Diabetes and Pre-Diabetes among Persons Aged 35 to 60 Years in Eastern Uganda: Prevalence and Associated Factors

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Abstract

Background

Our aim was to estimate the prevalence of abnormal glucose regulation (AGR) (i.e. diabetes and pre-diabetes) and its associated factors among people aged 35-60 years so as to clarify the relevance of targeted screening in rural Africa.

Methods

A population-based survey of 1,497 people (786 women and 711 men) aged 35-60 years was conducted in a predominantly rural Demographic Surveillance Site in eastern Uganda. Participants responded to a lifestyle questionnaire, following which their Body Mass Index (BMI) and Blood Pressure (BP) were measured. Fasting plasma glucose (FPG) was measured from capillary blood using On-Call® Plus (Acon) rapid glucose meters, following overnight fasting. AGR was defined as FPG ≥6.1mmol L ^-1 (World Health Organization (WHO) criteria or ≥5.6mmol L ^-1 (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG >6.9mmol L ^-1, or being on diabetes treatment.

Results

The mean age of participants was 45 years for men and 44 for women. Prevalence of diabetes was 7.4% (95%CI 6.1-8.8), while prevalence of pre-diabetes was 8.6% (95%CI 7.3-10.2) using WHO criteria and 20.2% (95%CI 17.5-22.9) with ADA criteria. Using WHO cut-offs, the prevalence of AGR was 2 times higher among obese persons compared with normal BMI persons (Adjusted Prevalence Rate Ratio (APRR) 1.9, 95%CI 1.3-2.8). Occupation as a mechanic, achieving the WHO recommended physical activity threshold, and higher dietary diversity were associated with lower likelihood of AGR (APRR 0.6, 95%CI 0.4-0.9; APRR 0.6, 95%CI 0.4-0.8; APRR 0.5, 95%CI 0.3-0.9 respectively). The direct medical cost of detecting one person with AGR was two US dollars with ADA and three point seven dollars with WHO cut-offs.

Conclusions

There is a high prevalence of AGR among people aged 35-60 years in this setting. Screening for high risk persons and targeted health education to address obesity, insufficient physical activity and non-diverse diets are necessary.

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Most cited references 29

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2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension.

Judith Whitworth (2003)

Hypertension is estimated to cause 4.5% of current global disease burden and is as prevalent in many developing countries, as in the developed world. Blood pressure-induced cardiovascular risk rises continuously across the whole blood pressure range. Countries vary widely in capacity for management of hypertension, but worldwide the majority of diagnosed hypertensives are inadequately controlled. This statement addresses the ascertainment of overall cardiovascular risk to establish thresholds for initiation and goals of treatment, appropriate treatment strategies for non-drug and drug therapies, and cost-effectiveness of treatment. Since publication of the WHO/ISH Guidelines for the Management of Hypertension in 1999, more evidence has become available to support a systolic blood pressure threshold of 140 mmHg for even 'low-risk' patients. In high-risk patients there is evidence for lower thresholds. Lifestyle modification is recommended for all individuals. There is evidence that specific agents have benefits for patients with particular compelling indications, and that monotherapy is inadequate for the majority of patients. For patients without a compelling indication for a particular drug class, on the basis of comparative trial data, availability, and cost, a low dose of diuretic should be considered for initiation of therapy. In most places a thiazide diuretic is the cheapest option and thus most cost effective, but for compelling indications where other classes provide additional benefits, even if more expensive, they may be more cost effective. In high-risk patients who attain large benefits from treatment, expensive drugs may be cost effective, but in low-risk patients treatment may not be cost-effective unless the drugs are cheap.

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Global physical activity questionnaire (GPAQ): nine country reliability and validity study.

