Age-standardized Prevalence Of Diabetes Research Articles

Socioeconomic Differential of Cardiovascular Diseases Risk Factors in Bangladesh: Findings From a Nationally Representative Survey

Diabetes, hypertension, and overweight/obesity are three major risk factors for cardiovascular diseases (CVD). However, their distributions across socioeconomic status (SES) are debated despite its critical importance to design healthcare system. This study aimed to examine the associations between SES and diabetes, hypertension, and overweight/obesity in Bangladesh. Data was extracted from the 2017/18 Bangladesh Demographic and Health Survey. Diabetes, hypertension, and overweight/obesity were outcome of interest. Three variables —wealth quintiles, education, and paid employment— were considered as proxy of respondents’ SES, as such the major explanatory variables of interest. Age-standardised prevalence of diabetes, hypertension, and overweight/obesity by SES were estimated using direct standardisation. Associations between SES and CVD risk factors were examined using multilevel Poisson regression model with robust variance. The overall age-standardized prevalence of diabetes, hypertension, and overweight/obesity in the sample were 9.82% (95% CI, 9.11-10.58), 27.37% (95% CI, 26.37-28.40) and 40.11% (35% CI, 38.82-41.42), respectively. We found a significant gradient of diabetes, hypertension, and overweight/obesity in Bangladesh with a higher prevalence among the respondents of advantageous wealth quintiles, education, and paid employment. In the fully adjusted models improved wealth quintiles and higher education were found as important predictors of diabetes and overweight/obesity. Prevalence ratio of hypertension and overweight/obesity was found lower among respondents with no education/pre-school or primary education as compared to the respondents with primary education. Diabetes, hypertension, and overweight/obesity are not distributed proportionately by SES in Bangladesh, especially by wealth quintiles and levels of education. Policies and programs to increase awareness on importance of controlling weight and regular screening for diabetes and hypertension are important. Treatment facilities for diabetes and hypertension should also need to be spread up at the community level.

The levels and trends of metabolic risk factors in the elderly population at the national and sub-national scale in Iran from 1990 to 2016.

Describing the trends of metabolic risk factors (MRFs) in the elderly population. We used modeled data from previous comprehensive systematic reviews for MRFs among adults aged ≥ 60 years. Two stages of age-specific Spatio-temporal modeling and Gaussian process regression were used to estimate the mean of MRFs. We used crosswalk modeling to estimate the prevalence of elevated and raised Total cholesterol (TC), overweight/obesity and obesity, hypertension, and diabetes. Estimates were analyzed based on combinations of sex, age, year, and province from 1990 to 2016. Comparing prevalence estimates from 2016 with those of 1990, in the elderly population, the age-standardized prevalence of overweight/obesity, obesity, diabetes, and hypertension increased, conversely, the prevalence of hypercholesteremia decreased. The prevalence of hypertension increased about 141.5% and 129.9% in men and women respectively. The age-standardized prevalence of diabetes increased about 109.5% in females, and 116.0% in males. Prevalence of elevated TC at the national level decreased to 67.4% (64.1-70.4) in women and to 51.1% (47.5-54.8) in men. These findings were almost shown across provinces. In general, the northern and western provinces had the highest prevalence of overweight/obesity in women in 2016. The rising prevalence of most MRFs, as well as the greater prevalence and mean of all MRFs in women, necessitate effective public health policies to reduce the burden of non-communicable diseases and run preventive programs. The online version contains supplementary material available at 10.1007/s40200-023-01297-z.

