Division of Global Health-IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2013 Aug 14;8(8):e72554. doi: 10.1371/journal.pone.0072554. eCollection 2013.
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.
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.
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.
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.
我们的目的是评估 35-60 岁人群中异常葡萄糖调节（AGR）（即糖尿病和糖尿病前期）的患病率及其相关因素，以明确在非洲农村进行有针对性筛查的意义。
在乌干达东部一个以农村为基础的人口监测站点，对 1497 名 35-60 岁的人群（786 名女性和 711 名男性）进行了一项基于人群的调查。参与者回答了一份生活方式问卷，随后测量了他们的体重指数（BMI）和血压（BP）。使用 On-Call® Plus（Acon）快速血糖仪从毛细血管血样中测量空腹血糖（FPG），在禁食过夜后进行。根据世界卫生组织（WHO）标准（FPG≥6.1mmol/L）或美国糖尿病协会（ADA）标准（FPG≥5.6mmol/L），将 AGR 定义为 FPG≥6.1mmol/L。糖尿病定义为 FPG>6.9mmol/L，或正在接受糖尿病治疗。
参与者的平均年龄为男性 45 岁，女性 44 岁。根据 WHO 标准，糖尿病的患病率为 7.4%（95%CI 6.1-8.8%），根据 ADA 标准，糖尿病的患病率为 8.6%（95%CI 7.3-10.2%）。使用 ADA 切点时，肥胖者的 AGR 患病率是正常 BMI 者的 2 倍（调整后患病率比（APRR）1.9，95%CI 1.3-2.8）。职业为机械师、达到世卫组织推荐的体力活动阈值和较高的饮食多样性与较低的 AGR 发生率相关（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）。用 ADA 切点检测一个 AGR 患者的直接医疗费用为 2 美元，用 WHO 切点检测则为 3.7 美元。
在这一环境中，35-60 岁人群中 AGR 的患病率很高。有必要对高危人群进行筛查，并开展有针对性的健康教育，以解决肥胖、体力活动不足和饮食不均衡等问题。
