Diabetes Risk Assessment Research Articles

IDF21-0271 Assessment of Diabetes Risk among Selected Residents of a Barangay in Mandaluyong City

Background: The World Health Organization defined Diabetes as a chronic, metabolic disease characterized by elevated levels of blood glucose, which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. In the past three decades the prevalence of Type 2 Diabetes has risen dramatically in countries of all income levels.

A Comparative Study of Two Rule-Based Explanation Methods for Diabetic Retinopathy Risk Assessment

Understanding the reasons behind the decisions of complex intelligent systems is crucial in many domains, especially in healthcare. Local explanation models analyse a decision on a single instance, by using the responses of the system to the points in its neighbourhood to build a surrogate model. This work makes a comparative analysis of the local explanations provided by two rule-based explanation methods on RETIPROGRAM, a system based on a fuzzy random forest that analyses the health record of a diabetic person to assess his/her degree of risk of developing diabetic retinopathy. The analysed explanation methods are C-LORE-F (a variant of LORE that builds a decision tree) and DRSA (a method based on rough sets that builds a set of rules). The explored methods gave good results in several metrics, although there is room for improvement in the generation of counterfactual examples.

Letter to Editor: Positive predictive value of diabetes mellitus risk assessment

Diabetes mellitus (DM) is an important public health challenge [1 ].Different studies predicted that the frequency of diabetic patients will be increased to 642 million throughout the world by 2040 [2]. A notable percentage of diabetic patients are not aware of their disease (approximately 30% in Iran) [3]. Lag in the diagnosis of DM raises the expense of controlling disease and makes the prognosis poorer [4]. It is indicated the importance of diabetic risk assessment as a screening test for high risk populations. However, most of the screening methods to detect high risk people are invasive [5]. So, detecting population at high risk of developing DM by an easy way that can be applied by health care providers in the health centers may lead to preventive measures of public health magnitude [4]. Griffin et al developed a questionnaire according to the risk factors commonly collected in clinical practice and evaluated the characteristics of the questionnaire. They reported the positive predictive value of 11% for diabetes screening questionnaire in England and Wales [6].In Iran, primary health care providers in rural regions were named “Behvarz”. They were performed diabetes mellitus risk assessment as a screening program in health houses. They worked in “Health House,” which is the small health center in the rural areas of Iran. In the present study, we evaluated DM risk assessment positive predictive value (PPV) on the 30 years and older rural population. The PPV is the probability of the diabetes in a person with a positive risk assessment result ( ) [7]. A cross-sectional study was done in three villages of Bostanabad, one of East Azerbaijan ‘s cities in Iran. Three villages out of more than fifteen hundred villages in the Bostanabad were selected as considered concerns about arranging the population in the villages. In these three villages, Behvarzes performed screening activities for diabetes between March2019 to January2020. Screening for diabetes was regarded for all individuals older than 30 years of age living in chosen villages. Participants were interviewed and asked the presence of risk factors of DM. Risk factors contained family history of DM, overweight or obesity (BMI>25), already detected pre-diabetes. Among persons took part in screening test, those even with one risk factor were regarded positive and they as soon as were visited by a primary care physician for detection of individuals with unknown DM. The total population of the three villages, namely Saeid abad, Tikmedash and Kordkandy was 5137. More than half of them (57.62%) were more than 30years old in these villages. Out of 1305 people, who had at least one risk factor, 57 persons were diabetics. Accordingly, 57 was true positive .The value of1305 was the sum of true positive and false positive. Calculated positive predictive value was 4.36%. So, the positive predictive value of the risk factor assessment was low. In Conclusion, the ability of the risk factor assessment to predict individuals with DM was quite poor (96% of people with risk factors were not diabetic) and the risk assessment did not work well to identify at risk individuals

What is the effectiveness of a personalised video story after an online diabetes risk assessment? A Randomised Controlled Trial.

