric, and biochemical data were collected. Diabetes and pre-diabeteswere defined as a fasting plasma glucose 126 mg/dl and 100 to 125 mg/dl, respectively. Diabetes controlwas 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%) and17.1% (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% to24.7%) 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 to44 years. In South Asia, the sharpest rise in pre-diabetes prevalence occurred younger at 25 to 34 years. Theprevalence of diabetes rose sharply at 45 to 54 years in the Southern Cone of Latin America, Peru, and SouthAfrica, 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-weightSouth Asians had a higher prevalence of diabetes and pre-diabetes than overweight and obese individuals fromother regions. Across all regions, only 79.8% of persons with diabetes were aware of their diagnosis, of these only78.2% 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 periurbanpopulations in Latin America, South Asia, and South Africa. Even more alarming is the propensity for SouthAsians to develop diabetes and pre-diabetes at a younger age and lower body mass index compared withindividuals from other low and middle income countries. It is concerning that one-fifth of all people withdiabetes were unaware of their diagnosis and that only two-thirds of those under treatment were able to attainglycemic control. Health systems and policy makers must make concerted efforts to improve diabetes prevention,detection, and control to prevent long-term consequences.