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High prevalence of diabetes and intermediate hyperglycemia - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Schmidt MI, Hoffmann JF, de Fátima Sander Diniz M, Lotufo PA, Griep RH, Bensenor IM, Mill JG, Barreto SM, Aquino EM, Duncan BB - Diabetol Metab Syndr (2014)

Bottom Line: With this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed.Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%.The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Av. Ramiro Barcelos, 2600/414, 90035-003 Porto Alegre, RS Brazil.

ABSTRACT

Background: The global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes now live in low and middle income countries. Yet, little information is available regarding prevalence of diabetes and intermediate hyperglycemia in these countries, especially when a full range of diagnostic tests is employed. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population.

Methods: We report baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 civil servants aged 35-74 years. Diabetes mellitus was ascertained by self-report of diagnosis, medication use, fasting glucose, an oral glucose tolerance test, and/or glycated hemoglobin. Cut-offs for diabetes and intermediate hyperglycemia followed the recommendations of the World Health Organization and the American Diabetes Association. Adjusted prevalences were estimated through logistic regression.

Findings: With this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed. Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%. Diabetes or intermediate hyperglycemia was present in 79.1% of participants when using the most comprehensive definitions. The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).

Interpretation: That four of every five free-living individuals aged 35-74 years working in selected public institutions in six Brazilian state capitals presented either diabetes or intermediate hyperglycemia highlights the advanced stage of the obesity - diabetes epidemic in urban Brazil and indicates the need for urgent action.

No MeSH data available.


Related in: MedlinePlus

Percent of the total sample presenting a glucose abnormality by category and age. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), N = 15102, 2008-2010. Smoothing performed using a spline routine (Statistical Analysis System). DM = diabetes mellitus; IGT = impaired glucose tolerance; iIFG (WHO) = isolated impaired fasting glucose; iIFG(ADA) represents the additional cases of IFG when ascertained by the ADA criteria; iPre-diabetes by HbA1c represents the additional cases of intermediate hyperglycemia when diagnosed by ADA criteria; WHO = World Health Organization; ADA = American Diabetes Association. See Methods for diagnostic criteria.
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Fig1: Percent of the total sample presenting a glucose abnormality by category and age. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), N = 15102, 2008-2010. Smoothing performed using a spline routine (Statistical Analysis System). DM = diabetes mellitus; IGT = impaired glucose tolerance; iIFG (WHO) = isolated impaired fasting glucose; iIFG(ADA) represents the additional cases of IFG when ascertained by the ADA criteria; iPre-diabetes by HbA1c represents the additional cases of intermediate hyperglycemia when diagnosed by ADA criteria; WHO = World Health Organization; ADA = American Diabetes Association. See Methods for diagnostic criteria.

Mentions: Considering diabetes and intermediate hyperglycemia together, more than half of participants presented an abnormality, regardless of the criteria used to define IFG. In fact, when IFG (ADA) was considered, this combined frequency reached 79.1%, leaving only 20.9% of participants classified as having normoglycemia. Figure 1 illustrates the fully accounted burden of diabetes and intermediate hyperglycemia graphically, showing the cumulative percentage of participants presenting these conditions by age. Of note, over 80% of participants aged 50 or greater were affected, and this fraction exceeded 90% in those above age 65.Table 6


High prevalence of diabetes and intermediate hyperglycemia - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Schmidt MI, Hoffmann JF, de Fátima Sander Diniz M, Lotufo PA, Griep RH, Bensenor IM, Mill JG, Barreto SM, Aquino EM, Duncan BB - Diabetol Metab Syndr (2014)

Percent of the total sample presenting a glucose abnormality by category and age. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), N = 15102, 2008-2010. Smoothing performed using a spline routine (Statistical Analysis System). DM = diabetes mellitus; IGT = impaired glucose tolerance; iIFG (WHO) = isolated impaired fasting glucose; iIFG(ADA) represents the additional cases of IFG when ascertained by the ADA criteria; iPre-diabetes by HbA1c represents the additional cases of intermediate hyperglycemia when diagnosed by ADA criteria; WHO = World Health Organization; ADA = American Diabetes Association. See Methods for diagnostic criteria.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4363046&req=5

Fig1: Percent of the total sample presenting a glucose abnormality by category and age. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), N = 15102, 2008-2010. Smoothing performed using a spline routine (Statistical Analysis System). DM = diabetes mellitus; IGT = impaired glucose tolerance; iIFG (WHO) = isolated impaired fasting glucose; iIFG(ADA) represents the additional cases of IFG when ascertained by the ADA criteria; iPre-diabetes by HbA1c represents the additional cases of intermediate hyperglycemia when diagnosed by ADA criteria; WHO = World Health Organization; ADA = American Diabetes Association. See Methods for diagnostic criteria.
Mentions: Considering diabetes and intermediate hyperglycemia together, more than half of participants presented an abnormality, regardless of the criteria used to define IFG. In fact, when IFG (ADA) was considered, this combined frequency reached 79.1%, leaving only 20.9% of participants classified as having normoglycemia. Figure 1 illustrates the fully accounted burden of diabetes and intermediate hyperglycemia graphically, showing the cumulative percentage of participants presenting these conditions by age. Of note, over 80% of participants aged 50 or greater were affected, and this fraction exceeded 90% in those above age 65.Table 6

Bottom Line: With this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed.Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%.The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Av. Ramiro Barcelos, 2600/414, 90035-003 Porto Alegre, RS Brazil.

ABSTRACT

Background: The global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes now live in low and middle income countries. Yet, little information is available regarding prevalence of diabetes and intermediate hyperglycemia in these countries, especially when a full range of diagnostic tests is employed. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population.

Methods: We report baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 civil servants aged 35-74 years. Diabetes mellitus was ascertained by self-report of diagnosis, medication use, fasting glucose, an oral glucose tolerance test, and/or glycated hemoglobin. Cut-offs for diabetes and intermediate hyperglycemia followed the recommendations of the World Health Organization and the American Diabetes Association. Adjusted prevalences were estimated through logistic regression.

Findings: With this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed. Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%. Diabetes or intermediate hyperglycemia was present in 79.1% of participants when using the most comprehensive definitions. The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).

Interpretation: That four of every five free-living individuals aged 35-74 years working in selected public institutions in six Brazilian state capitals presented either diabetes or intermediate hyperglycemia highlights the advanced stage of the obesity - diabetes epidemic in urban Brazil and indicates the need for urgent action.

No MeSH data available.


Related in: MedlinePlus