The Prevalence, Correlates, Detection and Control of Diabetes among Older People in Low and Middle Income Countries. A 10/66 Dementia Research Group Population-Based Survey.

Aquiles Salas,Juan J Llibre Rodriguez,Yueqin Huang,A M Lopez Medina,Ana L Sosa,Mariella Guerra,Richard Uwakwe,Martin J Prince,K S Jacob,Rosa Maria Salinas-Contreras,Joseph D Williams,A T Jotheeswaran,Daisy Acosta,Zhaorui Liu,Ivonne Z Jimenez-Velazquez,Cleusa P Ferri

doi:10.1371/journal.pone.0149616

Abstract

BackgroundLittle is known of the epidemiology of diabetes among older people in low and middle income countries. We aimed to study and compare prevalence, social patterning, correlates, detection, treatment and control of diabetes among older people in Latin America, India, China and Nigeria.MethodsCross-sectional surveys in 13 catchment area sites in nine countries. Diagnosed diabetes was assessed in all sites through self-reported diagnosis. Undiagnosed diabetes was assessed in seven Latin American sites through fasting blood samples (glucose > = 7mmol/L).ResultsTotal diabetes prevalence in catchment sites in Cuba (prevalence 24.2%, SMR 116), Puerto Rico (43.4%, 197), and urban (27.0%, 125), and rural Mexico (23.7%, 111) already exceeds that in the USA, while that in Venezuela (20.9%, 100) is similar. Diagnosed diabetes prevalence varied very widely, between low prevalences in sites in rural China (0.9%), rural India (6.6%) and Nigeria (6.0%). and 32.1% in Puerto Rico, explained mainly by access to health services. Treatment coverage varied substantially between sites. Diabetes control (40 to 61% of those diagnosed) was modest in the Latin American sites where this was studied. Diabetes was independently associated with less education, but more assets. Hypertension, central obesity and hypertriglyceridaemia, but not hypercholesterolaemia were consistently associated with total diabetes.ConclusionsDiabetes prevalence is already high in most sites. Identifying undiagnosed cases is essential to quantify population burden, particularly in least developed settings where diagnosis is uncommon. Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data. Given the high prevalence among older people, more population research is indicated to quantify the impact of diabetes, and to monitor the effect of prevention and health system strengthening on prevalence, treatment and control.

Highlights

In the USA National Health and Nutrition Examination Survey (US NHANES) 1999–2002 [1], the prevalence of total diabetes increases sharply with age, from 2.4% in those aged 20–39 years to 21.6% among those aged 65 years and over
Diabetes prevalence is already high in most sites
Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data

Summary

Introduction

In the USA National Health and Nutrition Examination Survey (US NHANES) 1999–2002 [1], the prevalence of total (diagnosed and undiagnosed) diabetes increases sharply with age, from 2.4% in those aged 20–39 years to 21.6% among those aged 65 years and over. The proportion of total diabetes that was diagnosed, 70%, did not vary significantly with age. Representative surveys in China [2] and Mexico (Encuesta Nacional de Salud 2000—ENSA[3,4]) provide age-stratified estimates for older adults. In China total diabetes prevalence rose from 3.2% (20–39 years) to 20.4% for those aged 60 or over [2]. In Mexico, total diabetes prevalence was 1% at 20–29 years rising to 23% at ages 60–79 [3]. In the Salud Bienestar y Envejecimiento (SABE) study prevalence of diagnosed diabetes was assessed by self-report, in representative samples of people aged 60 and over in seven Latin American and Caribbean cities [5]. Prevalence varied between 12.2% and 21.6%, higher in Bridgetown, Mexico City and São Paulo than in Havana, Buenos Aires, Santiago, and Montevideo

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