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

Maria Inês Schmidt, Juliana F Hoffmann, Maria de Fátima Sander Diniz, Paulo A Lotufo, Rosane Härter Griep, Isabela M Bensenor, José G Mill, Sandhi Maria Barreto, Estela M L Aquino, Bruce B Duncan, Maria Inês Schmidt, Juliana F Hoffmann, Maria de Fátima Sander Diniz, Paulo A Lotufo, Rosane Härter Griep, Isabela M Bensenor, José G Mill, Sandhi Maria Barreto, Estela M L Aquino, Bruce B Duncan

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.

Keywords: Brazil; Diabetes mellitus; Hyperglycemia; Prediabetic state; Prevalence.

Figures

Figure 1
Figure 1
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.

References

    1. World Health Organization . Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. Geneva: WHO; 2013.
    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez M-G, Baxter A, Bell ML, Benjamin EJ, Bennett D, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–2196. doi: 10.1016/S0140-6736(12)61729-2.
    1. International Diabetes Federation . IDF Diabetes Atlas. 6. Brussels: IDF; 2013.
    1. Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69 yr. Diabetes Care. 1992;15:1509–1516. doi: 10.2337/diacare.15.11.1509.
    1. Schmidt MI, Duncan BB, Azevedo e Silva G, Menezes AM, Monteiro CA, Barreto SM, Chor D, Menezes PR. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011;377:1949–1961. doi: 10.1016/S0140-6736(11)60135-9.
    1. Morris DH, Khunti K, Achana F, Srinivasan B, Gray LJ, Davies MJ, Webb D. Progression rates from HbA1c 6.0–6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia. 2013;56:1489–1493. doi: 10.1007/s00125-013-2902-4.
    1. Aquino EML, Barreto SM, Bensenor IM, Carvalho MS, Chor D, Duncan BB, Lotufo PA, Mill JG, Molina MDC, Mota ELA, Passos VMA, Schmidt MI, Szklo M. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol. 2012;175:315–324. doi: 10.1093/aje/kwr294.
    1. Schmidt MI, Duncan BB, Mill JG, Lotufo PA, Chor D, Barreto SM, Aquino EM, Passos VMA, Matos SM, M d CB M, Carvalho MS, Bensenor IM. Int J Epidemiol. 2014. Cohort profile: Longitudinal Study of Adult Health (ELSA-Brasil)
    1. Fedeli LG, Vidigal PG, Leite CM, Castilhos CD, Pimentel RA, Maniero VC, Mill JG, Lotufo PA, Pereira AC, Bensenor IM. Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA-Brasil. Rev Saude Publica. 2013;47(Suppl 2):63–71. doi: 10.1590/S0034-8910.2013047003807.
    1. World Health Organization . Definition, Diagnosis and Classification Of Diabetes Mellitus and its Complications. Report of a WHO Consultation. 1999.
    1. American Diabetes Association Standards of medical care in diabetes: 2014. Diabetes Care. 2014;37(Suppl 1):S14–S80. doi: 10.2337/dc14-S014.
    1. World Health Organization . Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation. Geneva: WHO; 2011.
    1. World Health Organization . Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO/IDF Consulation. Geneva: WHO; 2006.
    1. Gillett MJ. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes: Diabetes Care 2009; 32(7): 1327-1334. Clin Biochem Rev Aust Assoc Clin Biochem. 2009;30:197–200.
    1. Schmidt MI, Duncan BB, Hoffmann JF, de Moura L, Malta DC, de Carvalho RMSV. Prevalence of diabetes and hypertension based on self-reported morbidity survey, Brazil, 2006. Rev Saude Publica. 2009;43(Suppl 2):74–82. doi: 10.1590/S0034-89102009000900010.
    1. Brasil. Ministério da Saúde . Vigitel Brasil 2013: Vigilância de Fatores de Risco E Proteção Para Doenças Crônicas Por Inquérito Telefônico. Brasília: MS; 2014.
    1. Maruthur NM, Kao WHL, Clark JM, Brancati FL, Cheng C-Y, Pankow JS, Selvin E. Does genetic ancestry explain higher values of glycated hemoglobin in African Americans? Diabetes. 2011;60:2434–2438. doi: 10.2337/db11-0319.
    1. Bullard KM, Saydah SH, Imperatore G, Cowie CC, Gregg EW, Geiss LS, Cheng YJ, Rolka DB, Williams DE, Caspersen CJ. Secular changes in U.S. Prediabetes prevalence defined by hemoglobin A1c and fasting plasma glucose: National Health and Nutrition Examination Surveys, 1999-2010. Diabetes Care. 2013;36:2286–2293. doi: 10.2337/dc12-2563.
    1. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J, China National Diabetes and Metabolic Disorders Study Group Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–1101. doi: 10.1056/NEJMoa0908292.
    1. Mc Donald PAJ, Montenegro GJA, Cruz GCE, Moreno de Rivera AL, Cumbrera OA. Prevalence, sociodemographic distribution, treatment and control of diabetes mellitus in Panama. Diabetol Metab Syndr. 2013;5:69. doi: 10.1186/1758-5996-5-69.
    1. Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen C-S, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G, China Noncommunicable Disease Surveillance Group Prevalence and control of diabetes in Chinese adults. JAMA. 2010;2013(310):948–959.
    1. Borch-Johnsen K, Colagiuri S, Balkau B, Glümer C, Carstensen B, Ramachandran A, Dong Y, Gao W. Creating a pandemic of prediabetes: the proposed new diagnostic criteria for impaired fasting glycaemia. Diabetologia. 2004;47:1396–1402. doi: 10.1007/s00125-004-1468-6.
    1. Monteiro CA, Conde WL, Popkin BM. Income-specific trends in obesity in Brazil: 1975-2003. Am J Public Health. 2007;97:1808–1812. doi: 10.2105/AJPH.2006.099630.
    1. Ferreira SR, Iunes M, Franco LJ, Iochida LC, Hirai A, Vivolo MA. Disturbances of glucose and lipid metabolism in first and second generation Japanese-Brazilians. Japanese-Brazilian Diabetes Study Group. Diabetes Res Clin Pract. 1996;34(Suppl):S59–S63. doi: 10.1016/S0168-8227(96)90009-1.
    1. Selvin E, Crainiceanu CM, Brancati FL, Coresh J. Short-term variability in measures of glycemia and implications for the classification of diabetes. Arch Intern Med. 2007;167:1545–1551. doi: 10.1001/archinte.167.14.1545.
    1. Instituto Brasileiro de Geografia e Estatística . Atlas Do Censo Demográfico 2010. Rio de Janeiro: Ministério do Planejamento, Orçamento e Gestão, Instituto Brasileiro de Geografia e Estatística; 2013.
    1. Seshasai SRK, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, Whincup PH, Mukamal KJ, Gillum RF, Holme I, Njølstad I, Fletcher A, Nilsson P, Lewington S, Collins R, Gudnason V, Thompson SG, Sattar N, Selvin E, Hu FB, Danesh J, Emerging Risk Factors Collaboration Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364:829–841. doi: 10.1056/NEJMoa1008862.
    1. Zimmet PZ, Magliano DJ, Herman WH, Shaw JE. Diabetes: a 21st century challenge. Lancet Diabetes Endocrinol. 2014;2:56–64. doi: 10.1016/S2213-8587(13)70112-8.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren