Public health burden of pre-diabetes and diabetes in Luxembourg: finding from the 2013-2015 European Health Examination Survey

Prevalence of prediabetes and undiagnosed diabetes in a large urban middle-aged population: the CARVAR 92 cohort

BACKGROUND

The aim of this study was to assess the prevalence of prediabetes and unknown diabetes and its long-term change in a large middle-aged urban population.

METHODS

We conducted a screening campaign between 2007 and 2018 for cardiovascular risk factors in the western suburbs of Paris including subjects aged 40-70 (CARVAR 92). Among subjects who reported no previous diabetes, prediabetes and undiagnosed diabetes were defined as follows: fasting plasma glucose (FPG) ≥ 6.1 mmol/l (110 mg/dl) and < 7 mmol/l (126 mg/dl) for prediabetes according to WHO criteria (FPG between 5.6 and 6.9 mmol/l according to ADA criteria) and FPG ≥ 7.0 mmol/l for undiagnosed diabetes.

RESULTS

Of the 32,721 subjects in the CARVAR 92 cohort, 32,675 were included in this analysis. The median age of the patients was 56 years [30, 94], 45.4% were male, 5.9% had known diabetes, 36.4% were overweight and 18.7% obese. Among patients without previously known diabetes (n = 30,759), 8.1% had prediabetes according to WHO criteria (27.2% according to ADA criteria) and 2.3% had diabetes. Subjects with prediabetes and unknown diabetes were more likely to be male, older, and overweight or obese than non-diabetic subjects. From 2007 to 2018, the prevalence of prediabetes, unknown diabetes, and known diabetes decreased, except for prediabetes which remained stable for people aged 55-64.

CONCLUSION

The prevalence of prediabetes and unknown diabetes remains high but decreased during a 12-year period. About one-quarter of diabetes cases remain undiagnosed. Our results highlight that there is still a room for screening and cardiovascular prevention campaigns.

TRIAL REGISTRATION

IRB00012437.

Sociodemographic, anthropometric, and lifestyle correlates of prediabetes and type 2 diabetes in europe: The Feel4Diabetes study

BACKGROUND AND AIMS

The current work aimed to identify the predominant correlates of prediabetes and T2DM among a variety of socio-demographic, anthropometric and lifestyle indices, in a large sample of adults from families at high risk for T2DM.

METHODS AND RESULTS

In this cross-sectional study, 2816 adults were recruited from low-socioeconomic areas in high-income countries (HICs) (Belgium-Finland), HICs under austerity measures (Greece-Spain), and low/middle-income countries (LMICs) (Bulgaria-Hungary). A positive association between the male sex (OR, 95% C.I.2.77 (1.69-4.54)) and prediabetes was revealed compared to females, while there was a negative association between younger age (<45 years) (OR, 95% C.I. 0.58 (0.37-0.92)), and low/medium levels of waist circumference (OR, 95% C.I. 0.44 (0.22-0.89)) with prediabetes compared to older age and high levels of waist circumference, respectively. Concerning T2DM, 0-0.5 cups/day of fruits and berries (OR, 95% C.I.2. 13 (1.16-3.91)) and 150-300 g fish/week (OR, 95% C.I. 2.55 (1.01-6.41)) have a positive association compared to higher consumptions, respectively. Conversely, <1 cup/week legumes (OR, 95% C.I. 0.55 (0.31-0.99) as well as 0-0.5 servings (OR, 95% C.I. 0.34 (0.12-0.95) and 0.5-1 servings (OR, 95% C.I. 0.37 (0.19-0.71) of full-fat dairy/day have a negative association compared to higher consumptions, respectively.

CONCLUSION

These findings indicate the need for diabetes prevention measures targeting young adults and especially men, above 45 years of age, with central obesity and poor dietary habits and prioritize vulnerable groups and populations living in LMICs.

NATIONAL CLINICAL TRIAL NUMBER

NCT02393872.