BackgroundOnline risk assessment tools for type 2 diabetes communicate risk information to motivate individuals to take actions and reduce their risk if needed. The impact of these tools on follow-up behaviours (e.g., General Practitioner (GP) visits, improvement in health behaviours) is unknown. This study examined effectiveness of a personalised video story and text-based message on GP and health professional visitations and health behaviours, of individuals assessed as ‘high risk’ following completion of the online Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK).MethodsA Randomised Controlled Trial (conducted between October 2018 and April 2019) included 477 participants with a high score (≥12). The control group received a text-based message (TM) and the intervention group received both the text-based message and a personalised video story (TM+VS) encouraging them to take follow-up action. Participants reported follow-up actions (one- and three months), and physical activity (PA), dietary behaviours and body weight (baseline, one and three months). Generalized Linear Mixed Models and chi-squared tests were used to test differences in outcomes between groups over time.ResultsThe intervention was not more effective for the TM+VS group compared to the TM only group (p-values>0.05 for all outcomes). More participants in the TM only group (49.8% compared to 40.0% in the VS+TM group) visited either a GP or health professional (p = 0.18). During the 3-month follow-up: 44.9% of all participants visited a GP (36.7%) and/or other health professional (31.0%). Significant improvements were found between baseline and three months, in both groups for weekly physical activity, daily fruit and vegetable intake and weight status.ConclusionsMessages provided with online diabetes risk assessment tools to those with high-risk, positively influence GP and health professional visitations and promote short-term improvements in health behaviours that may contribute to an overall reduction in the development of type 2 diabetes.Trial registrationAustralia New Zealand Clinical Trials Registry; ACTRN12619000809134.

Regression of Diabetic Macular Edema by Remission of Type 2 Diabetes with Plant-Based Diet: A Case Report and Review

In most patients, retinopathy develops 10 to 15 years after diabetes has been diagnosed. With increased prevalence of diabetes, more people are at risk for retinopathy, and greater resources are required to identify and treat these conditions. Given the disease burden, efficient and accurate diagnosis of diabetic retinopathy, risk assessment, treatment, and strategies for prevention are crucial.

Impact of Income and Industry on New-Onset Diabetes among Employees: A Retrospective Cohort Study.

The purpose of this study was to investigate the impact of income and industry type on the risk of developing diabetes among Japanese workers, including how this impact is affected by sex. A total of 24,516 employees at small- and medium-sized enterprises in Japan aged 40–74 years who underwent health examinations in fiscal years 2010–2015 were included in this retrospective cohort study. Generalized linear regression models were used to assess the association between new-onset diabetes and income and industry. In men, the cumulative incidence rate was significantly higher in the low-income group; it was highest in the transportation and postal service industries. Although income and industry were independent risk factors for developing diabetes in men, an interaction was found between income and industry, which was affected by participants’ sex: in specific industries (i.e., lifestyle-related, personal services, and entertainment services), men had a significantly higher risk of developing diabetes in the high-income group, and women had a significantly higher risk of developing diabetes in the low-income group. These findings highlight important factors to consider in assessing diabetes risk and suggest that efficient primary and secondary prevention should be encouraged in industries where workers have a high risk of diabetes.

Diabetic foot ulcer risk assessment and prevention in patients with diabetes: a best practice implementation project.

Diabetic foot ulcer (DFU) is one of the most serious complications in patients with diabetes. Early identification of risk factors can prevent its occurrence and delay its progression. The aim of this project is to conduct an audit of DFU risk assessment protocols at a large tertiary hospital and evaluate the impact of any changes in compliance with the developed evidence-based best practice criteria. Preimplementation and postimplementation audits based on JBI's Practical Application of Clinical Evidence System were conducted at the Department of Endocrinology and Metabolism of a tertiary hospital in China. The Getting Research into Practice audit tool was used to analyze the barriers and inadequacies encountered in practice. A total of 12 nurses and 30 patients with diabetes were included in the baseline and follow-up audits. There were 15 baseline audits that indicated deficits in DFU risk assessment by nurses, with 0% compliance for three criteria and 50% compliance or less for seven others. Strategies developed by the project team to address the identified barriers to compliance were adopted, leading to significant improvement in compliance with most criteria at the follow-up audit compared with baseline with 11 criteria achieving at least 90% compliance. The project showed that regular audits of foot ulcer risk assessment can help to identify barriers to their implementation. Advising patients of their risk status can support appropriate self-care practices. Further audits are needed to implement evidence-based practices in all aspects of diabetes patient care.