1845-PUB: Key Lifestyle Behaviours among Diabetics, Prediabetics, and Nondiabetics in India

Purpose: To assess prevalence of key lifestyle behaviours including maintaining a body mass index (BMI) <25Kg/m2, engaging in physical activity for ≥150 min/week, consuming >5 servings of fruits & vegetables daily, & no tobacco use among diabetics, pre-diabetics, & nondiabetics. Methods: We conducted a large population-based survey among 12284 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using multistage cluster random sampling. Trained personnel collected data using a questionnaire, conducted anthropometry & collected bio-samples. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or being on treatment & prediabetes as FPG ≥ 100 mg/dl & <126 mg/dl or HbA1C ≥ 5.7% & <6.5%. Results: Age-standardized prevalence of diabetes was 17.4% (95% CI: 16.7-18.1) & prediabetes was 31.3% (30.7-31.9). Diabetics were more likely to be overweight/obese [BMI≥25Kg/m2: 60.7% (58.6-62.7)], & less physically active [physical activity (PA) <150 min/week: 30.6% (28.8-32.6), compared to pre-diabetics [BMI: 49.1% (47.5-50.7); PA: 22.3% (21.0-23.7)] & nondiabetics [BMI: 36.6% (35.4-37.8); PA: 22.2% (21.1-23.2)]. Mean (±SD) waist circumference (WC) was higher among diabetics [92.8 cm (±11.9)] compared to pre-diabetics [88.0 cm (±12.6)] & nondiabetics [83.7 cm (±12.5)] with more diabetics [65.4% (63.4-67.4)] having WC above World Health Organization’s recommended cut-off compared to pre-diabetics [54.2% (52.6-55.8) & nondiabetics [43.4% (42.4-44.6)]. Consumption of fruits & vegetables was low among all groups. Diabetics were less likely to be current tobacco users [21.7% (19.9-23.4)] compared to pre-diabetics [26.2% (24.8-27.7)] & nondiabetics [28.1% (27.0-29.2)]. Conclusions: Tailored clinic based, and population wide health promotion programs focussed on improving diet and physical activity are warranted to advance diabetes prevention and control in India. Disclosure S. Mohan: None. P. Jarhyan: None. D. Prabhakaran: None.

The Joint Secular Trends of Sleep Quality and Diabetes Among US Adults, 2005-2018.

Sleep quality has been related to the risk of diabetes; however, little is known about the prevalence of diabetes in the United States according to the levels of sleep quality. To examine the joint secular trends of the overall sleep quality and diabetes among US adults from 2005-2006 to 2017-2018. Seven cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 2005-2006 and 2017-2018 were included. Nonpregnant adults aged 20 years or older were eligible for the study. A healthy sleep score was calculated to represent overall sleep quality. The prevalence of diabetes was estimated and mean levels of fasting plasma glucose (FPG), glycated hemoglobin, and insulin resistance were calculated. Both the estimated age-standardized prevalence of diabetes and changing trend in prevalence of diabetes varied by the overall sleep quality groups. The highest prevalence of diabetes was consistently observed in the low sleep quality group in each cycle, in which a significantly increasing trend was also noted across cycles (P for trend = .004). In contrast, the lowest prevalence of diabetes was consistently observed in the high sleep quality group in each cycle, in which no increasing trend over time was observed (P for trend = .346). Overall sleep quality decreased significantly between 2005-2006 and 2017-2018 among US adults. The estimated prevalence of diabetes and related measures only increased in participants with low or medium overall sleep quality but remained stable in participants with high sleep quality.

Prevalence of, and risk factors for, diabetes and prediabetes in Bangladesh: Evidence from the national survey using a multilevel Poisson regression model with a robust variance.

To estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels. Data from 11952 Bangladeshi adults aged 18-95 years available from the most recent Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardized with direct standardization, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. The overall age-standardised prevalence of diabetes was 9.2% (95%CI 8.7-9.7) (men: 8.8%, women: 9.6%), and prediabetes was 13.3% (95%CI 12.7-13.9) (men: 13.0%, women: 13.6%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% took treatment regularly, and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile, and living in the Dhaka division. People currently employed and living in the Rangpur division were less likely to have diabetes than those currently not employed and living in the Barishal division. Diabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, focusing on obesity reduction and hypertension management, are urgently needed.

