Carta Acesso aberto Revisado por pares

HIGH PREVALENCE OF DIABETES MELLITUS IN OLDER PEOPLE IN A RURAL AREA IN LAOS

2006; Wiley; Volume: 54; Issue: 11 Linguagem: Inglês

10.1111/j.1532-5415.2006.00920.x

ISSN

1532-5415

Autores

Kentaro Suzuki, Kiyohito Okumiya, Masayuki Ishine, Taizo Wada, Teiji Sakagami, Matheus Roriz‐Cruz, Idiane Rosset, Tiengkham Pongvongsa, Boungnong Boupha, Kozo Matsubayashi,

Tópico(s)

Diabetes Treatment and Management

Resumo

To the Editor: The global prevalence of diabetes mellitus (DM) has been estimated as 2.8% in 2000 and to become 4.4% in 2030, and the number of people with DM is expected to approximately double between 2000 and 2030.1 However, the most striking demographic change in global terms will be the increase in the proportion of people aged 65 and older.1 There is little population-based epidemiological data on DM in southeast Asia, and the prevalence of DM in Laos remains unknown.1–5 In Laos, a developing Asian country, a previous study found a high prevalence of random blood glucose (RBG) higher than 140 mg/dL (28.3%) and higher than 200 mg/dL (11.6%) in community-dwelling older people.6 The prevalence of DM according to RBG (subjects with RBG≥200 mg/dL or those taking blood glucose–lowering medicine) in community-dwelling older people was much higher in Laos (11.6%) than in other nearby southeast Asian countries in the survey (1.6% in Vietnam, 1.7% in Indonesia, and 5.7% in Myanmar).6–9 In this study, to clarify the exact prevalence of DM and impaired glucose tolerance (IGT), 75-g oral glucose tolerance tests (OGTTs) were conducted in Laos. In the previous study, examination of RBG, medical history interviews, and physical examinations had been conducted on 504 Laotians aged 60 and older (male:female=207:297, mean age 70.2) living in rural villages in the Lahanam and Paxon zones in Songkhon District in Savannakhet Province in Laos. The villages had a total population of 12,009 people, with 744 people aged 60 and older; and 504 older people were examined (67.7% of all eligible subjects). Of those tested, 72 had DM (RBG≥200 mg/dL), 180 had high RBG (110–199 mg/dL), and 252 had normal RBG (<110 mg/dL) (Figure 1). Estimated prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in community-dwelling older people in Laos using 75-g oral glucose tolerance test (OGTT). OGTT was performed on 209 subjects, 82.9% of all people in the district noted with high random blood glucose (RBG) (≥110 mg/dL). NGT=normal glucose tolerance. In 2005, 252 people with high RBG (≥110 mg/dL) were recommended for OGTT; of these, 209 (82.9%) agreed to participate. According to the criteria of the World Health Organization, DM (fasting blood sugar (FBS)≥126 mg/dL or 2-hour plasma glucose (PG)≥200 mg/dL), IGT (FBS 110–125 mg/dL or 2-hour PG 140–199 mg/dL), and normal glucose tolerance (NGT) (FBS<110 mg/dL and 2-hour PG<140 mg/dL) were defined using OGTT, which indicated that there were 28 subjects (18.3%) with DM and 39 (25.5%) with IGT among the 153 subjects with RBG between 110 and 199 mg/dL and 44 subjects (78.6%) with DM and six (10.7%) with IGT among the 56 subjects with RBG of 200 mg/dL or higher (Figure 1). From the results of OGTT, the estimated prevalence of DM or IGT was calculated for all 504 subjects (Figure 1). For this estimate, it was hypothesized that nonresponders in each of the two groups (RBG 110–199 mg/dL or RBG≥200 mg/dL) would have the same prevalence of DM or IGT according to OGTT as the responders. The estimated prevalence of DM and IGT according to OGTT were as much as 17.7% and 10.7%, respectively. Because OGTT was not given to people with normal RBG (<110 mg/dL), some people with IGT or DM who might have had high blood glucose levels only after glucose intake may have been overlooked. A high prevalence of DM and IGT was shown in community-dwelling older people in a rural area of Laos, a developing southeast Asian country. This might reflect that the rate of increase of DM is much faster in developing countries than in developed ones.1,2 By 2030, it is estimated that the number of people aged 65 and older with DM will be 82 million in developing countries and more than 48 million in developed ones.1 Even considering such study limitations as the small data sampling, the high prevalence of DM and IGT in community-dwelling older people in a developing country, Laos, is of particular note. The high prevalence of DM in older people in a rural area in Laos could be associated with factors such as ethnic and genetic vulnerable factors, rapid economic development followed by nutritional transition, and other factors, such as the “fetal origins of disease” hypothesis, which postulates that early undernutrition increases the risk of certain chronic diseases in adulthood.10 It will be necessary to investigate the causes behind the high prevalence of DM and IGT and their risk factors in Laos to prevent not only DM, but also related cardiovascular diseases, which are increasing in Asian countries. Financial Disclosure Kiyohito Okumiya received funding for Project 4–2 of the Research Institute for Humanity and Nature from the Japanese Ministry of Education, Science and Culture. The study was also supported by the overseas grant-in-aid of the Ministry of Health, Labor and Welfare, Japan. Author Contributions: Kentaro Suzuki, Kiyohito Okumiya, Masayuki Ishine, Tiengkham Pongvongsa Boungnong Boupha, and Kozo Matsubayashi conceived and designed the project. All authors participated in the medical survey in Laos. Kentaro Suzuki, Kiyohito Okumiya, and Kozo Matsubayashi were engaged in analysis and interpretation of data and preparation of the manuscript. Sponsor's Role: None.

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