Identifying employees at high risk of diabetes among the medical staff of Jaber Al-Ahmed Armed Forces Hospital in Kuwait and screening them for diabetes

Background: Diabetes mellitus is one of the top diseases leading to morbidity and mortality in Kuwait. There is often a delay in diagnosing patients with type 2 diabetes due to the long asymptomatic pre-clinical stage and complications are commonly present at diagnosis. Screening can identify diabetics and treatment can be initiated earlier to prevent complications. Screening can detect pre-diabetics who may benefit from interventions to prevent or delay progression to diabetes. Objectives: The aim of this study is to estimate the prevalence of risk factors for diabetes in healthy employees and screen those with high risk for diabetes. Method: A cross-sectional study conducted in Jaber Al-Ahmed Hospital from October to November 2012. The Finnish questionnaire for diabetes risk assessment was used to categorize participants into different risk categories for diabetes. Participants considered to be at high risk were screened for diabetes using HbA1c. Results: 647 employees participated in the study. 70.6% of the participants were overweight or obese; more than half had a high waist circumference and 23% were smokers. Kuwaiti employees tended to have more risk compared to non- Kuwaitis (P<0.001) with 27.6% of Kuwaitis belonging to the low risk group compared to 42.4% of the non-Kuwaitis. HbA1c testing showed that out of the 51 participants with high/very high risk, 6 (11.8%) were diabetics and 26 (51.0%) were pre-diabetics. Conclusion: Screening and a diabetic risk assessment for those at high risk should be part of the routine occupational health check program in the hospital.

Diabetes risk assessment in Ahmedabad population using Indian diabetic risk score#

Diabetes risk assessment in Ahmedabad population using Indian diabetic risk score#

The Relationship of Diabetes Mellitus Risk with Well-Being, and Physical Activity among Young Adults

Background: The growing prevalence of diabetes mellitus poses a worldwide health risk for young adults. Objective: To investigate the risk of diabetes mellitus, well-being, and physical activity in university students. Materials and Methods: This cross-sectional study was conducted with 925 university students. Personal Information Form, Finnish Diabetes Risk Score - Type 2 Diabetes Risk Assessment Form, The Well Star Scale, and The international Physical Activity Questionnaire Short Form have been used in the study. Results: All the students were classified in a low-risk group for diabetes. Examining lifestyle behaviours among the students, 52.8% did not have regular and balanced dietary habits and 66% did not exercise regularly. In the study, increased levels of physical activity promoted overall scores for well-being. Increased physical activity decreased the risk of diabetes. Significant differences were found in terms of wellbeing, physical activity, and Finnish Diabetes Risk Score scores among students who had regular and balanced eating habits in comparison to those who did not (p<0.05). Conclusion: The students’ levels of well-being have increased, and the risk of diabetes has reduced as their physical activity levels increase. On the contrary, those who did not exercise regularly and did not have a regular dietary habit have an increased risk of diabetes mellitus. There is a need for more studies investigating diabetes risk levels and related variables in young adults

A Cross-sectional Study of Prevalence of Diabetes among Patients with Hepatitis C

Objective: To estimate the prevalence of type 2 diabetes in patients with chronic hepatitis C. Study design: Descriptive cross-sectional Study setting: Department of Medicine, Aziz Fatimah Medical and Dental College, Faisalabad and Mohtrama Benazir Bhutto Shaheed Medical College / Divisional Headquarters Teaching Hospital, Mirpur Azad Kashmir. Study duration: Six months from April 2021 to September 2021. Methods: Study participants were recruited from the outpatient department at Aziz Fatimah Medical and Dental College, Faisalabad and Mohtrama Benazir Bhutto Shaheed Medical College / Divisional Headquarters Teaching Hospital, Mirpur Azad Kashmir for duration of six months from April 2021 to September 2021. All demographic, medical and laboratory information were collected. Descriptive statistics, chi-square tests of independence were used to analyse the data. Results: Out of 300 hepatitis C patients (53% males, 47% females), overall, 26% (77 out of 300) were found to have diabetes. When characteristics of patients with and without diabetes disease were compared using χ2 tests, we could not find any statistically significant relation of gender, BMI, hepatitis C disease duration, family history of diabetes and Child-Pugh classification of liver disease with prevalence of diabetes. Younger, middle-aged (30-50 years) patients had significantly higher prevalence of diabetes compared to older (51-70 years) aged patients (28% vs. 13%, p = 0.022). Conclusion: 1 in 4 hepatitis C patients also manifest co-morbidity of diabetes. Having a younger or middle age (≤ 50 years) appears to contribute to diabetes prevalence in hepatitis C patients, however, the study sample comprises around 4 in 5 patients aged 30-50 years. Glucose intolerance and diabetes risk assessment, and early non-pharmaceutical management (probably uptake of healthy eating and physically active behaviour) among hepatitis C patients is warranted if complications are to be prevented. Key Words: Hepatitis C, diabetes, Child-Pugh class Key Points • Question: What is the prevalence of type 2 diabetes in patients with chronic hepatitis C in Faisalabad setting? • Findings: In this one-centre study that included 300 patients with ELISA and PCR confirmed hepatitis C disease presented in the OPD of Aziz Fatimah Medical and Dental College, Faisalabad and Mohtrama Benazir Bhutto Shaheed Medical College / Divisional Headquarters Teaching Hospital, Mirpur Azad Kashmir, nearly 26% of patients had type 2 diabetes. Among those patients with chronic hepatitis C disease, having type 2 diabetes was associated with much greater odds of having under 50 years age. Meaning: Patients with chronic hepatitis C warrant glucose intolerance risk assessment and monitoring for progression of pre-diabetes/ diabetes, liver disease and the consequences of both.