Abstract P166: The Joint Secular Trends Of Sleep Quality And Diabetes Among The US Adults

Introduction: Despite the extensive efforts in controlling diabetes-related modifiable risk factors, two recent studies showed that the estimated prevalence of diabetes in the U.S. has still increased in the past two decades. The sleep quality has been related to the risk of diabetes. Hypothesis: We examined the secular trends of the overall sleep quality, and the joint trends in the prevalence of diabetes by the overall sleep quality among US adults from 2005 to 2018. Methods: A total of 17,046 participants aged 20 years or older, from seven cycles of National Health and Nutrition Examination Survey (NHANES) data between 2005 to 2018, were eligible for the study. A healthy sleep score was calculated based on sleep 7-8 hours, no trouble sleeping, no snoring, no nocturia and no excessive daytime sleepiness to represent an overall sleep quality. The trends in estimated prevalence of diabetes were examined in different sleep quality groups. Results: From 2005 to 2018, the overall sleep quality significantly declined among US adults ( P for trend<0.001). Both the estimated age-standardized prevalence of diabetes and changing trend in prevalence of diabetes varied by the overall sleep quality groups. The highest prevalence of diabetes was consistently observed in the low sleep quality group in each cycle, in which a significantly increasing trend was also noted across cycles ( P for trend=0.004). In contrast, the lowest prevalence of diabetes was consistently observed in the high sleep quality group in each cycle, in which no increasing trend over time was observed ( P for trend=0.346). Such differential secular trends by sleep quality were more significant among Non-Hispanic Whites than other racial/ethnic minorities. Conclusions: The overall sleep quality decreased significantly between 2005-2018 in U.S. adults. The estimated prevalence of diabetes only increased in participants with low or medium overall sleep quality but remained stable in participants with high sleep quality.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Undiagnosed diabetes based on HbA1c by socioeconomic status and healthcare consumption in the Tromsø Study 1994–2016

IntroductionWe aimed to investigate whether the proportion of undiagnosed diabetes varies by socioeconomic status and healthcare consumption, in a Norwegian population screened with glycated hemoglobin (HbA1c).Research design and methodsIn this...

Nationwide Prevalence of Diabetes and Prediabetes and Associated Risk Factors Among Iranian Adults: Analysis of Data from PERSIAN Cohort Study.

IntroductionOver the past decades prevalence of diabetes has increased in Iran and other countries. This study aimed to update the prevalence of diabetes and prediabetes in Iran and to determine associated sociodemographic risk factors, as well as diabetes awareness and control.MethodsThis is a nationally representative cross-sectional survey that included 163,770 Iranian adults aged 35–70 years, from different ethnic backgrounds, between 2014 and 2020. Diabetes was diagnosed at fasting blood sugar of ≥ 6.99 mmol/L (126 mg/dL), or receiving blood glucose-lowering treatment. Multivariable logistic regression was applied to detect determinants associated with prevalence of diabetes and prediabetes, as well as predictors of diabetes awareness and glycemic control.ResultsSex- and age-standardized prevalence of diabetes and prediabetes was 15.0% (95% CI 12.6–17.3) and 25.4% (18.6–32.1), respectively. Among patients with diabetes, 79.6% (76.2–82.9) were aware of their diabetes. Glycemic control was achieved in 41.2% (37.5–44.8) of patients who received treatment. Older age, obesity, high waist to hip ratio (WHR), and specific ethnic background were associated with a significant risk of diabetes and prediabetes. Higher awareness of diabetes was observed in older patients, married individuals, those with high WHR, and individuals with high wealth score. Moreover, glycemic control was significantly better in women, obese individuals, those with high physical activity, educational attainment, and specific ethnic background.ConclusionsThe prevalence of diabetes and prediabetes is increasing at an alarming rate in Iranian adults. High proportion of uncontrolled patients require particular initiatives to be integrated in the health care system.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01152-5.

Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. Survey cycle. Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.