Melissa Maslin, Fiona Bull, F. Bull … (2009)

Instruments to assess physical activity are needed for (inter)national surveillance systems and comparison. Male and female adults were recruited from diverse sociocultural, educational and economic backgrounds in 9 countries (total n = 2657). GPAQ and the International Physical Activity Questionnaire (IPAQ) were administered on at least 2 occasions. Eight countries assessed criterion validity using an objective measure (pedometer or accelerometer) over 7 days. Reliability coefficients were of moderate to substantial strength (Kappa 0.67 to 0.73; Spearman's rho 0.67 to 0.81). Results on concurrent validity between IPAQ and GPAQ also showed a moderate to strong positive relationship (range 0.45 to 0.65). Results on criterion validity were in the poor-fair (range 0.06 to 0.35). There were some observed differences between sex, education, BMI and urban/rural and between countries. Overall GPAQ provides reproducible data and showed a moderate-strong positive correlation with IPAQ, a previously validated and accepted measure of physical activity. Validation of GPAQ produced poor results although the magnitude was similar to the range reported in other studies. Overall, these results indicate that GPAQ is a suitable and acceptable instrument for monitoring physical activity in population health surveillance systems, although further replication of this work in other countries is warranted.

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Diabetes in sub-Saharan Africa.

Jean Claude N Mbanya, Ayesha Motala, Eugene Sobngwi … (2010)

In Sub-Saharan Africa, prevalence and burden of type 2 diabetes are rising quickly. Rapid uncontrolled urbanisation and major changes in lifestyle could be driving this epidemic. The increase presents a substantial public health and socioeconomic burden in the face of scarce resources. Some types of diabetes arise at younger ages in African than in European populations. Ketosis-prone atypical diabetes is mostly recorded in people of African origin, but its epidemiology is not understood fully because data for pathogenesis and subtypes of diabetes in sub-Saharan African communities are scarce. The rate of undiagnosed diabetes is high in most countries of sub-Saharan Africa, and individuals who are unaware they have the disorder are at very high risk of chronic complications. Therefore, the rate of diabetes-related morbidity and mortality in this region could grow substantially. A multisectoral approach to diabetes control and care is vital for expansion of socioculturally appropriate diabetes programmes in sub-Saharan African countries. Copyright 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Christian Herder: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 14 August 2013

Volume: 8

Issue: 8

Electronic Location Identifier: e72554

Affiliations

[1 ]Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

[2 ]Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda

[3 ]Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda

[4 ]International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden

[5 ]Division of Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden

[6 ]Endocrine and Diabetes Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

[7 ]Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda

German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Duesseldorf, Germany

Author notes

* E-mail: wromay2000@ 123456yahoo.co.uk

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: RWM DG SP GT CO. Performed the experiments: RWM. Analyzed the data: RWM DG FM FNN SP GT CO. Contributed reagents/materials/analysis tools: RWM DG FM FNN GT SP CO. Wrote the manuscript: RWM DG FM FNN SP GT CO.

Article

Publisher ID: PONE-D-13-04086

DOI: 10.1371/journal.pone.0072554

PMC ID: 3743823

PubMed ID: 23967317

SO-VID: 240648f4-b125-45e9-b4ea-390858158e1f

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 20 January 2013

Date accepted : 11 July 2013

Funding

This work was primarily funded by the Swedish International Development Agency. This work was funded by the Swedish International Development Agency (SIDA) through its support to Makerere University in Uganda. The grant covered the costs of field work, including training of research assistants, data collection and entry ( http://www.sida.se/English/Countries-and-regions/Africa/Uganda/Our-work-in-Uganda/). The African Population and Health Research Centre (APHRC) ( http://www.aphrc.org/) in partnership with the International Development Research Centre (IDRC) are also duly acknowledged for their additional financial support through the African Doctoral Dissertation Research Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Diabetes and Pre-Diabetes among Persons Aged 35 to 60 Years in Eastern Uganda: Prevalence and Associated Factors

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Abstract

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PLOS Climate

Most cited references 29

2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension.

Global physical activity questionnaire (GPAQ): nine country reliability and validity study.

Diabetes in sub-Saharan Africa.

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