Utilizing point-of-care A1c to impact outcomes - can we make it happen in primary care?

Hemoglobin A1c testing provides a marker of glycemic control and is the standard for diabetes risk assessment. According to the Centers for Disease Control (CDC), only 67.3-71.4% of diabetic patients between 2011 and 2016 had at least two A1c levels tested per year. Moreover, 27.8% had uncontrolled diabetes with an A1c of ≥8.0%, increasing the risk of microvascular complications. Lack of monitoring presents a significant barrier, and improving ease of testing could improve glycemic control. Point-of-care (POC) A1c testing, obtained via capillary blood with results provided in 5-6 min, is available and used frequently in endocrine clinics. However, POC A1c testing is not standard in primary care, where 90% of type 2 diabetes patients are treated. Barriers include access and costs of POC A1c machines and standardization of testing in the primary care setting. Review of literature, however, suggests that POC A1c testing in primary care may lead to A1c reduction whereas being potentially cost-effective and strengths the patient-physician relationship. POC A1c testing in primary care, if widely available and integrated into workflow, has the potential to positively impact diabetes care. Real-time feedback may change patient and physician behaviors, allowing earlier therapeutic intensification.

Risk assessment of type-2 diabetes using the Indian diabetes risk score: a cross-sectional study on medical students from a tertiary care hospital

Background: Diabetes mellitus is a major public health problem which affects all age groups and has now been identified in young. Indian diabetes risk score (IDRS), devised and developed by Mohan et al. at the Madras Diabetes Research Foundation, is a validated tool to identify individuals with high risk of developing type 2 diabetes mellitus.Methods: Present cross-sectional study was conducted among medical students of a medical college in Jhansi from June 2021 to September 2021. A semi-structured interview schedule for socio demographic details of subjects like age, gender, education/occupation of parents and physical activity. Written informed consent was taken. Statistical analysis used was SPSS trial version was used for data analysis. P<0.05 was considered as statistically significant.Results: A total of 300 medical students were included in the study. IDRS categorization revealed 10 (3.3%) respondents had score >60 (high risk) and 84 (28%) respondents had score between 30-50 (moderate risk). While 206 (68.6%) respondent had score <30 (low risk).Conclusions: Our study supports the use of IDRS method as screening of diabetes at mass level as it is cost effective as well as time saving procedure.

Assessment of Diabetes Risk Using Indian Diabetes Risk Score Among Medical Students at a Medical College in Telangana, India

Objective: The aim of this article is to assess the risk of diabetes among medical students in one medical college using IDRS (Indian Diabetes Risk Score) and to study the association between risk of diabetes and various factors. Materials and Methods: An institution-based cross-sectional study was carried out among 246 medical students at Mall Reddy Institute of Medical Sciences, Hyderabad, Telangana, India from June to July 2019. Questions pertaining to modified IDRS and measurements such as waist circumference were recorded. Results: The mean IDRS (34.15±11.57) indicated that this population was at moderate risk of diabetes. Majority (78%) were at moderate risk. IDRS was not found to be associated with blood pressure (mean systolic blood pressure for IDRS <30=117.51±6.25; for 30–50=115.72±6.65; and for >60=117.78±6.06; mean diastolic blood pressure for IDRS <30=75.55±6.15; for 30–50=75.39±6.26; for >60=73.33±6.14). Being female (mean IDRS =35.55±11.48 vs. 30.93±11.62 for males) and being overweight or obese (mean IDRS =36.84±11.56 vs. 33.07±11.54 for normal weight) were significantly associated with IDRS (P < 0.05). Conclusion: This population was at moderate risk of developing diabetes. Overweight or obese patients and females had higher IDRS and thus they were at more risk of developing diabetes in future.

