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Abstract
BackgroundThe global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes now live in low and middle income countries. Yet, little information is available regarding prevalence of diabetes and intermediate hyperglycemia in these countries, especially when a full range of diagnostic tests is employed. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population.MethodsWe report baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 civil servants aged 35-74 years. Diabetes mellitus was ascertained by self-report of diagnosis, medication use, fasting glucose, an oral glucose tolerance test, and/or glycated hemoglobin. Cut-offs for diabetes and intermediate hyperglycemia followed the recommendations of the World Health Organization and the American Diabetes Association. Adjusted prevalences were estimated through logistic regression.FindingsWith this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed. Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%. Diabetes or intermediate hyperglycemia was present in 79.1% of participants when using the most comprehensive definitions. The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).InterpretationThat four of every five free-living individuals aged 35-74 years working in selected public institutions in six Brazilian state capitals presented either diabetes or intermediate hyperglycemia highlights the advanced stage of the obesity – diabetes epidemic in urban Brazil and indicates the need for urgent action.
Highlights
The United Nations has declared that the global burden of chronic non-communicable diseases (NCDs) constitutes one of the major challenges for development in the 21st century, for developing countries
To gain insight in terms of the current burden of diabetes and intermediate hyperglycemia with a full accounting of diagnostic laboratory exams, the objective of this study is to describe their prevalence, overall and according to sociodemographic and nutritional variables, in the baseline examination of a large cohort of Brazilian adults conducted in six capitals of Brazil, allowing for a broad representation of major relevant population groups
In 2006, a telephone survey based on wider age range (18 years or older), found a prevalence of 5.3% among adults residing in Brazilian capital cities [15]
Summary
The United Nations has declared that the global burden of chronic non-communicable diseases (NCDs) constitutes one of the major challenges for development in the 21st century, for developing countries. Diabetes mellitus (diabetes) along with cancer, cardiovascular and chronic respiratory diseases represent about 80% of the NCD mortality [1]. The International Diabetes Federation (IDF) estimated that 382 million people in 2013 had diabetes, 175 million (46%) being undiagnosed [3]. Based on the IDF estimates, 80% of the cases of diabetes globally live in low and middle income countries. Prevalence of diabetes in Brazil has been largely based on self-reported cases, given the difficulties in conducting large surveys with laboratory determinations. The global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes live in low and middle income countries. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population
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