Dataset Information

Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan.

ABSTRACT:

Objectives

We conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan.

Design, settings and participants

Multistaged stratified cluster sampling was used for the representative selection of people aged ?20 years, residing in 378 sampled clusters of 16 randomly selected districts, in this cross-sectional study. Eligible participants had blood drawn for HbA1c analyses at field clinics near to their homes. The oral glucose tolerance test (OGTT) was conducted on a subsample of the participants. Overall and stratified prevalence of type 2 diabetes and its association with risk factors were estimated using logistic regression models.

Main outcome measures

Prevalence of prediabetes and type 2 diabetes.

Results

Of 18?856 eligible participants the prevalence of prediabetes was 10.91% (95% CI 10.46 to 11.36, n=2057) and type 2 diabetes was 16.98% (95% CI 16.44 to 17.51, n=3201). Overall, the mean HbA1c level was 5.62% (SD 1.96), and among newly diagnosed was 8.56% (SD 2.08). The prevalence was highest in age 51-60 years (26.03%, p<0.001), no formal education (17.66%, p<0.001), class III obese (35.09%, p<0.001), family history (31.29%, p<0.001) and female (17.80%, p=0.009). On multivariate analysis, there was a significant association between type 2 diabetes and older age, increase in body mass index and central obesity, positive family history, and having hypertension and an inverse relation with education as a categorical variable. On a subsample (n=1027), summary statistics for diagnosis of diabetes on HbA1c showed a sensitivity of 84.7%, specificity of 87.2% and area under the receiver operating characteristic curve 0.86, compared with OGTT.

Conclusions

The prevalence of type 2 diabetes and prediabetes is much higher than previously thought in Pakistan. Comprehensive strategies need to be developed to incorporate screening, prevention and treatment of type 2 diabetes at a community level.

SUBMITTER: Aamir AH

PROVIDER: S-EPMC6398762 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan.

Aamir Azizul Hasan AH Ul-Haq Zia Z Mahar Saeed A SA Qureshi Faisal Masood FM Ahmad Ibrar I Jawa Ali A Sheikh Aisha A Raza Abbas A Fazid Sheraz S Jadoon Zahid Z Ishtiaq Osama O Safdar Nauman N Afridi Hussain H Heald Adrian H AH

BMJ open 20190221 2

<h4>Objectives</h4>We conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan.<h4>Design, settings and participants</h4>Multistaged stratified cluster sampling was used for the representative selection of people aged ≥20 years, residing in 378 sampled clusters of 16 randomly selected districts, i ...[more]

PMID: 30796126

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Project description:BackgroundBoth fasting plasma glucose (FPG) and HbA1c are recommended for the diagnosis of diabetes and prediabetes by the American Diabetes Association (ADA), and for diabetes by the World Health Organization. The ADA guidance is influential on clinical practice in many developing countries, including in the Caribbean and Latin America. We aimed to compare the prevalence and characteristics of individuals identified as having diabetes and prediabetes by FPG and HbA1c in a predominantly African ancestry Caribbean population.MethodsA representative population-based sample of 1234 adults (≥25 years of age) resident in Barbados was recruited. Standard methods with appropriate quality control were used to collect data on height, weight, blood pressure, fasting lipids and history of diagnosed diabetes, and to measure fasting glucose and HbA1c. Those with previously diagnosed diabetes (n = 192) were excluded from the analyses. Diabetes was defined as: FPG ≥7.0 mmol/L or HbA1c ≥6.5%; prediabetes as: FPG ≥5.6 to <7mmol/L or HbA1c ≥5.7 to <6.5%.ResultsComplete data were available on 939 participants without previously diagnosed diabetes. The prevalence of undiagnosed diabetes was higher, but not significantly so, by HbA1c (4.9%, 95% CI 3.5, 6.8) vs FPG (3.5%, 2.4, 5.1). Overall 79 individuals had diabetes by either measure, but only 21 on both. The prevalence of prediabetes was higher by HbA1c compared to FPG: 41.7% (37.9, 45.6) vs 15.0% (12.8, 17.5). Overall 558 individuals had prediabetes by either measure, but only 107 on both. HbA1c, but not FPG, was significantly higher in women than men; and FPG, but not HbA1c, was significantly associated with raised triglycerides and low HDL cholesterol.ConclusionThe agreement between FPG and HbA1c defined hyperglycaemia is poor. In addition, there are some differences in the phenotype of those identified, and HbA1c gives a much higher prevalence of prediabetes. The routine use of HbA1c for screening and diagnosis in this population would have major implications for clinical and public health policies and resources. Given the lack of robust evidence, particularly for prediabetes, on whether intervention in the individuals identified would improve outcomes, this approach to screening and diagnosis cannot be currently recommended for this population.