2279-PUB: High Prevalence and Suboptimal Management of Diabetes in India: Findings from a Community-Based Study

Purpose: Diabetes is rapidly increasing in India. This study aimed to determine the current prevalence of diabetes and its management in rural and urban India. Methods: We conducted a large population based cross-sectional survey among 12284 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using a multistage cluster random sampling technique. Trained personnel collected the data using a questionnaire, measured blood pressure, conducted anthropometry and collected bio-samples. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or being on treatment. Control was defined as HbA1C &amp;lt; 7%. Results: The mean (±SD) age of participants was 49.2 (±12.6) years, women comprised 53% of the sample. The age-standardized prevalence of diabetes was 17.4% (95% CI: 16.7-18.1). The prevalence was higher among men [19.3% (18.3-20.3)], elderly i.e., ≥ 60 years [26.8% (25.1-28.6)], urban residents [23.1% (22.1-24.2)] and in those with higher socioeconomic status [22.5% (21.0-24.1)]. Nearly, one-third participants had prediabetes [29.7% (28.9-30.5)] and there were no rural-urban, gender or socioeconomic differences. The awareness and treatment [49.1% (46.8-51.4), 43.3% (41.0-45.5)] rates respectively, were poor among diabetics, who were young (41.9%, 36.0%), rural residents (37.8%,31.5%) and those with lower socioeconomic status (30.1%,28.4%). Overall control rate was 45.5% (42.9-48.1) with no significant differences between the aforementioned groups. Conclusions: Despite the increasing burden of both diabetes and prediabetes in India, the awareness, treatment and control rates remain suboptimal. Active screening and tailored public education to increase awareness, are essential for promoting early detection and improving management, especially among poor rural populations. Disclosure S. Mohan: None. P. Jarhyan: None. G. Sharnngadharan: None. D. Prabhakaran: None.

Diabetes in Normal-Weight Individuals: High Susceptibility in Nonwhite Populations.

Type 2 diabetes is one of the most prevalent diseases of our time. There are an estimated 425 million people with diabetes worldwide, and 625 million people are projected to have the disease by 2045 (1). Over the next three decades, the largest increases in diabetes prevalence and overall numbers of people with the disease are expected to occur in low- and middle-income countries and among nonwhite ethnic minorities living in high-income nations (1). Overweight and obesity are well-established risk factors for diabetes; however, evidence suggests that the relationship between body weight and diabetes risk may differ by race/ethnicity (2–4), which has implications for the prevention, screening, and treatment of individuals who develop diabetes with a BMI below the overweight or obesity range. In their article in this issue of Diabetes Care , Zhu et al. (5) examined racial/ethnic disparities in the prevalence of diabetes by BMI category in a large, racially/ethnically and geographically diverse cohort of 4.9 million adults. Individuals enrolled in the cohort were members of three integrated health care systems in the U.S. in the years 2012–2013 and were from six racial/ethnic groups including white, black, Hispanic, Asian, Hawaiian/Pacific Islander, and American Indian/Alaskan Native. They found that the age-standardized prevalence of diabetes increased across BMI categories among all racial/ethnic groups. However, compared with whites, all other racial/ethnic groups had a higher prevalence of diabetes at any given BMI, and these differences were more pronounced in lower BMI categories. Strikingly, in those with a normal weight, the prevalence of diabetes was 5.0% in whites, 10.1% in Asians and American Indians/Alaskan Natives, 13.0% in …

Trends in diabetes prevalence, awareness, treatment, control in Yangon, Myanmar between 2004-2014

