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      Rising Diabetes Prevalence among Urban-Dwelling Black South Africans

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          Abstract

          Objective

          To examine the prevalence of and the association of psychosocial risk factors with diabetes in 25–74-year-old black Africans in Cape Town in 2008/09 and to compare the prevalence with a 1990 study.

          Research Design and Methods

          A randomly selected cross-sectional sample had oral glucose tolerance tests. The prevalence of diabetes (1998 WHO criteria), other cardiovascular risk factors and psychosocial measures, including sense of coherence (SOC), locus of control and adverse life events, were determined. The comparison of diabetes prevalence between this and a 1990 study used the 1985 WHO diabetes criteria.

          Results

          There were 1099 participants, 392 men and 707 women (response rate 86%). The age-standardised (SEGI) prevalence of diabetes was 13.1% (95% confidence interval (CI) 11.0–15.1), impaired glucose tolerance (IGT) 11.2% (9.2–13.1) and impaired fasting glycaemia 1.2% (0.6–1.9). Diabetes prevalence peaked in 65–74-year-olds (38.6%). Among diabetic participants, 57.9% were known and 38.6% treated. Using 1985 WHO criteria, age-standardised diabetes prevalence was higher by 53% in 2008/09 (12.2% (10.2–14.2)) compared to 1990 (8.0% (5.8–10.3)) and IGT by 67% (2008/09: 11.7% (9.8–13.7); 1990: 7.0% (4.9–9.1)). In women, older age (OR: 1.05, 95%CI: 1.03–1.08, p<0.001), diabetes family history (OR: 3.13, 95%CI: 1.92–5.12, p<0.001), higher BMI (OR: 1.44, 95%CI: 1.20–1.82, p = 0.001), better quality housing (OR: 2.08, 95%CI: 1.01–3.04, p = 0.047) and a lower SOC score (≤40) was positively associated with diabetes (OR: 2.57, 95%CI: 1.37–4.80, p = 0.003). Diabetes was not associated with the other psychosocial measures in women or with any psychosocial measure in men. Only older age (OR: 1.05, 95%CI: 1.02–1.08, p = 0.002) and higher BMI (OR: 1.10, 95%CI: 1.04–1.18, p = 0.003) were significantly associated with diabetes in men.

          Conclusions

          The current high prevalence of diabetes in urban-dwelling South Africans, and the likelihood of further rises given the high rates of IGT and obesity, is concerning. Multi-facetted diabetes prevention strategies are essential to address this burden.

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          Most cited references12

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          Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India.

          Using data from India, we estimate the relationship between household wealth and children's school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children's enrollment across Indian states. On average a "rich" child is 31 percentage points more likely to be enrolled than a "poor" child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.
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            Diabetes in sub-Saharan Africa.

            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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              The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat.

              In a survey of a random sample of the general population recent life events, collected and rated for long-term contextual threat according to the methods of Brown & Harris (1978), were also recorded where possible on an inventory of life event categories (Tennant & Andrews, 1977). Of the 82.5% of all events collected which were covered by the inventory, 12 of the 67 event categories accounted for 77% of life events with an aetiologicaly significant rating of marked or moderate long-term threat. Where practical and economic constraints oblige research workers to choose the inventory method, a brief list of event categories, such as the List of Threatening Experiences, is recommended in preference to much longer lists.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                4 September 2012
                : 7
                : 9
                : e43336
                Affiliations
                [1 ]Chronic Diseases of Lifestyle Unit, Medical Research Council, Durban, South Africa
                [2 ]Chronic Disease Initiative in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
                [3 ]Biostatistics Unit, Medical Research Council, Cape Town, South Africa
                [4 ]University of Cape Town/Medical Research Council Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
                [5 ]Department of Psychiatry, University of Cape Town, Cape Town, South Africa
                [6 ]Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, Cape Town, South Africa
                German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Duesseldorf, Germany
                Author notes

                Competing Interests: NL has received honoraria from Novartis for serving on the steering committee for the Navigator Trial and travel support from Novo Nordisk, Eli Lilly Laboratories and Sanofi Aventis. All other authors report no potential conflicts of interest, including specific financial interests, relevant to the subject of this manuscript. This study was partially funded by a commercial source (Servier Laboratories [South Africa]). This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

                Conceived and designed the experiments: NP KS CL NSL. Analyzed the data: NP CL EVL. Contributed reagents/materials/analysis tools: BV. Wrote the paper: NP KS CL EVL BV NSL.

                Article
                PONE-D-12-03850
                10.1371/journal.pone.0043336
                3433459
                22962583
                99eb2b8f-161f-4f98-a270-2e266178d47a
                Copyright @ 2012

                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
                : 3 February 2012
                : 20 July 2012
                Page count
                Pages: 9
                Funding
                This study was funded by an unrestricted grant from Servier Laboratories (South Africa), the Medical Research Council of South Africa, the Initiative for Cardiovascular Health Research in Developing Countries (IC Health) Foundation Council and Brigham Hospital/Harvard University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine
                Endocrinology
                Diabetic Endocrinology
                Epidemiology
                Cardiovascular Disease Epidemiology
                Non-Clinical Medicine
                Health Care Quality
                Socioeconomic Aspects of Health
                Public Health
                Health Screening
                Preventive Medicine
                Socioeconomic Aspects of Health
                Social and Behavioral Sciences
                Psychology
                Psychological Stress

                Uncategorized
                Uncategorized

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