Cardiovascular Disease Risk Assessment in Diabetes

Diabetes has become an increasing issue in the last century and even more pressing in the last few decades due to the exponential rise of obesity and has become one of the leading causes of death worldwide. Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in people with diabetes. Hyperglycemia, insulin resistance, and excess fatty acids increase oxidative stress, disrupt protein kinase C signaling, and increase advanced glycation end-products that result in vascular inflammation, vasoconstriction, thrombosis, and atherogenesis. Compared to non-diabetics, those with diabetes carry a higher mortality risk from CVD across ethnicity and sex. The most common cardiovascular manifestations in those with diabetes include heart failure, peripheral arterial disease, and coronary heart disease. CVD risk assessment in diabetes can present an opportunity for preventive strategies and decreased mortality for people with diabetes.

Insulin resistance and type 2 diabetes mellitus risk factors in systemic lupus erythematosus

Objective. To clarify the frequency of insulin resistance (IR) in patients with systemic lupus erythematosus (SLE), traditional and associated with rheumatic disease risk factors for its development, to assess the possibility of using the Finnish Type 2 Diabetes Risk Assessment Score (FINDRISC) questionnaire to detect IR.Material and methods. The cross-sectional study included 49 patients with SLE (46 women, 3 men) without diabetes mellitus and hyperglycemia, observed at the V.A. Nasonova Research Institute of Rheumatology in 2019–2020. The median age of the patients was 40 [33; 48] years, the duration of the disease was 3.0 [0.7; 8.0] years. Glucocorticoids (GC) were received by 41 (84%) patients, hydroxychloroquine – by 38 (78%), immunosuppressive drugs – by 10 (20%), biological agents – by 5 (10%). The glucose and fasting immunoreactive insulin levels were examined, and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated in all patients. HOMA-IR value ≥2.77 corresponded to IR. Traditional risk factors for type 2 diabetes and the risk of its development in the next 10 years in patients with SLE were assessed using the Russian version of the FINDRISC questionnaire.Results. The median HOMA-IR level in SLE patients was 1.7 [1.2; 2.5]. IR was detected in 10 (20%) of 49 patients with SLE. Patients with and without IR were comparable in terms of sex, age, duration and activity of SLE, therapy, and type 2 diabetes traditional risk factors. BMI, WC and insulin levels were higher in patients with IR. HOMA-IR correlated with body mass index (BMI) (r=0.6; p<0.001), waist circumference (WC) (r=0.5; p<0.001), risk categories for developing type 2 diabetes according to FINDRISС (r=0.3; p=0.03), SLEDAI-2K index (r=–0.4; p<0.01), C3 complement levels in serum (r=0.3; p=0.04) and the duration of GC therapy (r=0.3; p=0.03).Conclusion. IR was diagnosed in 20% of SLE patients without a history of diabetes and with normal fasting glucose in venous blood. The lower SLE activity, the longer GC intake in patient, the higher the HOMA-IR index was detected in him. However, the IR appearance was reliably associated only with an increasing BMI and WC. The use of the FINDRISC questionnaire, which allows to stratify respondents in the general population by the risk of developing type 2 diabetes mellitus, did not help to identify SLE patients with IR.

Assessment of diabetes knowledge, screening and uptake of community diabetes programs in a peri-urban region in Australia

AimsThe Wollondilly Diabetes Program (WDP) is testing ways to improve uptake of diabetes prevention services. This project evaluated the reach of WDP in diabetes promotion while assessing diabetes knowledge and risk among residents. MethodsA WDP member travelled in the DW weekly to community events including outreach programs between October 2016 and June 2019. Data from diabetes knowledge questionnaire (DKQ), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), HbA1c and Random Blood Glucose (RBG) measurements obtained from participants who attended community events and road shows. ResultsOver the 32 months period, WDP attended 32 community events reaching 1415 people (∼3% of the Wollondilly adult population). DKQ was completed by 154 people (52.9% females, 78% Australian born, median age 69 years), 39% had diabetes and their mean score (25.0 ± 3.1, maximum possible score = 31) was similar to those without diabetes (24.0 ± 4.6, p = 0.093). AUSDRISK assessment was completed by 166 people with 85% at intermediate or high risk of diabetes. There were 65% results above range for RBG (≥5.5 mmol/l) and/or HbA1c (≥5.7%,39 mmol/mol). ConclusionA community outreach team set up in partnership with local stakeholders that offers opportunistic diabetes screening, is an effective way of engaging with the community to increase diabetes awareness and knowledge.