Abstract Background In 2004, a survey in Yangon Region was conducted as the first STEP survey in Myanmar, which was repeated in 2014, assessing diabetes prevalence. Whether there have been any changes over time in the awareness, treatment and control status of diabetes is not known. The study aimed to assess changes in the prevalence, awareness, treatment and control of diabetes from 2004 to 2014, among adults in Yangon region. Methods The study was conducted in urban and rural areas of Yangon region, Myanmar, using two cross-sectional household based studies, in accordance with World Health Organization STEPS methodology. Men and women aged 25-74 years old participated in the studies (n = 4448 in 2004) and (n = 1372 in 2014). Logistic and linear regression were performed and outcome variables were diabetes and fasting plasma glucose. Results The overall age-standardized prevalence of diabetes were 8.3% (95% CI 6.5-10.6) in 2004 and 10.2% (7.6-13.6) in 2014 (p = 0.296). The diabetes prevalence increased from 2004 to 2014 only among participants aged ≥60 years, from 14.6% (11.7-18.1) to 31.9% (21.1-45.0) (p = 0.009). Awareness of having diabetes increased between 2004 and 2014 (44.3% (39.2, 49.6) to 69.4% (62.9-75.2)) (p &amp;lt; 0.001). Among participants who were aware of having diabetes, the proportion under treatment had increased between 2004 and 2014 from 55.1% (46.8-63.1) to 68.6% (61.5-74.8) (p = 0.015). There were no increase between 2004 and 2014 in the proportion of participants with controlled diabetes. After adjustments for age, sex and education, mean fasting plasma glucose levels in 2014 was 0.56 mmol/l (0.26-0.84) higher than in 2004. Conclusions The studies to monitor the development of diabetes prevalence in Myanmar are needed. Preventive measures to halt increases prevalence, to increase the detection rate of undiagnosed DM also treatment rate and to help people with diabetes to control their situation are needed. Key messages Mean plasma glucose levels were higher in 2014 than in 2004, but an increase in DM prevalence during this period was seen only among the oldest participants. The proportion of women being aware of having DM, as well as the proportion under treatment for most groups, had increased, however not the proportion under control.

1511-P: Trend in the Prevalence of Diabetes between 2002-2009 in Populations in Qingdao, China

The current study aims to determine the secular trend of prevalence of type 2 diabetes and prediabetes and risk factors for diabetes from 2002 to 2009. We conducted 3 population-based surveys for diabetes in individuals aged 35-74 years in Qingdao in 2002, 2006 and 2009, respectively, with random-sampling approach. The sample size was 1792, 4549 and 4310 in 2002, 2006 and 2009, respectively. We performed a questionnaire-based survey to collect general information. All participants underwent standardized 2-h 75-g oral glucose tolerance tests (OGTTs). The 1999 WHO diagnostic criteria for diabetes and prediabetes was applied. Age-standardized prevalence of diabetes was calculated. Multiple non-conditional logistic regression were applied to analyze the risk factors for diabetes, taking diabetes as the dependent variable. In 2002, the age-standardized prevalence of diabetes was 12.32%, the corresponding prevalence was 16.57% and 18.01%, respectively, in 2006 and 2009. The prevalence of diabetes increased from 2002 to 2009 (p&amp;lt;0.05). The age-standardized prevalence of prediabetes in 2002, 2006 and 2009 was 16.18%, 24.56% and 28.25%, respectively (P for trend &amp;lt; 0.05). Multiple non-conditional logistic regression analysis showed that the risk factor for diabetes were age, waist, systolic blood pressure (SBP), total cholesterol, triglyceride, and family history of diabetes in both 2002 and 2006. The risk factor for diabetes included age, waist, SBP, total cholesterol, triglyceride, and family history of diabetes in 2009. High density lipoprotein cholesterol was negatively associated with increased risk for diabetes. The prevalence of diabetes and prediabetes in Qingdao increases from 2002 to 2009, implying an epidemic of diabetes in this area. The common risk factors contributing to the increasing trend are age, waist, SBP, total cholesterol, triglyceride, and family history of diabetes. Disclosure L. Zhang: None. W. Gao: None. N. Wang: None. J. Wang: None. X. Yin: None. Y. Zhu: None. Y. Dong: None.

1608-P: Suboptimal Management of Diabetes in India: Findings from a Large Community-Based Study