Self-reported diabetes and factors associated with it in the Brazilian adult population: National Health Survey, 2019

This study aims to analyze the prevalence of self-reported diabetes and its associated factors in the Brazilian adult population. It is a cross-sectional study using the 2019 National Health Survey. Prevalence and crude prevalence ratios (PRc) and adjusted prevalence ratios (PRa) of self-reported diabetes were estimated, with confidence intervals (95% CI), using Poisson regression. In the 82,349 adults, the prevalence of self-reported diabetes was 7.7%. Positively associated factors were: advanced age with greater association after 60 years (PRa 24.87; 95%CI 15.78-39.18); living in the Northeast (PRa 1.16; 95%CI 1.04-1.29), Southeast (PRa 1.27; 95% CI 1.14-1.43), South (PRa 1.18; 95%CI 1, 05-1.34), and Midwest (PRa 1.21; 95%CI 1.06-1.38); being a former smoker (PRa 1.17; 95%CI 1.09-1.27); self-assessment of regular health (PRa 2.41; 95%CI 2.21-2.64), bad/very bad (PRa 3.45; 95%CI 3.06-3.88); having heart disease (PRa 1.81; 95%CI 1.64-2.00), hypertension (PRa 2.84; 95%CI 2.60-3.69), high cholesterol (PRa 2.22; 95%CI 2.05-2.41), overweight (PRa 1.49; 95%CI 1.36-1.64), and obesity (PRa 2.25; 95%CI 2.05-2.47). It could be concluded that diabetes in Brazilian adults is associated with sociodemographic factors, aging, lifestyle, and morbidities. These results can guide public policies for the prevention and control of disease in Brazil.

Prevalence of prediabetes and association with cardiometabolic and renal factors. SIMETAP-PRED study

INTRODUCTION

Prediabetes is a major public health problem. The aims of the SIMETAP-PRED study were to determine the prevalence rates of prediabetes according to two diagnostic criteria, and to compare the association of cardiometabolic and renal risk factors between populations with and without prediabetes.

METHODS

Cross-sectional observational study conducted in Primary Care. Based random sample: 6,588 study subjects (response rate: 66%). Two diagnostic criteria for prediabetes were used: 1) prediabetes according to the Spanish Diabetes Society (PRED-SDS): Fasting plasma glucose (FPG) 110-125mg/dL or HbA1c 6.0% -6.4%; 2) prediabetes according to the American Diabetes Association (PRED-ADA): FPG 100-125mg/dL or HbA1c 5.7%-6.4%. The crude and sex- and age-adjusted prevalence rates, and cardiometabolic and renal variables associated with prediabetes were assessed.

RESULTS

The crude prevalence rates of PRED-SDS and PRED-ADA were 7.9% (95% CI 7.3-8.6%), and 22.0% (95% CI 21.0-23.0%) respectively, their age-adjusted prevalence rates were 6.6% and 19.1 respectively. The high or very high cardiovascular risk of the PRED-SDS or PRED-ADA populations were 68.6% (95%CI 64.5-72.6%) and 61.7% (95%CI 59.1-64.1%) respectively. Hypertension, hypertriglyceridemia, overweight, obesity, and increased waist-to-height ratio were independently associated with PRED-SDS. In addition to these factors, low glomerular filtration rate and hypercholesterolemia were also independently associated with PRED-ADA.

CONCLUSIONS

The prevalence of PRED-ADA triples that of PRED-SDS. Two thirds of the population with prediabetes had a high cardiovascular risk. Several cardiometabolic and renal risk factors were associated with prediabetes. Compared to the SDS criteria, the ADA criteria make the diagnosis of prediabetes easier.

Self-reported diabetes and factors associated with it in the Brazilian adult population: National Health Survey, 2019

Abstract This study aims to analyze the prevalence of self-reported diabetes and its associated factors in the Brazilian adult population. It is a cross-sectional study using the 2019 National Health Survey. Prevalence and crude prevalence ratios (PRc) and adjusted prevalence ratios (PRa) of self-reported diabetes were estimated, with confidence intervals (95% CI), using Poisson regression. In the 82,349 adults, the prevalence of self-reported diabetes was 7.7%. Positively associated factors were: advanced age with greater association after 60 years (PRa 24.87; 95%CI 15.78-39.18); living in the Northeast (PRa 1.16; 95%CI 1.04-1.29), Southeast (PRa 1.27; 95% CI 1.14-1.43), South (PRa 1.18; 95%CI 1, 05-1.34), and Midwest (PRa 1.21; 95%CI 1.06-1.38); being a former smoker (PRa 1.17; 95%CI 1.09-1.27); self-assessment of regular health (PRa 2.41; 95%CI 2.21-2.64), bad/very bad (PRa 3.45; 95%CI 3.06-3.88); having heart disease (PRa 1.81; 95%CI 1.64-2.00), hypertension (PRa 2.84; 95%CI 2.60-3.69), high cholesterol (PRa 2.22; 95%CI 2.05-2.41), overweight (PRa 1.49; 95%CI 1.36-1.64), and obesity (PRa 2.25; 95%CI 2.05-2.47). It could be concluded that diabetes in Brazilian adults is associated with sociodemographic factors, aging, lifestyle, and morbidities. These results can guide public policies for the prevention and control of disease in Brazil.

