Rising diabetes prevalence among urban-dwelling black South Africans.

Nasheeta Peer,Estelle V Lambert,Naomi S Levitt,Krisela Steyn,Carl Lombard,Bavanisha Vythilingum

doi:10.1371/journal.pone.0043336

Abstract

ObjectiveTo examine the prevalence of and the association of psychosocial risk factors with diabetes in 25–74-year-old black Africans in Cape Town in 2008/09 and to compare the prevalence with a 1990 study.Research Design and MethodsA randomly selected cross-sectional sample had oral glucose tolerance tests. The prevalence of diabetes (1998 WHO criteria), other cardiovascular risk factors and psychosocial measures, including sense of coherence (SOC), locus of control and adverse life events, were determined. The comparison of diabetes prevalence between this and a 1990 study used the 1985 WHO diabetes criteria.ResultsThere were 1099 participants, 392 men and 707 women (response rate 86%). The age-standardised (SEGI) prevalence of diabetes was 13.1% (95% confidence interval (CI) 11.0–15.1), impaired glucose tolerance (IGT) 11.2% (9.2–13.1) and impaired fasting glycaemia 1.2% (0.6–1.9). Diabetes prevalence peaked in 65–74-year-olds (38.6%). Among diabetic participants, 57.9% were known and 38.6% treated. Using 1985 WHO criteria, age-standardised diabetes prevalence was higher by 53% in 2008/09 (12.2% (10.2–14.2)) compared to 1990 (8.0% (5.8–10.3)) and IGT by 67% (2008/09: 11.7% (9.8–13.7); 1990: 7.0% (4.9–9.1)). In women, older age (OR: 1.05, 95%CI: 1.03–1.08, p<0.001), diabetes family history (OR: 3.13, 95%CI: 1.92–5.12, p<0.001), higher BMI (OR: 1.44, 95%CI: 1.20–1.82, p = 0.001), better quality housing (OR: 2.08, 95%CI: 1.01–3.04, p = 0.047) and a lower SOC score (≤40) was positively associated with diabetes (OR: 2.57, 95%CI: 1.37–4.80, p = 0.003). Diabetes was not associated with the other psychosocial measures in women or with any psychosocial measure in men. Only older age (OR: 1.05, 95%CI: 1.02–1.08, p = 0.002) and higher BMI (OR: 1.10, 95%CI: 1.04–1.18, p = 0.003) were significantly associated with diabetes in men.ConclusionsThe current high prevalence of diabetes in urban-dwelling South Africans, and the likelihood of further rises given the high rates of IGT and obesity, is concerning. Multi-facetted diabetes prevention strategies are essential to address this burden.

Highlights

Diabetes has globally emerged as a major public health challenge of the 21st century
Using 1985 WHO criteria, age-standardised diabetes prevalence was higher by 53% in 2008/09 (12.2% (10.2–14.2)) compared to 1990 (8.0% (5.8–10.3)) and impaired glucose tolerance (IGT) by 67% (2008/09: 11.7% (9.8– 13.7); 1990: 7.0% (4.9–9.1))
Older age (OR: 1.05, 95%CI: 1.03–1.08, p,0.001), diabetes family history (OR: 3.13, 95%CI: 1.92–5.12, p,0.001), higher BMI (OR: 1.44, 95%CI: 1.20–1.82, p = 0.001), better quality housing (OR: 2.08, 95%CI: 1.01– 3.04, p = 0.047) and a lower sense of coherence (SOC) score (#40) was positively associated with diabetes (OR: 2.57, 95%CI: 1.37–4.80, p = 0.003)

Summary

Introduction

Diabetes has globally emerged as a major public health challenge of the 21st century. Sub-Saharan Africa (SSA), where diabetes was considered rare prior to the 1990s, has witnessed a rise in the burden [1,2]. Studies conducted 10–20 years ago found that diabetes prevalence varied across the region. There are, limited data as to the extent of the rise. Diabetes was associated with 4.3% of South African adult mortality in 2000, placing it among the top ten leading causes of adult deaths in the country at that stage. 14% of ischaemic heart disease (IHD), 10% of stroke, 12% of hypertensive disease and 12% of renal disease mortality in those $30 years were attributable to diabetes [3]

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