Diabetes incidence and projections from prevalence surveys in Fiji

Abstract

BackgroundType 2 diabetes mellitus (T2DM) incidence is traditionally derived from cohort studies that are not always feasible, representative, or available. The present study estimates T2DM incidence in Fijian adults from T2DM prevalence estimates assembled from surveys of 25–64 year old adults conducted over 30 years (n = 14,288).MethodsT2DM prevalence by five-year age group from five population-based risk factor surveys conducted over 1980–2011 were variously adjusted for urban-rural residency, ethnicity, and sex to previous censuses (1976, 1986, 1996, 2009) to improve representativeness. Prevalence estimates were then used to calculate T2DM incidence based on birth cohorts from the age-period (Lexis) matrix following the Styblo technique, first used to estimate annual risk of tuberculosis infection (incidence) from sequential Mantoux population surveys. Poisson regression of year, age, sex, and ethnicity strata (n = 160) was used to develop projections of T2DM prevalence and incidence to 2020 based on various scenarios of population weight measured by body mass index (BMI) change.ResultsT2DM prevalence and annual incidence increased in Fiji over 1980–2011. Prevalence was higher in Indians and men than i-Taukei and women. Incidence was higher in Indians and women. From regression analyses, absolute reductions of 2.6 to 5.1% in T2DM prevalence (13–26% lower), and 0.5–0.9 per 1000 person-years in incidence (8–14% lower), could be expected in 2020 in adults if mean population weight could be reduced by 1–4 kg, compared to the current period trend in weight gain.ConclusionsThis is the first application of the Styblo technique to calculate T2DM incidence from population-based prevalence surveys over time. Reductions in population BMI are predicted to reduce T2DM incidence and prevalence in Fiji among adults aged 25–64 years.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0114-0) contains supplementary material, which is available to authorized users.

Obesity and incidence of diabetes: Effect of absence of metabolic syndrome, insulin resistance, inflammation and fatty liver

“…Incidence of T2DM was ~90% lower among obese people who do not have any other MetS components, or evidence of IR, inflammation and fatty liver, than among the group with one or more of these metabolic abnormalities. The overall incidence of T2DM in our study is similar to that described in many cohorts from different regions around the world [1,[25][26][27][28][29].…”

End‐stage kidney disease in Fiji

“…The high incidence of ESKD in Fiji may be attributable to the very high burden of non‐communicable diseases. Obesity, diabetes and hypertension have increased in Fiji over several decades and are predicted to continue steadily rising . In 2011, the STEPwise approach to Surveillance (STEPS) survey of adults in Fiji found a high prevalence of overweight (32.1%), raised blood pressure ≥140/90 mm Hg (29.6%) and raised fasting glucose (29.6%) .…”

“…Obesity, diabetes and hypertension have increased in Fiji over several decades and are predicted to continue steadily rising. [21][22][23] In 2011, the STEPwise approach to Surveillance (STEPS) survey of adults in Fiji found a high prevalence of overweight (32.1%), raised blood pressure ≥140/90 mm Hg (29.6%) and raised fasting glucose (29.6%). 24 Our findings with regards to diabetes as the dominant reported cause of ESKD are consistent with this epidemiological data.…”

Global burden of diabetes: regional disparities in prevalence, incidence, and mortality

“…One study reported data on recent trends in DM incidence in Fiji [42], and it showed rates on a constant rise (from 261 per 100,000 in 1980 to 502 per 100,000 per year in 2011) (Fig. 2).…”