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. 2016 Feb 25;11(2):e0149616.
doi: 10.1371/journal.pone.0149616. eCollection 2016.

The Prevalence, Correlates, Detection and Control of Diabetes Among Older People in Low and Middle Income Countries. A 10/66 Dementia Research Group Population-Based Survey

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The Prevalence, Correlates, Detection and Control of Diabetes Among Older People in Low and Middle Income Countries. A 10/66 Dementia Research Group Population-Based Survey

Aquiles Salas et al. PLoS One. .
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Background: Little is known of the epidemiology of diabetes among older people in low and middle income countries. We aimed to study and compare prevalence, social patterning, correlates, detection, treatment and control of diabetes among older people in Latin America, India, China and Nigeria.

Methods: Cross-sectional surveys in 13 catchment area sites in nine countries. Diagnosed diabetes was assessed in all sites through self-reported diagnosis. Undiagnosed diabetes was assessed in seven Latin American sites through fasting blood samples (glucose > = 7 mmol/L).

Results: Total diabetes prevalence in catchment sites in Cuba (prevalence 24.2%, SMR 116), Puerto Rico (43.4%, 197), and urban (27.0%, 125), and rural Mexico (23.7%, 111) already exceeds that in the USA, while that in Venezuela (20.9%, 100) is similar. Diagnosed diabetes prevalence varied very widely, between low prevalences in sites in rural China (0.9%), rural India (6.6%) and Nigeria (6.0%). and 32.1% in Puerto Rico, explained mainly by access to health services. Treatment coverage varied substantially between sites. Diabetes control (40 to 61% of those diagnosed) was modest in the Latin American sites where this was studied. Diabetes was independently associated with less education, but more assets. Hypertension, central obesity and hypertriglyceridaemia, but not hypercholesterolaemia were consistently associated with total diabetes.

Conclusions: Diabetes prevalence is already high in most sites. Identifying undiagnosed cases is essential to quantify population burden, particularly in least developed settings where diagnosis is uncommon. Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data. Given the high prevalence among older people, more population research is indicated to quantify the impact of diabetes, and to monitor the effect of prevention and health system strengthening on prevalence, treatment and control.

Conflict of interest statement

Competing Interests: None of the authors identified any competing interests. The University of Puerto Rico received an unrestricted educational grant from Pfizer Co USA to fund the clinical chemistry analyses, including glucose, in that site. Pfizer Co and other sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Neither does their funding affect in any way affect the authors' adherence to PLOS ONE policies on sharing data and materials. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication.


Fig 1
Fig 1. Diabetes prevalence.
The prevalence of diabetes, by site according to awareness (diagnosis status) and control.
Fig 2
Fig 2. Diabetes treatment.
Treatment profile of those with diagnosed diabetes, by site.

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