Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data.
Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data.
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DOI：
10.1016/s2214-109x(23)00348-0
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发表时间：
2023-10
影响因子：
34.3
通讯作者：
Manne-Goehler, Jennifer
中科院分区：
文献类型：
--
作者：
Rahim, Nicholas Errol;Flood, David;Marcus, Maja E.;Theilmann, Michaela;Aung, Taing N.;Agoudavi, Kokou;Kumararyal, Krishna;Bahendeka, Silver;Bicaba, Brice;Bovet, Pascal;Diallo, Alpha Oumar;Farzadfar, Farshad;Guwatudde, David;Houehanou, Corine;Houinato, Dismand;Hwalla, Nahla;Jorgensen, Jutta;Kagaruki, Gibson Bernard;Mayige, Mary;Wong-McClure, Roy;Larijani, Bagher;Moghaddam, Sahar Saeedi;Mwalim, Omar;Mwangi, Kibachio Joseph;Sarkar, Sudipa;Sibai, Abla M.;Sturua, Lela;Wesseh, Chea;Geldsetzer, Pascal;Atun, Rifat;Vollmer, Sebastian;Baernighausen, Till;Davies, Justine;Ali, Mohammed K.;Seiglie, Jacqueline A.;Manne-Goehler, Jennifer
糖尿病的全球负担正在迅速上升，但几乎没有证据表明低收入和中等收入国家（LMIC）的卫生系统开展了个人层面的糖尿病预防活动。在这里，我们描述了糖尿病高危人群，估计糖尿病预防活动，并探讨这些活动在LMIC的社会人口学差异。我们对2009年10月至2019年5月期间在44个LMIC中进行的具有全国代表性的基于人口的调查中的个人水平数据进行了汇总，横断面分析。我们的样本包括所有年龄超过25岁的参与者，他们没有糖尿病，也没有怀孕。我们根据空腹血糖受损（或在血红蛋白A1 c可用的国家中的前驱糖尿病）或超重或肥胖定义了糖尿病高危人群，与WHO 2型糖尿病管理的基本非传染性疾病指南包一致。我们根据这一定义估计了调查参与者中患糖尿病风险高的比例。我们还估计了报告四种基本糖尿病预防活动的高危人群比例：体育活动咨询，减肥咨询，饮食咨询和血糖筛查，总体和按世界银行收入组分层。最后，我们使用多变量泊松回归模型来评估社会人口特征和这些活动之间的关联。最终的合并样本包括145739名成年人（其中86 269人[59.2%]为女性，59 468人[40.4%]为男性），其中59 308人（40.6%[95% CI 38.5 - 42.8]）被认为是糖尿病的高风险人群（低收入国家为20.6%[19.8 - 21.5]，中低收入国家为38.0%[37.2 - 38.9]，中高收入国家为57.5%[54.3 - 60.6]）。总体而言，糖尿病预防活动的覆盖率较低，体力活动咨询为40.0%（38.6 - 41.4），减肥咨询为37.1%（35.9 - 38.4），饮食咨询为42.7%（41.6 - 43.7），血糖筛查为37.1%（34.7 - 39.6）。糖尿病预防因国家财富水平的不同而存在很大差异：低收入国家68.1%（64.6 - 71.4）的糖尿病高危人群没有报告这些活动，而中高收入国家49.0%（47.4 - 50.7）的糖尿病高危人群报告至少有三种活动。受教育程度与糖尿病预防相关，与没有受过正规教育的人相比，接受饮食水果和蔬菜咨询的预测概率估计增加6.5（3.6 - 9.4）个百分点，血糖筛查增加21.3（19.5 - 23.2）个百分点。低收入国家中有很大比例的人处于糖尿病的高风险之中，但不到一半的人报告说接受了总体的基本预防活动，低收入国家和没有受过正规教育的人接受这些活动的程度最低。这些发现为未来的全球糖尿病预防目标提供了基础性证据，并加强了预防全球糖尿病持续增加的政策和计划。哈佛陈通熙公共卫生学院麦克伦南基金：院长的挑战赠款计划和欧盟的研究和创新计划地平线2020。
The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodemographic variation in these activities across LMICs. We performed a pooled, cross-sectional analysis of individual-level data from nationally representative, population-based surveys conducted in 44 LMICs between October, 2009, and May, 2019. Our sample included all participants older than 25 years who did not have diabetes and were not pregnant. We defined the population at high risk of diabetes on the basis of either the presence of impaired fasting glucose (or prediabetes in countries with a haemoglobin A1c available) or overweight or obesity, consistent with the WHO Package of Essential Noncommunicable Disease Guidelines for type 2 diabetes management. We estimated the proportion of survey participants that were at high risk of developing diabetes based on this definition. We also estimated the proportion of the population at high risk that reported each of four fundamental diabetes prevention activities: physical activity counselling, weight loss counselling, dietary counselling, and blood glucose screening, overall and stratified by World Bank income group. Finally, we used multivariable Poisson regression models to evaluate associations between sociodemographic characteristics and these activities. The final pooled sample included 145 739 adults (86 269 [59·2%] of whom were female and 59 468 [40·4%] of whom were male) across 44 LMICs, of whom 59 308 (40·6% [95% CI 38·5–42·8]) were considered at high risk of diabetes (20·6% [19·8–21·5] in low-income countries, 38·0% [37·2–38·9] in lower-middle-income countries, and 57·5% [54·3–60·6] in upper-middle-income countries). Overall, the reach of diabetes prevention activities was low at 40·0% (38·6–41·4) for physical activity counselling, 37·1% (35·9–38·4) for weight loss counselling, 42·7% (41·6–43·7) for dietary counselling, and 37·1% (34·7–39·6) for blood glucose screening. Diabetes prevention varied widely by national-level wealth: 68·1% (64·6–71·4) of people at high risk of diabetes in low-income countries reported none of these activities, whereas 49·0% (47·4–50·7) at high risk in upper-middle-income countries reported at least three activities. Educational attainment was associated with diabetes prevention, with estimated increases in the predicted probability of receipt ranging between 6·5 (3·6–9·4) percentage points for dietary fruit and vegetable counselling and 21·3 (19·5–23·2) percentage points for blood glucose screening, among people with some secondary schooling compared with people with no formal education. A large proportion of individuals across LMICs are at high risk of diabetes but less than half reported receiving fundamental prevention activities overall, with the lowest receipt of these activities among people in low-income countries and with no formal education. These findings offer foundational evidence to inform future global targets for diabetes prevention and to strengthen policies and programmes to prevent continued increases in diabetes worldwide. Harvard T H Chan School of Public Health McLennan Fund: Dean’s Challenge Grant Program and the EU’s Research and Innovation programme Horizon 2020.
影响因子：
82.9
作者：
Seiglie JA;Nambiar D;Beran D;Miranda JJ
通讯作者：
Miranda JJ