Epidemiology/Health Services/Psychosocial Research ORIGINAL ARTICLE High Prevalence of Diabetes in Adana, a Southern Province of Turkey 1 4 ADNAN GOKCEL, MD MUHSIN AKBABA, MD widely between populations, reflecting 2 1 AKATLI KURSAT OZSAHIN, MD NUH BAKLACI, MD differences in both environmental influ- 3 5 NURZEN SEZGIN, MD AYSEGUL SENGUL, MD ences and genetic susceptibility (5). In 1 1 HATICE KARAKOSE, MD NILGUN GUVENER, MD 1 Turkey, there have been a number of pop- MELEK EDA ERTORER, MD ulation-based studies of diabetes preva- lence, and screening programs started in the 1940s. Nearly 1 million subjects have been screened to date, but because of dif- ferent methodologies and lack of stan- OBJECTIVE — To determine the prevalence of diabetes and glucose intolerance and their dardization between studies, considerable relationship with risk factors in Adana, a southern province of Turkey, where risk factors are more prominent, probably because of social and economic reasons. variations in diabetes prevalence have been reported, even in the same area (6–8). RESEARCH DESIGN AND METHODS — The study population included 1,637 ran- The objective of this study was to de- domly selected adults aged 20–79 years. Diagnosis of diabetes was based on plasma glucose termine the prevalence of diabetes and values using the 1999 diagnostic criteria recommended by the World Health Organization. glucose intolerance and their relationship with risk factors in Adana, a southern RESULTS — The crude prevalence of diabetes was 12.9% in men and 10.9% in women (P ϭ province of Turkey, where risk factors are 0.207). Total prevalence of diabetes was 11.6%. The screening process identified previously more prominent, probably because of so- undiagnosed diabetes in 4.2% of individuals and impaired glucose homeostasis (consisting of cial and economic reasons. impaired glucose tolerance and impaired fasting glucose) in an additional 4.3% of subjects. The prevalence of hypertension was 26.4% among men and 36.6% among women (P Ͻ 0.0001). Total prevalence of hypertension was 32.9%, and prevalence of obesity was 43.4%. Age, sex, RESEARCH DESIGN AND BMI, waist circumference, hypertension, family history of diabetes, and triglycerides were inde- METHODS — The study was con- pendently associated with diabetes. ducted in 18 (9 urban and 9 rural) areas in Adana. The study population included CONCLUSIONS — The prevalence of diabetes in Adana is higher than expected in both randomly selected nonpregnant adults urban and rural areas. Obesity and hypertension also seem to be common metabolic disorders in 20–79 years of age. Areas and study sub- this area. Age, hypertension, obesity, high triglyceride level, and family history of diabetes are jects were randomly selected from the independently associated with diabetes. Therefore, primary prevention through lifestyle modi- fications may have a critical role in the control of diabetes. electoral roll, which was taken from the National Statistics Institute. A written in- ϳ Diabetes Care 26:3031–3034, 2003 vitation was sent 2 weeks before the survey to officials of the villages or quar- ters. A total of 2,000 subjects (900 men and 1,100 women) were invited to partic- ype 2 diabetes is recognized as a ma- control delays many of these complica- ipate in the study. Of those, 1,637 sub- jor global health problem, and its tions in patients with diabetes. Typically, jects (607 men and 1,030 women) prevalence has been rising around it has been an asymptomatic disease for T participated. The response rate was the world (1). Individuals with diabetes many years and about half of diabetic in- 78.6% for men and 93.6% for women. All have an increased risk of developing sig- dividuals are unrecognized (3). Type 2 di- subjects gave informed consent, and the nificant end-organ damage such as reti- abetes is usually only recognized 5–12 study protocol was approved by the nopathy, nephropathy, neuropathy, and years after hyperglycemia develops (4). Baskent University Internal Review cardiovascular disease (2). Tight glucose The prevalence of diabetes varies ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● Board. Between 7:00 and 10:00 A.M. each From the 1Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana, ϳ Turkey; the 2Department of Family Medicine, Baskent University Faculty of Medicine, Adana, Turkey; the day, 100 individuals were invited to the 