Over the past few decades diabetes prevalence has rapidly increased across India. However, limited information is available on the levels of awareness, treatment and control, particularly in epidemiologically transitioning communities. We estimated the prevalence, awareness, treatment and control rates of diabetes in a large representative population sample aged ≥ 30 years, selected using a multistage cluster random sampling technique, residing in rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and phlebotomists collected venous blood samples to estimate fasting plasma glucose (FPG) and HbA1C. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-report of physician diagnosis or being on treatment. Participants were considered to be aware of diabetes if they reported a diagnosis or being on treatment. Control was defined as HbA1C &amp;lt; 7%. In total 12243 participants (6208 in North and 6035 in South) were surveyed. The mean (±SD) age was 47.7 (±12.5) years. Women constituted 54%. The age-standardized prevalence of diabetes was 14.2 (95% CI: 13.6 - 14.9), with significant difference between urban (21.4%; 20.4-22.5) and rural (7.5%; 6.8-8.2) areas. Among those with diabetes, the awareness, treatment and control rates were 49.4% (46.6-52.2), 38.6% (35.9-41.3) and 12.6% (10.9-14.5) respectively. Compared to urban residents, rural counterparts were less likely to be aware (35% Vs. 55%), treated (26% Vs. 43%) and controlled (8% Vs. 14%). Similarly, patients in the lowest tertile of wealth index had lower awareness (33% Vs. 55%), treatment (22% Vs. 43%) and control rates (5% Vs. 15%) compared to those in the highest tertile. Despite a high burden, management of diabetes is sub-optimal in India. Health system strengthening to better manage diabetes with a focus on rural residents and the poor is imperative to stem the rising burden and improve diabetes related health outcomes. Disclosure S. Mohan: None. N.S. Venkateshmurthy: None. P. Jarhyan: None. G. Sharnngadharan: None.

The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990-2016.

SummaryBackgroundThe burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016.MethodsWe analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsThe number of people with diabetes in India increased from 26·0 million (95% UI 23·4–28·6) in 1990 to 65·0 million (58·7–71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9–6·1) in 1990 to 7·7% (6·9–8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1–46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6–49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7–9·3) in 1990 to 20·4% (19·9–20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34–42) with diabetes, compared with the global average of 19 adults (17–21) in 2016.InterpretationThe increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation.FundingBill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes among Four Million Overweight and Obese Adults in the U.S.

Racial/ethnic disparities in diabetes remain a persistent public health concern. We aimed to examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by body mass index (BMI) category, in a large racial/ethnically and regionally diverse cohort of overweight and obese insured adults in the U.S. Data were from the Patient Outcomes Research to Advance Learning (PORTAL) network-Overweight and Obese Cohort, a consortium of 3 integrated health care systems. A total of 4,490,649 members (50% white, 22.7% Hispanic, 11.3% black, 10.6% Asian, 1.4% Native Hawaiian/Other Pacific Islander, 0.6% American Indian/Alaskan Native, and 4.3% other/unknown) aged ≥18 years during 2012 or 2013, with a BMI ≥23.0 kg/m2 were included. Ascertainment of diabetes and prediabetes were based on diagnosis codes, medication use, and laboratory results according to the ADA criteria. Age-adjusted prevalence was derived by BMI and racial/ethnic groups. Overall, the age-standardized prevalence of diabetes and prediabetes was 17.5% and 34.5%, respectively. A linear increasing trend was observed in prevalence of diabetes and prediabetes across BMI categories within racial/ethnic groups (all P-for-trend &amp;lt;0.001), except for prediabetes among Asian and Native Hawaiian/Other Pacific Islander, who tended to have a higher prevalence of diabetes and prediabetes compared to white across BMI categories, even more pronounced at a lower BMI. At BMI 23.0-24.9 kg/m2, the age-standardized prevalence of diabetes among Asians was 16.9%, comparable to that among white at BMI 30.0-34.9 kg/m2; the age-standardized prevalence of prediabetes was 37.3% among Asians at BMI 23.0-24.9 kg/m2, even higher than that among white at BMI ≥50.0 kg/m2. In conclusion, disproportional impact of BMI on diabetes and prediabetes among minority groups highlight the importance of tailored screening, prevention, and intervention strategies to mitigate the risk of diabetes and prediabetes. Disclosure Y. Zhu: None. D. Arterburn: None. M.F. Daley: None. J.R. Desai: None. S.L. Fitzpatrick: None. M.A. Horberg: None. C. Koebnick: None. E.V. Mccormick: None. C. Oshiro: None. D.R. Young: None. A. Ferrara: None.

Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012.

