Prevalence of prediabetes and associated factors of prediabetic stages: a cross-sectional study among adults in Nepal

Abstract

ObjectivesTo estimate the prevalence of prediabetes and to assess the association of prediabetic stages with sociodemographic, lifestyle and clinical factorsDesignCross-sectional study at the screening and inclusion stage of a Diabetes Prevention Education Program (DiPEP) trialSettingThe study was conducted in two urban communities in Nepal (October 2019–March 2020).ParticipantsA total of 6222 residents of two study sites, aged 18–64 years and without a history of diabetes, were eligible for prediabetes screening. Exclusion criteria were pregnancy, history of diabetes and critical illness. A total of 291 participants with prediabetes were included in this study.Primary and secondary outcome measuresPrevalence of prediabetes based on glycated haemoglobin (HbA1c) criteria (5.7%–6.4%) was the primary outcome of the study. Odds Ratio and 95% CI were estimated to assess the associations between the outcome prediabetic stages (5.7%–5.9% vs 6.0%–6.4%) and sociodemographic, lifestyle and clinical factors in both unadjusted and adjusted models.ResultsOut of 6222 screened participants, 308 (5%, 95% CI: 4.4% to 5.5%) individuals were detected with prediabetes based on HbA1c. The mean age of 291 responded participants was 50.3±7.6 years and 67% were females. Among them, 78% aged 45–64 years, 97% had central obesity, 90% had high waist–hip ratio, 63% were hypertensive and 66% had no family history of diabetes. Approximately, 54% and 46% of individuals with prediabetes had HbA1c of 5.7%–5.9% and 6.0%–6.4%, respectively. Female gender was associated with prediabetes with HbA1c 6.0%–6.4% (OR, 1.98, 95% CI: 1.07 to 3.67) in the adjusted model.ConclusionThe estimated prevalence of prediabetes was 5% among screened participants, and female gender was associated with the prediabetic stage. As a large proportion of the population with prediabetes were not aware of their status, this study demonstrates a need for regular community screening programmes to detect individuals with prediabetes and provide them a comprehensive lifestyle intervention for diabetes prevention.Trial registration numberNCT04074148, 2019/783.

How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal

“…The RCT took place in two urban community settings in Nepal (Patan and Dhulikhel) [ 9 , 36 ]. However, due to the practical consequences of the COVID-19 lockdown, the qualitative study included participants in the intervention arm of the RCT from Patan only.…”

“…Individuals included in the present qualitative study met the following inclusion criteria: prediabetes detected by HbA1c 5.7–6.4%; age of 18–64 years; participation in the intervention arm of the RCT [ 9 , 36 ]; attendance at a minimum of one of the four educational sessions; access to the internet, as the interviews were performed digitally due to COVID-19 lockdown. To ensure diversity in the study sample, participants were purposively selected considering gender, education level, ethnic group, physical or digital participation in the intervention, and the number of educational sessions attended.…”

“…A meta-analysis has shown that the prevalence of prediabetes in Nepal was 9.2% in 2020 [ 8 ]. In the urban settings of Nepal, the prevalence of prediabetes determined by HbA1c was 5% [ 9 ]. The annual risk of development of type 2 diabetes (T2D) among individuals with prediabetes has been estimated to be 5–10% [ 10 , 11 ].…”

Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal

“…DCA Vantage 2000 HbA1c analyser was used for the POC HbA1c test 24. The details of these factors are discussed elsewhere 19 25…”

“…Baseline data included sociodemographic characteristics (marital status, education, occupation, living status, annual household per capita income), clinical history (history of pre-diabetes and history of hypertension), lifestyle characteristics (smoking history, history of alcohol intake, diet intake, physical activity and sleep history), anthropometric measurement (weight and height) and blood pressure measurement. Details have been published elsewhere 19 25…”