3Department of Biochemistry, Baskent University Faculty of Medicine, Adana, Turkey; the 4Department of health station after an overnight fast. An- Public Health, Cukurova University Faculty of Medicine, Adana, Turkey; and the 5Department of Internal thropometric and demographic data were Medicine; Baskent University Faculty of Medicine, Adana, Turkey. obtained for each subject. Age, sex, and Address correspondence and reprint requests to Adnan Gokcel, MD, Baskent University, Medical Faculty, personal and family history of hyperten- Department of Internal Medicine, Division of Endocrinology and Metabolism, Dadaloglu Mah, Serin Evler 39, Sok. No. 6, 01250, Yuregir, Adana, Turkey. E-mail: [email protected]. sion, coronary artery disease, and diabe- Received for publication 14 April 2003 and accepted in revised form 24 July 2003. tes were recorded for all subjects. Weight, Abbreviations: dBP, diastolic blood pressure; FPG, fasting plasma glucose; IFG, impaired fasting glucose; height, and waist circumference were IGT, impaired glucose tolerance; OGTT, oral glucose tolerance test; sBP, systolic blood pressure; TURDEP, measured for each subject; BMI and vis- Turkish Diabetes Epidemiology Study. A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion ceral obesity were determined from these factors for many substances. parameters. Body weight and height were © 2003 by the American Diabetes Association. measured while subjects wore light cloth- DIABETES CARE, VOLUME 26, NUMBER 11, NOVEMBER 2003 3031 High prevalence of diabetes in Adana ing without shoes. BMI was calculated as Table 1—Prevalence of known and new diabetes, IGT, and IFG by age weight (in kilograms) divided by the square of height (in meters). Subjects with Normal Ն 2 Ͻ 2 aBMI 25 kg/m but 30 kg/m were glucose Known New IGT and classified as overweight, and those with a tolerance diabetes diabetes IGT only IFG only IFG BMI Ն30 kg/m2 were classified as obese. Waist circumference was measured with a Age 20–29 years soft tape on standing subjects midway be- Total 221 (98.2) 1 (0.4) — 1 (0.4) 2 (0.9) — tween the lowest rib and the iliac crest. Men 82 (100) ————— Visceral obesity was defined as a waist cir- Women 139 (92.7) 1 (0.7) — 1 (0.7) 2 (1.4) — cumference Ͼ88 cm in women and Ͼ102 Age 30–39 years cm in men. Systolic blood pressure (sBP) Total 280 (92.7) 10 (3.3) 6 (2.0) 4 (1.3) 1 (0.3) 1 (0.3) and diastolic blood pressure (dBP) were Men 102 (87.9) 6 (5.2) 5 (4.3) 2 (1.7) — 1 (0.9) measured twice in the sitting position af- Women 178 (95.7) 4 (2.2) 1 (0.5) 2 (1.1) 1 (0.5) — ter a 15-min rest, and the mean was taken Age 40–49 years in all cases. Hypertension was defined as Total 339 (86.0) 23 (5.8) 15 (3.8) 10 (2.5) 6 (1.5) 1 (0.3) sBP Ն140 mmHg, dBP Ն90 mmHg, or Men 136 (83.4) 13 (8.0) 6 (3.7) 4 (2.5) 3 (1.8) 1 (0.6) the use of antihypertensive agents. Women 203 (87.9) 10 (4.3) 9 (3.9) 6 (2.6) 3 (1.3) — Blood samples were drawn after 8–12 Age 50–59 years h fasting for the measurement of lipid Total 244 (74.6) 35 (10.7) 24 (7.3) 13 (4.0) 8 (2.4) 3 (0.9) profile (total cholesterol, HDL choles- Men 80 (70.8) 13 (11.5) 11 (9.7) 5 (4.4) 2 (1.8) 2 (1.8) terol, and triglycerides) and fasting glu- Women 164 (76.6) 22 (10.3) 13 (6.1) 8 (3.7) 6 (2.8) 1 (0.50) cose levels. A 75-g oral glucose tolerance Age 60–69 years test (OGTT) was performed in all nondi- Total 190 (74.8) 38 (15.0) 17 (6.7) 4 (1.6) 4 (1.6) 1 (0.4) abetic subjects. Samples for the measure- Men 59 (73.8) 13 (16.3) 6 (7.5) 1 (1.3) — 1 (1.3) ment of plasma glucose were drawn at 0 Women 131 (75.3) 25 (14.4) 11 (6.3) 3 (1.7) 4 (2.3) — and 120 min during the OGTT. They Age 70–79 years were centrifuged, and plasma was trans- Total 102 (75.6) 14 (10.4) 7 (5.2) 5 (3.7) 4 (3.0) 3 (2.2) ferred to separate tubes, transferred im- Men 40 (75.5) 4 (7.5) 1 (1.9) 4 (7.5) 2 (3.8) 2 (3.8) mediately to the laboratory in cold boxes Women 62 (75.6) 10 (12.2) 6 (7.3) 1 (1.2) 2 (2.4) 1 (1.2) filled with ice (2–8°C), and analyzed on Total 1,376 (84.1) 121 (7.4) 69 (4.2) 37 (2.3) 25 (1.5) 9 (0.5) the same day. Levels of plasma glucose, Men 499 (82.2) 49 (8.1) 29 (4.8) 16 (2.6) 7 (1.2) 7 (1.2) total cholesterol, HDL cholesterol, and Women 877 (85.1) 72 (7.0) 40 (3.9) 21 (2.0) 18 (1.7) 2 (0.3) triglycerides were determined by the en- Data are n (%). P Ͻ 0.0001. zymatic spectrophotometric method us- ing an Aeroset autoanalyzer (Abbott Laboratories, Chicago, IL).