Changes in the prevalence of diabetes, prediabetes and associated risk factors in rural Baluchistan; a secondary analysis from repeated surveys (2002-2017).

Abstract

To observe trends of diabetes and its associated risk factors from health surveys 2002-2017 in rural areas of Baluchistan-Pakistan and a secondary analysis based on community based health surveys of Baluchistan conducted between 2001-02, 2009-10, and 2016-17. A total of 4250 participants were included in this combined analysis, 2515 from 2001-2002, 1377 from 2009-2010 and 358 from 2016-2017 survey year. In each survey, detailed information of baseline parameters were noted on a predesigned questionnaire. Fasting plasma glucose (FPG) was used for diagnosis of diabetes for comparative purposes in this analysis. Cardiovascular (CVD) risk factors including hypertension, obesity, dyslipidaemia, tobacco use, alcohol consumption, and physical activity were compared. Most subjects were aged 30-50 years and males were found higher in 2016-17 compared to 2001-02 and 2009-10. Pronounced increases in BMI, waist circumference, blood pressure, and family history of diabetes were observed in 2016-17. Diabetes prevalence was 4.2 (3.4-4.9), 7.8 (6.6-9.2) and 31.9 (26.9-37.4), whilst pre-diabetes was 1.7 (1.3-2.2), 3.6 (2.8-4.6) and 10.7 (7.6-14.9) in years 2001-02, 2009-10, and 2016-17, respectively. Among those aged 20-39years, prevalence of diabetes was stable from 2001-10 yet increased considerably between the ages of 30-39years in 2016-17. Throughout the observed period, rapid increases were observed in hypertension, obesity, and dyslipidaemia, however, addiction to tobacco use and alcohol intake decreased. Adjusted odd ratios showed age, marital status, education, hypertension, and family history of diabetes as associated risk factors for glycaemic dysregulation. The rural Baluchistan population is confronted with increasing trends of early onset diabetes due to highly associated CVD risk factors, especially central obesity and dyslipidaemia, raising a major public health challenge.