Dietary Intake of Adult Residents in Luxembourg Taking Part in Two Cross-Sectional Studies-ORISCAV-LUX (2007-2008) and ORISCAV-LUX 2 (2016-2017)

Background: A balanced diet is an important lifestyle component and has been associated with a reduced risk of chronic diseases. Objectives: To assess dietary intake of adult residents in Luxembourg taking part in two population-based cross-sectional studies (ORISCAV-LUX, 2007–2008 and ORISCAV-LUX 2, 2016–2017). Methods: Dietary intake of the study participants (1242 in 2007/08 and 1326 in 2016/17), 25–69 years old, were evaluated using food-frequency questionnaires (134 items in 2007/2008 and 174 items in 2016/2017) according to the French ANSES-CIQUAL food composition database. Both food-group- and nutrient-based analyses were conducted. Results: Dietary patterns in ORISCAV-LUX 2, 2016–2017, were characterized by an increase in the estimated marginal means (EMM) of the intake of energy, total fat, saturated fatty acids, alcohol, and decreased EMM of total carbohydrates, magnesium, and calcium compared to 2007/08. We also observed an increased EMM of the intake of protein-rich food items and ready-to-eat foods/fast foods, together with a decreased intake of grains, dairy products, and vegetables (all p-values <0.05, linear mixed models). The intake of most micronutrients was stable or slightly increased in ORISCAV-LUX 2 vs. ORISCAV-LUX, except for the drop in magnesium and calcium, and generally met recommendations, in particular, EFSA population reference intakes (PRI), except for vitamin D. Conclusions: Though most micronutrient recommendations were met, nutrient consumption in terms of high energy, total fat, and sodium, as well as low carbohydrates, were not aligned with recommendations for balanced eating.

Mapping the burden of diabetes in five small countries in Europe and setting the agenda for health policy and strategic action

BACKGROUND

Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems' reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level.

METHODS

We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies.

RESULTS

Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population.

CONCLUSIONS

Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are among the greatest challenges faced by small countries to effectively measure health outcomes. Nevertheless, we identified means of how these can be overcome. For example, the creation of public interdisciplinary repositories enables easily accessible data that can be used for health policy and strategic planning. Health policy-makers, funders and practitioners can consider the use of regular health examination surveys and other tools to effectively manage diabetes at the population level.

Prevalence of prediabetes and undiagnosed type 2 diabetes in France: Results from the national survey ESTEBAN, 2014-2016

AIM

To assess the prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes in France, among adults between 2014 and 2016 using data from the nationwide Esteban survey.

METHODS

National cross-sectional study conducted between 2014 and 2016 in metropolitan France. Individuals aged 18 to 74 were recruited with a 3-stage geographic sampling. They completed two face-to-face interviews, filled in a self-administered questionnaire and underwent a medical examination with the collection of biological samples. Their data were linked to the National Health Data System to identify anti-diabetic drugs reimbursement. Prediabetes and undiagnosed diabetes were defined as no diagnosis of diabetes and 6.1 mmol/l ≤ Fasting Plasma Glucose (FPG) < 7.0 mmol/l for prediabetes and FPG ≥ 7.0 mmol/l for undiagnosed diabetes. Non-pharmacologically treated diabetes and pharmacologically treated diabetes were defined as self-reported diabetes without or with self-reported or reimbursed antidiabetic medication, respectively. Estimated prevalence were weighted to take into account survey design and non-response.

RESULTS

The ESTEBAN survey recruited 3476 adults, 2270 were included in this analysis. The weighted prevalence was 1.7% [1.1 - 2.4] for undiagnosed diabetes (men: 2.7%, women; 0.9%), 9.9% [8.3 - 11.5] for prediabetes (men: 13.2%, women: 7.0%), 5.7% [4.3 - 7.1] for diagnosed diabetes. Among the diagnosed cases, 79% were pharmacologically treated. Among all diabetes cases, 23% were undiagnosed.

CONCLUSION

The prevalence of undiagnosed diabetes and prediabetes is increasing in France. Our results highlight the need to increase primary prevention and reinforce secondary prevention of diabetes.