Assessment of prevalence and risk factors of diabetes and pre-diabetes in South Africa
Tóm tắt
Diabetes prevalence, as well as that of pre-diabetes, is rapidly increasing in South Africa. Individuals with pre-diabetes have a high risk of developing type 2 diabetes, which is reversible with a change in lifestyle. If left untreated, diabetes can lead to serious health complications. Our objective was to assess the prevalence of diabetes and pre-diabetes, and to investigate the associated risk factors of each in the South African population. This study made use of the South African Demographic Health Survey 2016 data. The study participants included 6442 individuals aged 15 years and older. A generalized additive mixed model was employed to account for the complex survey design of the study as well as well spatial autocorrelation in the data. The observed prevalence of pre-diabetes and diabetes was 67% and 22%, respectively. Among those who had never been tested for diabetes prior to the survey, 10% of females and 6% of males were found to be diabetic, and 67% of both males and females were found to be pre-diabetic. Thus, a large proportion of the South African population remains undiagnosed. The model revealed both common and uncommon factors significantly associated with pre-diabetes and diabetes. This highlights the importance of considering diabetic status as a three-level categorical outcome, rather than binary. In addition, significant interactions between some of the lifestyle factors, demographic factors and anthropometric measures were revealed, which indicates that the effects each these factors have on the likelihood of an individual being pre-diabetic or diabetic is confounded by other factors. The risk factors for diabetes and pre-diabetes are many and complicated. Individuals need to be aware of their diabetic status before health complications arise. It is therefore important for all stakeholders in government and the private sector of South Africa to get involved in providing education and creating awareness about diabetes. Regular testing of diabetes, as well as leading a healthy lifestyle, should be encouraged.
Tài liệu tham khảo
EKF Diagnostics. Complete guide to Diabetes and HbA1c testing; 2020. [Online; accessed March 2020]. https://www.ekfdiagnostics.com/diabetes-and-hba1c-testing.html.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843.
Stats SA. Mortality and causes of death in South Africa, 2016: Findings from death notification; 2017. [Online; accessed March 2020]. http://www.statssa.gov.za/publications/P03093/P030932017.pdf.
International Diabetes Federation. South Africa Diabetes report 2010-2045; 2020. [Online; accessed March 2020]. https://diabetesatlas.org/data/en/country/185/za.html.
Millington A. South Africa has just been ranked the unhealthiest country on earth; 2019. [Online; accessed March 2020]. https://www.businessinsider.co.za/most-unhealthy-countries-in-the-world-ranked-2019-3.
South African National Treasury. Policy Paper: Taxation of Sugar Sweetened Beverages. South Africa; 2016.
Green A. Diabetes risk because of status; 2017. [Online; accessed March 2020]. https://www.news24.com/SouthAfrica/Local/City-Vision/diabetes-risk-because-of-status-20170503.
Fung J. The diabetes code. Vancouver: Greystone Ltd.; 2018.
Iglay K, Hannachi H, Howie PJ, Xu J, Li X, Engel SS, et al. Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Curr Med Res Opin. 2016;32(7):1243–52.
Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29(3):725–31.
Long AN, Dagogo-Jack S. Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens. 2011;13(4):244–51.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA. 2020;323(13):1239–42.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–62.
Diabetes Association A. COVID-19 Frequently Asked Questions; 2020. [Online; accessed May 2020]. https://www.diabetes.org/covid-19-faq.
The Lancet. Burden of diabetes set to increase across sub-Saharan Africa, potentially diminishing health gains of recent years; 2017. [Online; accessed March 2020]. https://www.sciencedaily.com/releases/2017/07/170706072639.htm.
Peer N, Steyn K, Lombard C, Lambert EV, Vythilingum B, Levitt NS. Rising diabetes prevalence among urban-dwelling black South Africans. PLoS ONE. 2012;7(9):e43336.
Motala AA, Esterhuizen T, Gouws E, Pirie FJ, Omar MAK. Diabetes and other disorders of glycemia in a rural South African community. Diabetes Care. 2008;31(9):1783–8.
Levitt NS, Katzenellenbogen JM, Bradshaw D, Hoffman MN, Bonnici F. The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa. Diabetes Care. 1993;16:601–7.
Levitt NS, Steyn K, Lambert EV, Reagon G, Lombard CJ, Fourie JM, et al. Modifiable risk factors for Type 2 diabetes mellitus in a peri-urban community in South Africa. Diabetic Med. 1999;11(16):946–50.
National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC, ICF). South Africa Demographic and Health Survey 2016. Pretoria, South Africa and Rockville, Maryland, USA; 2019.
Diabetes co uk. HbA1c Test for Diabetes; 2019. [Online; accessed May 2021]. https://www.diabetes.co.uk/hba1c-test.html#:~:text=The%20HbA1c%20test%2C%20also%20known,type%202%20diabetes%20is%20diagnosed.
American Diabetes Association. Diagnosing diabetes and learning about prediabetes; 2016. [Online; accessed April 2020]. http://www.diabetes.org/diabetes-basics/diagnosis/?loc=db-slabnav.
Centre for disease control and prevention. The surprising truth about prediabetes; 2018. [Online; accessed April 2020]. https://www.cdc.gov/features/diabetesprevention/index.html.
Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist: hip ratio as predictors of cardiovascular risk-a review of the literature [Journal Article]. Eur J Clin Nutr. 2010;64:16.
Basu S, Yoffe P, Hills N, Lustig RH. The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PLOS ONE. 2013;02(8):1–8.
Noakes TD. Low-carbohydrate and high-fat intake can manage obesity and associated conditions: occasional survey. S Afr Med J. 2013;103(11):826–30.
Malhotra A, Noakes T, Phinney S. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med. 2015;49(15):967–8.
WHO. Body Mass Index—BMI; 2010. [Online; accessed May 2021]. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi.
Health UD. Is fruit juice bad for you and your children? 2019. [Online; accessed May 2021]. https://health.ucdavis.edu/blog/good-food/is-fruit-juice-bad-for-you-and-your-children/2019/07.
Heeringa SG, West BT, Berglund PA. Applied survey data analysis. Boca Raton, FL: Chapman and Hall/CRC; 2017.
Chen C. Generalized additive mixed models. Commun Stat Theory Methods. 2000;29(5–6):1257–71.
Wolfinger R. Laplace’s approximation for nonlinear mixed models. Biometrika. 1993;80(4):791–5.
King H, Aubert RE, Herman WH. Global Burden of Diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.
Pan A, Wang Y, Talaei M, Hu FB, Wu T. Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3:958–67.
Association AD, et al. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333–41.
Brunström M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016;352:1–10.