Project description:INTRODUCTION:Epidemiological data about diabetes mellitus (DM) for sub-Saharan Africa (SSA) are scarce and the utility of glycated hemoglobin (HbA1c) to diagnose DM is uncertain in African populations with a high proportion of anemia. RESEARCH DESIGN AND METHODS:In a cross-sectional study, age-adjusted prevalence rates and predictors for DM and pre-DM were prospectively assessed by HbA1c in a semirural walk-in population of Tanzania (n=992). Predictors for DM were calculated by logistic regression. Correlations between HbA1c, hemoglobin, and blood glucose levels were done by Pearson's correlation. RESULTS:Overall, DM and pre-DM prevalence rates were 6.8% (95% CI 5.3 to 8.5) and 25% (95% CI 22.8 to 28.3), respectively. There was an increase in DM prevalence in patients 50-59 (14.9%; 95%?CI 9.1 to 22.5), ?60 years old (18.5%; 95%?CI 12.2 to 26.2) and in patients with overweight (9.3%; 95%?CI 5.9 to 13.7), obesity (10.9%; 95%?CI 6.9 to 16) compared with patients 18-29 years old (2.2%; 95%?CI 0.9 to 4.4) (p<0.001) and to normal-weight patients (3.6%; 95%?CI 2.1 to 5.6) (p<0.01), respectively. Age (OR 1.08, 95%?CI 1.05 to 1.12; p<0.001), body mass index (BMI) (OR 1.10, 95%?CI 1.04 to 1.16; p<0.001), and acute infection (OR 3.46, 95%?CI 1.02 to 10.8; p=0.038) were predictors for DM. Comparing patients with a BMI of 20?kg/m2 and a BMI of 35?kg/m2, the relative risk for DM increases in average by 2.12-fold (range 1.91-2.24) across the age groups. Comparing patients 20 years old with patients 70 years old, the relative risk for DM increases in average 9.7-fold (range 8.9-10.4) across the BMI groups. Overall, 333 patients (36%) suffered from anemia. Pearson's correlation coefficients (r) between HbA1c and hemoglobin was -0.009 (p=0.779), and between HbA1c and fasting blood glucose and random blood glucose, it was 0.775 and 0.622, respectively (p<0.001). CONCLUSION:We observed a high prevalence of DM and pre-DM, mainly triggered by increasing age and BMI, and provide evidence that HbA1c is suitable to assess DM also in populations of SSA with high proportions of anemia. TRIAL REGISTRATION NUMBER:NCT03458338.

Project description:The purpose of this study is to evaluate the prevalence, awareness, treatment and glycemic control of diabetes mellitus (DM) in a Chinese population. The findings from this study are expected to offer scientific evidence to better prevent and control the growing number of reported and untreated cases.A cross-sectional survey was conducted in Jiangsu, China. We recruited permanent residents over 18 years of age from eight towns in Jintan (JT) and six towns in Yangzhong (YZ) using a three-stage stratified cluster sampling method. The rates of DM prevalence, awareness, treatment and control as well as their related factors were analyzed.A total number of 15,404 people were entered into the analysis. The DM prevalence, awareness, treatment and control rates were 7.31%, 58.35%, 51.87% and 14.12%, respectively. Multivariable logistic regression analysis showed that being female was positively related to prevalence (OR=1.21, 95% CI: 1.07-1.37), awareness (OR=1.52, 95% CI: 1.19-1.93), treatment (OR=1.48, 95% CI: 1.17-1.88) and control (OR=1.87, 95% CI: 1.30-2.67) of DM. Having a family history of diabetes was significantly correlated with DM risk (OR=1.86, 95% CI: 1.37-2.54) and increased awareness (OR=3.12, 95% CI: 2.19-4.47), treatment (OR=3.47, 95% CI: 2.45-4.90) and control (OR=1.81, 95% CI: 1.22-2.68) of DM. Former smoking status (OR=1.82, 95% CI: 1.23-2.71), overweight (OR=2.11, 95% CI: 1.72-2.60) and obesity (OR=3.46, 95% CI: 2.67-4.50) were related to the risk of DM. Additionally, we found current drinking status to be positively correlated with DM risk (OR=1.30, 95% CI: 1.01-1.66) and negatively correlated with DM awareness (OR=0.41, 95% CI: 0.29-0.59) and treatment (OR=0.41, 95% CI: 0.29-0.59). Our study highlights the high prevalence and inadequate awareness, treatment and control of DM in the Chinese population.Management and prevention of DM-related complications should be considered an essential strategy by governments and society. This study assessed the reasons why DM has been increasing and established the first step in determining where to start regarding preventative methods.

Dataset Information

Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan.

Objectives

Design, settings and participants

Main outcome measures

Results

Conclusions

Publications

Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan.

Similar Datasets

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