Prevalence and determinants of type 2 diabetes mellitus in a Greek adult population

Abstract

the prevalence of diabetes mellitus (dM) is increasing worldwide reaching epidemic proportions. the aim of the present study was to estimate the prevalence of dM in thessaly, a large region of central Greece, and to extrapolate our results to the population of the entire country. A random sample of 805 adults (421 females and 384 men) living in thessaly, aged 18-80 years, was surveyed. After completing a questionnaire about health status and a thorough physical examination, a blood sample was obtained from each participant for biochemical analysis. Participants with fasting glucose levels between 100-125 mg/dl underwent an oral glucose tolerance test (oGtt). A second survey was also conducted, via telephone call-interviews, in a randomly selected sample age-and sex-stratified to the country's adult population in order to extrapolate the dM data from thessaly to the whole country. the frequency of dM based on patient history and fasting blood glucose levels was 6.96%, comparable to that observed in the telephone-based nationwide survey (7.38%, p=0.669). However, after the oGtt an additional 3.72% of the population had undiagnosed dM, increasing dM prevalence to 10.68% (age adjusted 11.77%). the prevalence of pre-diabetes was 8.70%, with impaired fasting glucose at 5.84% and impaired glucose tolerance at 2.86%. the prevalence of dM was significantly higher in men (14.58%) than in women (7.13%, p<0.001), increased with age in both sexes and was more prevalent in hypertensive (p<0.001) and obese subjects (p=0.001) and in those living in rural areas (p=0.003). In the multiple logistic regression analysis, significant predictors of pre-diabetes and dM together were age, homeostasis model of assessment of insulin resistance (HoMA-IR), alcohol consumption and educational status, whereas those of dM alone were age, HoMA-IR and triglycerides. extrapolating our data to the whole country, the age-adjusted prevalence of dM was estimated at 11.97% (men 13.98%, women 9.25%), clearly indicating a major public health problem.

Trends in epidemiology of diabetes mellitus in Greece. Review of the major epidemiological studies

“…In the Thessaly study [8], the incidence in the 70-80 age group was 37.5%, while in the 40-49 age group it was only 8.37%. The reduction in the mortality of diabetic individuals due to better access to medical care is also a fact.…”

“…The study of Thessaly region by Koukoulis et al [8] concerns the period [2003][2004][2005]. It involved carrying out glucose measurements, and additionally performing an OGTT, which further increased the sensitivity of the study and therefore higher prevalence rates are expected.…”

“…In the above mentioned Thessaly survey in 2003-2005 [8], a partial analysis of the results showed an increased incidence of DM in rural areas. Figure 2 illustrates the huge (10-fold) overtime increase in the prevalence of DM in the rural population of Greece.…”

“…The Attica, Thessaly and Argolida studies [7,8,15], were performed with blood glucose measurements and with OGTT, and reported that about 30% of diabetics were not hitherto diagnosed. Because of the increased awareness of the population in recent years, which resulted in increased screening and earlier diagnosis, it would have been reasonable a "factitious" increase in the prevalence of DM.…”

Sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for type 2 diabetes: a narrative review with emphasis on data from Europe

“…The association between T2DM risk and additional metabolic syndrome components (e.g. hypertension and dyslipidemia) has been also investigated in various European studies [22,24,34]. As such, data from studies in Italy and Greece showed 2-to 3-fold higher T2DM incidence in patients with hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or treatment for hypertension) compared to normotensive individuals, further indicating that hypertension is independently associated with higher T2DM risk [22,24].…”