Background: Diabetes is a leading cause of progressive morbidity and early mortality worldwide. Little is known about the burden of diabetes and prediabetes in Namibia, a Sub-Saharan African (SSA) country that is undergoing a demographic transition.
Methods: We estimated the prevalence and correlates of diabetes (defined as fasting [capillary] blood glucose [FBG] ≥126 mg/dL) and prediabetes (defined by World Health Organization [WHO] and American Diabetes Association [ADA] criteria as FBG 110-125 and 100-125 mg/dL, respectively) in a random sample of 3278 participants aged 35-64 years from the 2013 Namibia Demographic and Health Survey.
Results: The prevalence of diabetes was 5.1% (95% confidence interval [CI]: 4.2-6.2), with no evidence of gender differences (P = 0.45). The prevalence of prediabetes was 6.8% (95% CI 5.8-8.0) using WHO criteria and 20.1% (95% CI 18.4-21.9) using ADA criteria. Male sex, older age, higher body mass index (BMI), and occupation independently increased the odds of diabetes in Namibia, whereas higher BMI was associated with a higher odds of prediabetes, and residing in a household categorized as "middle wealth index" was associated with a lower odds of prediabetes (adjusted odds ratio 0.71; 95% credible interval 0.46-0.99). There was significant clustering of prediabetes and diabetes at the community level.
Conclusions: One in five adult Namibians has prediabetes based on ADA criteria. Resources should be invested at the community level to promote efforts to prevent the progression of this disease and its complications.
背景: 在全世界范围内糖尿病都是一种进展性疾病并且是导致患者过早死亡的主要原因。纳米比亚是一个位于撒哈拉以南(Sub‐Saharan African,SSA)的非洲国家, 目前正处于人口转变之中, 对这个国家的糖尿病以及糖尿病前期的负担知之甚少。
方法: 我们在一个随机样本中(来自2013年纳米比亚人口统计与健康调查, 纳入了3278名年龄35‐64岁的参与者)评估了糖尿病(定义为空腹[毛细血管]血糖[FBG] ≥ 126 mg/dL)与糖尿病前期(根据世界卫生组织[WHO]与美国糖尿病协会[ADA]的标准分别将FBG定义为110‐125与100‐125 mg/dL)的患病率及其相关因素。
结果: 糖尿病的患病率为5.1%(95%置信区间[CI]:4.2‐6.2), 并且没有证据表明其具有性别差异(P = 0.45)。使用WHO标准的糖尿病前期患病率为6.8%(95% CI为5.8‐8.0), 使用ADA标准为20.1%(95% CI为18.4‐21.9)。男性性别、老龄、体重指数(BMI)更高以及工作都可以独立增加纳米比亚人患糖尿病的风险, 而BMI更高还可以导致糖尿病前期的风险更高, 若参与者居住在被归类为“中等财富指数”的家庭中, 那么他们发生糖尿病前期的可能性就比较低(校正后的可能性为0.71;95%置信区间为0.46‐0.99)。在社区层面上, 糖尿病前期与糖尿病都具有显著的聚集性。
结论: 根据ADA标准在每5名纳米比亚成年人中就有1名糖尿病前期患者。为了努力预防这种疾病及其并发症的进展, 我们应当将更多的资源投入到社区这一层面。
Keywords: Namibia; community factors; diabetes; multilevel analysis; socioeconomic status; 多层面分析; 社会经济状况; 社区因素; 糖尿病; 纳米比亚.
© 2018 The Authors. Journal of Diabetes published by John Wiley & Sons Australia, Ltd and Ruijin Hospital, Shanghai Jiaotong University School of Medicine.