South Africa faces an epidemic of chronic non-communicable diseases (NCDs), yet national surveillance is limited due to the lack of recent data. We used data from the first comprehensive national survey on NCDs—the South African National Health and Nutrition Examination Survey (SANHANES-1 (2011–2012))—to evaluate the prevalence of and health system response to diabetes through a diabetes care cascade. We defined diabetes as a Hemoglobin A1c equal to or above 6.5% or currently on treatment for diabetes. We constructed a diabetes care cascade by categorizing the population with diabetes into those who were unscreened, screened but undiagnosed, diagnosed but untreated, treated but uncontrolled, and treated and controlled. We then used multivariable logistic regression models to explore factors associated with diagnosed and undiagnosed diabetes. The age-standardized prevalence of diabetes in South Africans aged 15+ was 10.1%. Prevalence rates were higher among the non-white population and among women. Among individuals with diabetes, a total of 45.4% were unscreened, 14.7% were screened but undiagnosed, 2.3% were diagnosed but untreated, 18.1% were treated but uncontrolled, and 19.4% were treated and controlled, suggesting that 80.6% of the diabetic population had unmet need for care. The diabetes care cascade revealed significant losses from lack of screening, between screening and diagnosis, and between treatment and control. These results point to significant unmet need for diabetes care in South Africa. Additionally, this analysis provides a benchmark for evaluating efforts to manage the rising burden of diabetes in South Africa.

Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies.

BackgroundThe 2016 Dar Es Salaam Call to Action on Diabetes and Other non-communicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends from 1980 to 2014 in age-standardized mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the co-progression and assist policy formulation.MethodsWe pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged ≥ 18 years. A Bayesian hierarchical model was used to estimate trends by sex for 200 countries and territories including 53 countries across five African regions (central, eastern, northern, southern and western), in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of ≥ 7.0 mmol/l, history of diabetes diagnosis, or use of insulin or oral glucose control agents).ResultsAfrican data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n = 17), Nigeria (n = 15) and Egypt (n = 13); and for diabetes estimates, Tanzania (n = 8), Tunisia (n = 7), and Cameroon, Egypt and South Africa (all n = 6). The age-standardized mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3–21.7) to 23.0 kg/m2 (22.7–23.3) in men, and from 21.9 kg/m2 (21.3–22.5) to 24.9 kg/m2 (24.6–25.1) in women. The age-standardized prevalence of diabetes increased from 3.4% (1.5–6.3) to 8.5% (6.5–10.8) in men, and from 4.1% (2.0–7.5) to 8.9% (6.9–11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃ 0.9) was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014.ConclusionsThese estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa. This rise is being driven, at least in part, by increasing adiposity, with regional variations in observed trends. African countries’ efforts to prevent and control diabetes and obesity should integrate the setting up of reliable monitoring systems, consistent with the World Health Organization’s Global Monitoring System Framework.

Diabetes: Leveraging the Tipping Point of the Diabetes Pandemic.

Diabetes is one of the fastest growing public health problems in the world, with significant variations in its prevalence and in the major risk factors for type 2 diabetes among ethnic groups. In this issue of Diabetes , the Perspective by Unnikrishnan et al. (1) focuses on the global prevalence of diabetes, ethnic differences in susceptibility to diabetes, and major determining factors for type 2 diabetes. A major concern today is the increasing number of people with type 2 diabetes in middle-income and low-income countries, such as China and India. Vulnerability to diabetes among immigrants from Korea, the Pacific Islands, South Asia, and the Philippines to the U.S. or Europe compared with the Caucasian population is highlighted. Although obesity and its correlate insulin resistance, as well as genetic factors, have been considered the established determining factors for type 2 diabetes risk, recent evidence shows that early loss of β-cell function plays a much more important role in the pathogenesis of type 2 diabetes, especially in nonobese individuals of southern and eastern Asian origin. The results from the China National Diabetes Survey have indicated that the prevalence of diabetes in Chinese adults aged ≥20 years increased from 1% in 1980 (2) to 9.7% in 2007–2008 (3) and 11.6% in 2010 (4). One recent pooling of data from 751 studies including 4,372,000 adults from 146 of 200 countries estimated that the number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014, while the global age-standardized diabetes prevalence increased from 4.3% in 1980 to 9.0% in 2014 in men and from 5.0% to …