Diabetes and pre-diabetes among persons aged 35 to 60 years in eastern Uganda: prevalence and associated factors

PLoS One. 2013 Aug 14;8(8):e72554. doi: 10.1371/journal.pone.0072554. eCollection 2013.

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 ≥6.1 mmol L⁻¹ (World Health Organization (WHO) criteria or ≥5.6 mmol L⁻¹ (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG >6.9 mmol 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Income / statistics & numerical data
  • Male
  • Mass Screening / economics
  • Middle Aged
  • Prediabetic State / blood
  • Prediabetic State / diagnosis
  • Prediabetic State / epidemiology*
  • Prevalence
  • Risk
  • Rural Population / statistics & numerical data
  • Uganda / epidemiology

Substances

  • Blood Glucose

Grant support

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.