RESUMO
BACKGROUND: It is estimated that 37% of Mexican adults have undiagnosed diabetes, and are therefore at high risk of developing the severe and devastating complications associated to it. In recent years, a variety of screening tools based on the characteristics of the adult Mexican population have been proposed in order to reduce the negative effects of the disease. OBJECTIVES: To assess the performance of screening models to diagnose diabetes in the Mexican adult population and to propose a screening model based on HbA1c measurements. MATERIALS AND METHODS: Data from the 2016 Halfway National Health and Nutrition Survey (NHNS) were used to assess the screening models and to develop and validate the proposed 2016 NHNS model, built using a multivariate logistic regression model. Explanatory variables included in the 2016 NHNS 2016 model were selected through a stepwise backward procedure, using sensitivity and specificity as performance indicators. RESULTS: Of the screening models assessed, only the model based on the 2006 NHNS survey showed a performance consistent with previous reports. The proposed 2016 NHNS model included age, waist circumference, and systolic blood pressure as explanatory variables and showed a sensitivity of 0.72 and a specificity of 0.80 in the validation data set. CONCLUSIONS: Age, waist circumference, and systolic blood pressure are variables of special importance for early detection of undiagnosed diabetes in Mexican adults. Based on the consistent performance of the 2006 NHNS model in different data sets, its use as a screening tool for adults with undiagnosed diabetes in Mexico is recommended.
Assuntos
Diabetes Mellitus/diagnóstico , Programas de Rastreamento , Modelos Teóricos , Adulto , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Inquéritos NutricionaisRESUMO
BACKGROUND: Prevalence of diabetes in Mexico has constantly increased since 1993. Since type 2 diabetes may remain undiagnosed for many years, identification of subjects at high risk of diabetes is very important to reduce its impact and to prevent its associated complications. OBJECTIVE: To develop easily implementable screening models to identify subjects with undiagnosed diabetes based on the characteristics of Mexican adults. SUBJECTS AND METHODS: Screening models were developed using datasets from the 2006 and 2012 National Health and Nutrition Surveys (NHNS). Variables used to develop the multivariate logistic regression models were selected using a backward stepwise procedure. Final models were validated using data from the 2000 National Health Survey (NHS). RESULTS: The model based on the 2006 NHNS included age, waist circumference, and systolic blood pressure as explanatory variables, while the model based on the 2012 NHNS included age, waist circumference, height, and family history of diabetes. The sensitivity and specificity values obtained from the external validation procedure were 0.74 and 0.62 (2006 NHNS model) and 0.76 and 0.55 (2012 NHNS model) respectively. CONCLUSIONS: Both models were equally capable of identifying subjects with undiagnosed diabetes (â¼75%), and performed satisfactorily when compared to other models developed for other regions or countries.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Programas de Rastreamento/métodos , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Conjuntos de Dados como Assunto , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , Modelos Logísticos , México/epidemiologia , Pessoa de Meia-Idade , Modelos Teóricos , Inquéritos Nutricionais , Exame Físico , Autorrelato , Sensibilidade e Especificidade , Circunferência da Cintura , Adulto JovemRESUMO
PURPOSE: The purpose of the study was to examine the prevalence and determinants of prediabetes, undiagnosed diabetes, and diabetes among Mexican adults from a subsample of the Mexican Health and Aging Study. METHODS: We examined 2012 participants from a subsample of the Mexican Health and Aging Study. Measures included sociodemographic characteristics, body mass index, central obesity, medical conditions, cholesterol, high-density lipoprotein cholesterol, hemoglobin A1c, and vitamin D. Logistic regression was performed to identify factors associated with prediabetes, undiagnosed diabetes, and self-reported diabetes. RESULTS: Prevalence of prediabetes, undiagnosed, and self-reported diabetes in this cohort was 44.2%, 18.0%, and 21.4%, respectively. Participants with high waist-hip ratio (1.61, 95% confidence interval [CI] = 1.05-2.45) and high cholesterol (1.85, 95% CI = 1.36-2.51) had higher odds of prediabetes. Overweight (1.68, 95% CI = 1.07-2.64), obesity (2.38, 95% CI = 1.41-4.02), and high waist circumference (1.60, 95% CI = 1.06-2.40) were significantly associated with higher odds of having undiagnosed diabetes. Those residing in a Mexican state with high U.S. migration had lower odds of prediabetes (0.61, 95% CI = 0.45-0.82) and undiagnosed diabetes (0.53, 95% CI = 0.41-0.70). Those engaged in regular physical activity had lower odds of undiagnosed diabetes (0.74, 95% CI = 0.57-0.97). CONCLUSIONS: There is a high prevalence of prediabetes and undiagnosed diabetes among Mexican adults in this subsample. Findings suggest the need for resources to prevent, identify, and treat persons with prediabetes and undiagnosed diabetes.