低收入和中等收入国家老年人糖尿病的患病率、相关因素、检测与控制。一项基于10/66痴呆症研究小组人群的调查。
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.
作者信息
Salas Aquiles, Acosta Daisy, Ferri Cleusa P, Guerra Mariella, Huang Yueqin, Jacob K S, Jimenez-Velazquez Ivonne Z, Llibre Rodriguez Juan J, Sosa Ana L, Uwakwe Richard, Williams Joseph D, Jotheeswaran A T, Liu Zhaorui, Lopez Medina A M, Salinas-Contreras Rosa Maria, Prince Martin J
机构信息
Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela.
Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic.
出版信息
PLoS One. 2016 Feb 25;11(2):e0149616. doi: 10.1371/journal.pone.0149616. eCollection 2016.
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.
背景
关于低收入和中等收入国家老年人糖尿病的流行病学情况，人们了解甚少。我们旨在研究并比较拉丁美洲、印度、中国和尼日利亚老年人糖尿病的患病率、社会模式、相关因素、检测、治疗及控制情况。
方法
在九个国家的13个集水区站点开展横断面调查。所有站点均通过自我报告诊断来评估已确诊的糖尿病。在七个拉丁美洲站点通过空腹血样（血糖≥7毫摩尔/升）评估未确诊的糖尿病。
结果
古巴集水区站点的糖尿病总患病率（患病率24.2%，标准化发病比116）、波多黎各（43.4%，197）、墨西哥城市地区（27.0%，125）和农村地区（23.7%，111）已超过美国，而委内瑞拉（20.9%，10）与之相似。已确诊糖尿病的患病率差异很大，中国农村地区站点（0.9%）、印度农村地区（6.6%）和尼日利亚（6.0%）患病率较低，而波多黎各为32.1%，主要原因是能否获得医疗服务。各站点间治疗覆盖率差异很大。在开展此项研究的拉丁美洲站点，糖尿病控制情况（已确诊者的40%至61%）一般。糖尿病与受教育程度较低但资产较多独立相关。高血压、中心性肥胖和高甘油三酯血症而非高胆固醇血症始终与糖尿病总患病率相关。
结论
大多数站点的糖尿病患病率已经很高。识别未确诊病例对于量化人群负担至关重要，尤其是在诊断不常见的最不发达地区。代谢风险因素及相关生活方式可能在病因学中起重要作用，但这需要纵向数据予以证实。鉴于老年人患病率很高，需要开展更多的人群研究以量化糖尿病的影响，并监测预防措施及卫生系统强化对患病率、治疗及控制的效果。
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