Highlights
- •Nation-wide representative data are needed to capture prevalence of diabetes and pre-diabetes correctly.
- •Total diabetes prevalence in Greece was found at 11.9%.
- •Pre-diabetes prevalence was found at 12.4%.
- •Unknown diabetes prevalence was low (1.5%).
Abstract
Aims
To report the results of the first national Health Examination Survey (HES) on the
prevalence of diabetes, its pharmacologic treatment and level of control, as well
as pre-diabetes in Greece.
Methods
Data were derived from the National Survey of Morbidity and Risk Factors (EMENO),
in a randomly selected, representative sample of the adult Greek population. Sampling
weights were applied to adjust for study design and post-stratification weights to
match sample age/sex distribution to the population. Non-response was adjusted by
inverse probability weighting. Weighted prevalence estimates are provided.
Results
A total of 4393 persons with HbA1c and/or fasting plasma glucose measurements were
included. Total diabetes prevalence was 11.9% (95% CI: 10.9–12.9), known diabetes
10.4% (9.5–11.4), and unknown 1.5% (1.1–1.9), with considerable increase in older
age groups and no difference between genders. Pre-diabetes prevalence was 12.4% (11.4–13.6).
The majority of persons with known diabetes were receiving metformin. Of those with
known diabetes (and measured HbA1c), 70.9% were well controlled (HbA1c <7.0%).
Conclusions
This first representative national HES showed high prevalence of diabetes in Greece,
with low prevalence of unknown diabetes. Pre-diabetes prevalence is also substantial.
These results will hopefully enable national authorities develop tailored and efficient
strategies for disease prevention and management.
Keywords
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References
WHO. Global Report on Diabetes. Isbn 2016;978:1–88. doi:ISBN 978 92 4 156525 7.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Practice 2019;157:107843. doi:10.1016/j.diabres.2019.107843.
- Global epidemiology of prediabetes - present and future perspectives.Clin Diabetes Endocrinol. 2019; 5: 5https://doi.org/10.1186/s40842-019-0080-0
- Evidence of nephropathy and peripheral neuropathy in US adults with undiagnosed diabetes.Ann Family Med. 2006; 4: 427-432https://doi.org/10.1370/afm.577
- The burden of diabetes and its complications: Trends and implications for intervention.Diabetes Res Clin Pract. 2007; 76: S3-S12https://doi.org/10.1016/j.diabres.2007.01.019
- Global economic burden of diabetes in adults: projections from 2015 to 2030.Diabetes Care. 2018; 41: 963-970https://doi.org/10.2337/dc17-1962
- Hidden diabetes in the UK: use of capture-recapture methods to estimate total prevalence of diabetes mellitus in an urban population.J Royal Soc Med. 2003; 96: 328-332
- Evidence for an increase in the prevalence of known diabetes in a sample of an urban population in Greece.Diabetic Med J Br Diabetic Assoc. 1993; 10: 87-90
- Measuring the prevalence of diabetes mellitus in a Greek primary health care district.Family Pract. 1996; 13: 18-21
- The epidemiology of Type 2 diabetes mellitus in Greek adults: the ATTICA study.Diabetic Med J Br Diabetic Assoc. 2005; 22: 1581-1588https://doi.org/10.1111/j.1464-5491.2005.01731.x
- Increased prevalence of diabetes mellitus in a rural Greek population.Rural Remote Health. 2006; 6: 534
- Rising prevalence of diabetes among Greek adults: findings from two consecutive surveys in the same target population.Diabetes Res Clin Pract. 2008; 79: 325-329https://doi.org/10.1016/j.diabres.2007.09.002
- Prevalence of major cardiovascular risk factors and coronary heart disease in a sample of greek adults: the saronikos study.Open Cardiovasc Med J. 2016; 10: 69-80https://doi.org/10.2174/1874192401610010069
- Diet, life-style and cardiovascular morbidity in the rural, free living population of Elafonisos island.BMC Public Health. 2017; 17: 147https://doi.org/10.1186/s12889-017-4053-x
- Prevalence of diabetes mellitus and obesity in the general adult population of Greece: a door-to-door epidemiological study.Diabetic Med J Br Diabetic Assoc. 2009; 26: 451-452https://doi.org/10.1111/j.1464-5491.2009.02692.x
- The prevalence and treatment patterns of diabetes in the Greek population based on real-world data from the nation-wide prescription database.Diabetes Res Clin Pract. 2016; 118: 162-167https://doi.org/10.1016/j.diabres.2016.06.018
- Validation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in Greece.Diabetes Metab. 2011; 37: 144-151
- Estimating disease prevalence and incidence using administrative data: Some assembly required.J Rheumat. 2013; 40: 1241-1243https://doi.org/10.3899/jrheum.130675
- Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health And Nutrition Examination Survey 1999-2002.Diabetes Care. 2006; 29: 1263-1268https://doi.org/10.2337/dc06-0062
- Prevalence of and trends in diabetes among adults in the United States, 1988–2012.JAMA. 2015; 314: 1021-1029https://doi.org/10.1001/jama.2015.10029
- Temporal changes in the prevalence of diagnosed diabetes, undiagnosed diabetes and prediabetes: findings from the German health interview and examination surveys in 1997–1999 and 2008–2011.Diabetic Med J Br Diabetic Assoc. 2016; 33: 1406-1414https://doi.org/10.1111/dme.13008
- National Survey of Morbidity and Risk Factors (EMENO): Protocol for a Health Examination Survey Representative of the Adult Greek Population.JMIR Res Protoc. 2019; 8: e10997https://doi.org/10.2196/10997
- The declaration of helsinki and public health.Bull World Health Org. 2008; 86: 650-652
- Epidemiology of cardiovascular risk factors in Greece: aims, design and baseline characteristics of the ATTICA study.BMC Public Health. 2003; 3: 32https://doi.org/10.1186/1471-2458-3-32
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus*. Follow-up Report on the Diagnosis of Diabetes Mellitus. Diabetes Care 2003;26:3160–7. doi:10.2337/diacare.26.11.3160.
