TY - JOUR
T1 - Geographical variation in the progression of type 2 diabetes in Peru
T2 - The CRONICAS Cohort Study
AU - Bernabé-Ortiz, Antonio
AU - Carrillo-Larco, Rodrigo M.
AU - Gilman, Robert H.
AU - Miele, Catherine H.
AU - Checkley, William
AU - Wells, Jonathan C.
AU - Smeeth, Liam
AU - Miranda, J. Jaime
N1 - Funding Information:
This project has been funded in whole with Federal funds from the United States National Heart, Lung, and Blood Institute , National Institutes of Health , Department of Health and Human Services , under Contract No. HHSN268200900033C. William Checkley was further supported by a Pathway to Independence Award ( R00HL096955 ) from the National Heart, Lung and Blood Institute. Liam Smeeth is a Senior Clinical Fellow and Antonio Bernabe-Ortiz is a Research Training Fellow in Public Health and Tropical Medicine (103994/Z/14/Z), both funded by Wellcome Trust .
Publisher Copyright:
© 2016 The Authors
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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.
AB - 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.
KW - Altitude
KW - Incidence
KW - Obesity
KW - Risk factors
KW - Type 2 diabetes
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U2 - 10.1016/j.diabres.2016.09.007
DO - 10.1016/j.diabres.2016.09.007
M3 - Article
C2 - 27710820
AN - SCOPUS:84989329200
SN - 0168-8227
VL - 121
SP - 135
EP - 145
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -