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Geographical variation in the progression of type 2 diabetes in Peru: The CRONICAS Cohort Study

Title: Geographical variation in the progression of type 2 diabetes in Peru: The CRONICAS Cohort Study
Authors: Bernabe-Ortiz, A
Carrillo-Larco, RM
Gilman, RH
Miele, CH
Checkley, W
Wells, JC
Smeeth, L
Jaime Miranda, J
Item Type: Journal Article
Abstract: Background The study aims were to estimate the incidence and risk factors for T2D in four settings with different degree of urbanization and altitude in Peru. Methods Prospective cohort study conducted in urban, semi-urban, and rural areas in Peru. An age- and sex-stratified random sample of participants was taken from the most updated census. T2D was defined as fasting blood glucose ⩾7.0 mmol/L or taking anti-diabetes medication. Exposures were divided into two groups: geographical variables (urbanization and altitude), and modifiable risk factors. Incidence, relative risks (RR), 95% confidence intervals (95%CI), and population attributable fractions (PAF) were estimated. Results Data from 3135 participants, 48.8% males, mean age 55.6 years, was analyzed. Overall baseline prevalence of T2D was 7.1% (95%CI 6.2–8.0%). At follow-up, including 6207 person-years of follow-up, a total of 121 new T2D cases were accrued, equating to an incidence of 1.95 (95%CI 1.63–2.33) per 100 person-years. There was no urban to rural gradient in the T2D incidence; however, compared to sea level sites, participants living in high altitude had a higher incidence of diabetes (RR = 1.58; 95%CI 1.01–2.48). Obesity had the highest attributable risk for developing T2D, although results varied by setting, ranging from 14% to 80% depending on urbanization and altitude. Conclusions Our results suggest that the incidence of T2D was greater in high altitude sites. New cases of diabetes were largely attributed to obesity, but with substantial variation in the contribution of obesity depending on the environment. These findings can inform appropriate context-specific strategies to reduce the incidence of diabetes.
Issue Date: 21-Sep-2016
Date of Acceptance: 5-Sep-2016
URI: http://hdl.handle.net/10044/1/52851
DOI: https://dx.doi.org/10.1016/j.diabres.2016.09.007
ISSN: 0168-8227
Publisher: Elsevier
Start Page: 135
End Page: 145
Journal / Book Title: Diabetes Research and Clinical Practice
Volume: 121
Copyright Statement: © 2016 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ).
Keywords: Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
Type 2 diabetes
Incidence
Altitude
Risk factors
Obesity
BODY-MASS INDEX
RISK-FACTORS
SYSTEMATIC ANALYSIS
CARDIOMETABOLIC RISK
INSULIN-RESISTANCE
GLOBAL BURDEN
HIGH-ALTITUDE
21 REGIONS
DISEASE
PREVALENCE
Adult
Aged
Diabetes Mellitus, Type 2
Disease Progression
Female
Follow-Up Studies
Humans
Male
Middle Aged
Peru
Prevalence
Prospective Studies
Risk Factors
Rural Population
Urban Population
CRONICAS Cohort Study Group
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:School of Public Health