- International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes.Diabetes Care. 2009; 32: 1327-1334https://doi.org/10.2337/dc09-9033
Diabetes mellitus. Report of a WHO Study Group. World Health Organization - Technical Report Series 1985:Tech. Rep. Ser., no. 727. doi:10.7326/0003-4819-104-4-597_2.
American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43:S66–76. doi:10.2337/dc20-S006.
- The analysis of categorical data from complex sample surveys: chi-squared tests for goodness of fit and independence in two-way tables.J Am Stat Assoc. 1981; 76: 221-230https://doi.org/10.1080/01621459.1981.10477633
- Standards of medical care in diabetes - 2013.Diabetes Care. 2013; 36: S11-S66https://doi.org/10.2337/dc13-S011
- Considerations in epidemiologic definitions of undiagnosed diabetes.Diabetes Care. 2018; 41: 1835-1838https://doi.org/10.2337/dc17-1838
- Prevalence of and secular trends in diagnosed diabetes in Italy: 1980–2013.Nutr Metab Cardiovasc Dis. 2018; 28: 219-225https://doi.org/10.1016/j.numecd.2017.12.004
Giampaoli S, Palmieri L, Donfrancesco C, Noce C lo, Pilotto L, Vanuzzo D. Cardiovascular health in Italy. Ten-year surveillance of cardiovascular diseases and risk factors: Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 1998–2012. European Journal of Preventive Cardiology 2015;22:9–37. doi:10.1177/2047487315589011.
- Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] study.Diabetologia. 2012; 55: 88-93https://doi.org/10.1007/s00125-011-2336-9
- The burden and treatment of diabetes in France.Globalization Health. 2014; 10: 6https://doi.org/10.1186/1744-8603-10-6
Koch-Institut R. Incidence and mortality of diabetes mellitus in adults in Germany FOCUS Journal of Health Monitoring FOCUS Prevalence, incidence and mortality of diabetes mellitus in adults in Germany-A review in the framework of the Diabetes Surveillance 2017;2:DOI 10.17886/RKI-GBE-2017-062. doi:10.17886/RKI-GBE-2017-062.
- Early detection and treatment of type 2 diabetes reduce cardiovascular morbidity and mortality: a simulation of the results of the anglo-danish-dutch study of intensive treatment in people with screen-detected diabetes in primary care (ADDITION-Europe).Diabetes Care. 2015; 38: 1449-1455https://doi.org/10.2337/dc14-2459
- Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the atherosclerosis risk in communities (ARIC) study.Lancet Diabetes Endoc. 2017; 5: 34-42https://doi.org/10.1016/S2213-8587(16)30321-7
- Prevalence of prediabetes according to hemoglobin A1c versus fasting plasma glucose criteria in healthy adults.Acta Diabetol. 2015; 52: 631-632https://doi.org/10.1007/s00592-014-0659-y
- The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010.Diabetes Care. 2013; 36: 2271-2279https://doi.org/10.2337/dc12-2258
- Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population.Int J Obesity. 2005; 2017: 1615-1620https://doi.org/10.1038/ijo.2017.165
- Addressing challenges and implications of national surveillance for racial/ethnic disparities in diabetes.JAMA. 2019; 322: 2387-2388https://doi.org/10.1001/jama.2019.19428
- Effect of heterozygous beta thalassemia on HbA1c levels in individuals without diabetes mellitus: a cross sectional study.Clin Chim Acta. 2019; 494: 132-137https://doi.org/10.1016/j.cca.2019.03.1611
- Screening for diabetes and pre-diabetes with proposed A1C-based diagnostic criteria.Diabetes Care. 2010; 33: 2184-2189https://doi.org/10.2337/dc10-0433
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020;43:S14–31. doi:10.2337/dc20-S002.
Article info
Publication history
Published online: December 24, 2020
Accepted:
December 21,
2020
Received in revised form:
December 1,
2020
Received:
May 17,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
