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Abstract
Objective The second National Diabetes Survey of Pakistan (second NDSP) was planned to ascertain the updated prevalence of diabetes, pre-diabetes and associated risk factors at the national and provincial levels.
Research design and methods The survey was conducted by using multistage clustering technique in all four provinces of Pakistan from February 2016 to August 2017. An estimated sample size of 10 800 was calculated using probability sampling and multistage stratified sampling technique. Twenty-seven clusters were selected out of total 213 clusters from all four provinces (strata) of Pakistan. A total of 46 subclusters were selected by using the ‘Rule of thumb’. Out of 12 486 targeted individuals, 10 834 study subjects finally participated in the study (87% response rate). Seventeen trained teams collected data using the structured questionnaire. The clinical and anthropometric measurements included height, weight, blood pressure, waist circumference and waist-to-hip ratio while the blood tests included Oral Glucose Tolerance Test (OGTT), haemoglobin A1c and fasting lipid profiles. WHO criteria were used for the diagnosis of diabetes and pre-diabetes.
Results Overall weighted prevalence of diabetes was 26.3%, of which 19.2% had known diabetes, and 7.1% were newly diagnosed people with diabetes. Prevalence of diabetes in urban and rural areas was 28.3% and 25.3%, respectively. Prevalence of pre-diabetes was 14.4% (15.5% in urban areas and 13.9% in rural areas). Age greater than or equal to 43 years, family history of diabetes, hypertension, obesity and dyslipidaemia were significant associated risk factors for diabetes.
Conclusion The findings of the 2nd NDSP imply that diabetes has reached epidemic proportion and urgently need national strategies for early diagnosis and effective management as well as cost-effective diabetes primary prevention programme in Pakistan.
- epidemiology
- general diabetes
- public health
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Footnotes
Contributors AB: concept, design, interpretation of data, wrote and approved the final submitted version. AF: concept, design, literature search, designing quality assurance measures, research data, wrote and approved the final submitted version. HQ: involved in the quality control, edited and approved the final submitted version. ASS: concept, design and involved in the quality control. NDSP members were responsible for the supervision of the survey, concept, design, involved in the quality control and data management in their respective areas. All members approved the final submitted version. AB and AF are the guarantors and undertake the full responsibility for the contents of the article submitted for publication.
Funding Haemoglobin A1cs and lipid profiles were performed by Pakistan Health Research Council (PHRC). Field visits and data collection including clinical and anthropometric measurements and also fasting plasma glucose and 2-hour post/glucose load samples were run by the respective teams through their own funds. The whole survey was coordinated and supported by the Baqai Institute of Diabetology & Endocrinology (BIDE) on their own resources.
Competing interests None declared.
Patient consent Obtained.
Ethics approval National Bioethics Committee (NBC) of Pakistan (Ref: No.4-87/17/NBC-226/NBC/2664).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Collaborators NDSP members (with surnames in alphabetical order): (1) Dr Mujeeb Ur Rehman Abro, Assistant Professor of Medicine, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh; (2) Dr Khawaja Ishfaq Ahmed, Ex-PGR, Pakistan Institute of Medical Sciences, Islamabad, Punjab; (3) Dr Khurshid Ahmed, Consultant Physician, Zahid Medical Centre, Hub, Baluchistan; (4) Dr Sobia Sabir Ali, Assistant Professor, Department of Diabetes and Endocrinology, Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa; (5) Professor Ahmed Bilal, Professor and Head of Medical Department Faisalabad Medical College, Faisalabad, Punjab; (6) Dr Anam Butt, Research Officer, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Sindh; (7) Professor Bikha Ram Devrajani, Chairman, Department of Medicine and Director Sindh Institute of Endocrinology and Diabetes, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh; (8) Mr Ijaz Hayder, Research Officer, Pakistan Health Research Council, Karachi, Sindh; (9) Dr Yasir Humayun, EPI coordinator, DHO Office, Mansehra, Khyber Pakhtunkhwa; (10) Mrs Rabia Irshad, Research Officer, Pakistan Health Research Council, Karachi, Sindh; (11) Dr Riasat Ali Khan, Diabetologist, Canada Medical Group Hospital, Defence, Karachi, Sindh; (12) Dr Asima Khan, Head of Diabetes Department, Sindh Government Hospital, New Karachi, Karachi, Sindh; (13) Dr Aamir Akram Khowaja, Postgraduate Resident, Sindh Government Qatar Hospital, Karachi, Sindh; (14) Dr Raheela Khowaja, Postgraduate Resident, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Sindh; (15) Professor Qazi Masroor, Professor of Medicine and Head of Department, Quaid-e-Azam Medical College, Bahawalpur, Punjab; (16) Dr Maqsood Mehmood, Head of Department, Fatma tu Zahra Hospital, Gujranwala, Punjab; (17) Mr Hassan Moin, Statistician, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Sindh; (18) Dr Wasif Noor, Diabetologist, Akhuwat Health Services Diabetes Centre, Lahore, Punjab; (19) Mr Ibrar Rafique, Research Officer, Pakistan Health Research Council, Islamabad, Punjab; (20) Dr Tahir Rasool, Diabetologist, Akhuwat Health Services Diabetes Centre, Lahore, Punjab; (21) Mrs Rubina Sabir, Laboratory Manager, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Sindh; (22) Dr M Arif N Saqib, Senior Research Officer, Pakistan Health Research Council, Islamabad, Punjab; (23) Dr Pir Alam Said, Medical Specialist DHQ, Sawabi, Khyber Pakhtunkhwa; (24) Professor Abrar Shaikh, Head Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, Sindh; (25) Mr Bilal Tahir, NDSP Coordinator, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Sindh; (26) Professor Salma Tanveer, Professor of Medicine, In-charge Diabetes and Endocrinology, Nishter Medical University, Multan, Punjab; (27) Professor Bilal Bin Younus, Head of Sakeena Institute of Diabetes & Endocrine Research, Lahore, Punjab; (28) Professor Jamal Zafar, Professor of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Punjab.