Comparison of IDRS and ADA Diabetes Risk Assessment Tools Reveals Different Rsk Score in Same Population: A Cross-Sectional Analysis in a Tertiary Care Hospital

Background: To identify individuals at high risk of developing type2 diabetes (T2DM), use of a validated risk-assessment tool is currently recommended. Nevertheless, recent studies have shown that risk scores that are developed in the same country can lead to different results of an individual. The Objective of study was to reveal whether two different risk-assessment tools predict similar or dissimilar high-risk score in same population. Method: This cross-sectional analytical study was carried upon 336 non-diabetic adults visiting the outpatient department (OPD) of Medicine, MARKS Medical College & Hospital, Bangladesh from October 2018 to March 2019. Woman having previous history of Gestational Diabetes Mellitus (GDM) were also included. Both the Indian Diabetes risk Score (IDRS) and the American Diabetes (ADA) Risk Score questionnaire were used to collect the data on demographic and clinical characteristics, different risk factors of an individual subject, and to calculate predicted risk score for developing T2DM. Results: Among 336 subjects, 53.6% were female. The mean (±SD) age of the study subjects was 38.25±1.12 years. The average IDRS predicted risk score of developing T2DM was more in female subjects than male [p<0.05]. Whereas the ADA predicted increased risk score of developing type 2 diabetes was more in male subjects than female (p<0.05). IDRS categorized 37.2 % of individuals at high risk for developing diabetes; [p=0.10], while the ADA risk tool categorized 20.2% subjects in high risk group; [p<0.001]. Conclusions: The results indicate that risk for developing type 2 diabetes varies considerably according to the scoring system used. To adequately prevent T2DM, risk scoring systems must be validated for each population considered.

Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults

The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings. In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5-22·9 kg/m2], upper-normal [23·0-24·9 kg/m2], overweight [25·0-29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region. Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6-27·8), of obesity was 21·0% (19·6-22·5), and of diabetes was 9·3% (8·4-10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5-22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35-44 years and in men aged 25-34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean. The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.

BMI and diabetes risk in low-income and middle-income countries

Diabetes is a growing public health problem in all countries, but this increase has been much faster in low-income and middle-income countries (LMICs) 1 Seiglie JA Marcus M-E Ebert C et al. Diabetes prevalence and its relationship with education, wealth, and BMI in 29 low- and middle-income countries. Diabetes Care. 2020; 43: 767-775 Crossref PubMed Scopus (34) Google Scholar , 2 NCD Risk Factor Collaboration (NCD-RisC) – Africa Working GroupTrends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int J Epidemiol. 2017; 46: 1421-1432 Crossref PubMed Scopus (120) Google Scholar than in high income countries (HICs) 3 Narayan KMV Boyle JP Thompson TJ Gregg EW Williamson DF Effect of BMI on lifetime risk for diabetes in the U.S. Diabetes Care. 2007; 30: 1562-1566 Crossref PubMed Scopus (303) Google Scholar over the past three decades. 4 Zhou B Lu Y Hajifathalian K et al. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet. 2016; 387: 1513-1530 Summary Full Text Full Text PDF PubMed Scopus (2067) Google Scholar Concomitantly, the paucity of robust and representative data has prevented improved characterisation of the risk factors underlying this sharp increase in the burden in LMICs, which is needed to build more efficient diabetes screening and prevention policies than the current standard. Reliance on diabetes screening and diagnostic criteria based largely on data from HICs 5 WHOScreening for type 2 diabetes: report of a World Health Organization and International Diabetes Federation meeting. https://apps.who.int/iris/bitstream/handle/10665/68614/WHO_NMH_MNC_03.1.pdf?sequence=1&isAllowed=yDate: 2003 Date accessed: April 19, 2021 Google Scholar , 6 American Diabetes Association2. Classification and diagnosis of diabetes: standards of medical care in diabetes - 2021. Diabetes Care. 2021; 44: S15-S33 Crossref PubMed Scopus (502) Google Scholar has therefore substituted for these deficiencies, and tailoring diabetes screening strategies to cutoffs of measurable risk factors derived from data from representative cohorts in LMICs has been a long-term challenge. Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adultsThe association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Full-Text PDF