Prevalence and correlates of diagnosed and undiagnosed type 2 diabetes mellitus and pre-diabetes in older adults: Findings from the Irish Longitudinal Study on Ageing (TILDA).

AIMS The prevalence of type 2 diabetes and pre-diabetes has increased rapidly in recent decades and this trend will continue as the global population ages. This study investigates the prevalence of, and factors associated with, diagnosed and undiagnosed type 2 diabetes mellitus and pre-diabetes in older adults in Ireland. METHODS Cross-sectional data from 5377 men and women aged 50 and over from Wave 1 of the Irish Longitudinal Study on Ageing (TILDA) was analysed. Diagnosed diabetes was defined using self-reported doctors' diagnosis and medications data. Glycated haemoglobin (HbA1c) analysis was used to identify undiagnosed and pre-diabetes. Age and sex-specific prevalence estimates were generated. Logistic regression was used to investigate the association between diabetes classification and the demographic, health and lifestyle characteristics of the population. RESULTS The prevalence of diagnosed and undiagnosed type 2 diabetes was 8.6% (95% confidence interval (CI): 7.6-9.5%) and 0.9% (95% CI: 0.6-1.1%) respectively. Diabetes was more prevalent in men than women and increased with age. The prevalence of pre-diabetes was 5.5% (95% CI: 4.8-6.3%) and increased with age. Diabetes and pre-diabetes were independently associated with male sex, central obesity and a history of hypertension, while undiagnosed diabetes was associated with geographic location and medical costs cover. CONCLUSION Despite high rates of obesity and other undiagnosed health conditions, the prevalence of undiagnosed and pre-diabetes is relatively low in community-dwelling older adults in Ireland. Addressing lifestyle factors in this population may help to further reduce the prevalence of pre-diabetes and improve outcomes for those with a previous diagnosis.

[1]  I. Perry,et al.  Diabetes care in Ireland: a survey of general practitioners. , 2009, Primary Care Diabetes.

[2]  S. Kahn,et al.  Mechanisms linking obesity to insulin resistance and type 2 diabetes , 2006, Nature.

[3]  N. Soranzo Genetic Determinants of Variability in Glycated Hemoglobin (HbA1c) in Humans: Review of Recent Progress and Prospects for Use in Diabetes Care , 2011, Current diabetes reports.

[4]  J. Diamond,et al.  The double puzzle of diabetes , 2003, Nature.

[5]  2. Classification and Diagnosis of Diabetes , 2016, Diabetes Care.

[6]  R F Martin,et al.  General deming regression for estimating systematic bias and its confidence interval in method-comparison studies. , 2000, Clinical chemistry.

[7]  H Hanaire,et al.  Physical exercise for the prevention and treatment of type 2 diabetes. , 2010, Diabetes & metabolism.

[8]  Brian P Mcevoy,et al.  A Y-chromosome signature of hegemony in Gaelic Ireland. , 2006, American journal of human genetics.

[9]  J. Harbison,et al.  Factors that influence awareness and treatment of atrial fibrillation in older adults. , 2013, QJM : monthly journal of the Association of Physicians.

[10]  M. Woodward,et al.  Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds , 2012, Diabetologia.

[11]  D. Nathan,et al.  Relationship between glycated haemoglobin levels and mean glucose levels over time , 2007, Diabetologia.

[12]  Thomas,et al.  Elevated HbA 1 c and Fasting Plasma Glucose in Predicting Diabetes Incidence AmongOlder Adults Are two better than one ? , 2013 .

[13]  C. Caspersen,et al.  Secular Changes in U.S. Prediabetes Prevalence Defined by Hemoglobin A1c and Fasting Plasma Glucose , 2013, Diabetes Care.

[14]  P. Kearney,et al.  The Design of The Irish Longitudinal Study on Ageing , 2010 .

[15]  R. Collins,et al.  Reliable measurement of glycated hemoglobin in frozen blood samples: implications for epidemiologic studies. , 2002, Clinical chemistry.

[16]  D. Sacks Global harmonization of hemoglobin A1c. , 2005, Clinical chemistry.

[17]  P. Barberger‐Gateau,et al.  Characteristics of undiagnosed diabetes in community-dwelling French elderly: the 3C study. , 2007, Diabetes research and clinical practice.

[18]  T. Gill,et al.  Elevated HbA1c and Fasting Plasma Glucose in Predicting Diabetes Incidence Among Older Adults , 2013, Diabetes Care.

[19]  C. Sirtori,et al.  Statin therapy and related risk of new-onset type 2 diabetes mellitus. , 2014, European journal of internal medicine.

[20]  P. Raskin,et al.  Treatment of hypertension in adults with diabetes. , 2003 .

[21]  Richard Baker,et al.  Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study , 2014, BMJ Open.

[22]  B. Ainsworth,et al.  International physical activity questionnaire: 12-country reliability and validity. , 2003, Medicine and science in sports and exercise.

[23]  Bernadette A. Thomas,et al.  Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[24]  Bernadette A. Thomas,et al.  Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 , 2015, The Lancet.

[25]  Wolfgang Rathmann,et al.  Prediabetes: a high-risk state for diabetes development , 2012, The Lancet.

[26]  Bernadette A. Thomas,et al.  Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 , 2015, The Lancet.

[27]  S. Leahy,et al.  OBESITY IN AN AGEING SOCIETY: IMPLICATIONS FOR HEALTH, PHYSICAL FUNCTION AND HEALTH SERVICE UTILISATION , 2014 .

[28]  P. Nilsson,et al.  Smoking and diabetes--the double health hazard! , 2009, Primary care diabetes.

[29]  K. Balanda,et al.  Pre‐diabetes in adults 45 years and over in Ireland: the Survey of Lifestyle, Attitudes and Nutrition in Ireland 2007 , 2013, Diabetic medicine : a journal of the British Diabetic Association.

[30]  C. Walsh,et al.  Fasting Plasma Glucose as Initial Screening for Diabetes and Prediabetes in Irish Adults: The Diabetes Mellitus and Vascular Health Initiative (DMVhi) , 2015, PloS one.

[31]  P. Valensi,et al.  A large proportion of prediabetes and diabetes goes undiagnosed when only fasting plasma glucose and/or HbA1c are measured in overweight or obese patients. , 2010, Diabetes & metabolism.

[32]  Ying Li Increased Hemoglobin A1c threshold for prediabetes remarkably improving the agreement between A1c and oral glucose tolerance test criteria in obese population , 2016 .

[33]  P. Kearney,et al.  The Prevalence and Determinants of Undiagnosed and Diagnosed Type 2 Diabetes in Middle-Aged Irish Adults , 2013, PloS one.

[34]  Brendan J. Whelan,et al.  Fifty plus in Ireland 2011: first results from the Irish longitudinal study on ageing (TILDA). , 2011 .

[35]  A. Motala,et al.  Global estimates of undiagnosed diabetes in adults. , 2014, Diabetes research and clinical practice.

[36]  S. Wild,et al.  Diabetes in Europe: an update. , 2014, Diabetes research and clinical practice.

[37]  J. Lindström,et al.  Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study , 2006, The Lancet.

[38]  J. Shaw,et al.  Global estimates of diabetes prevalence for 2013 and projections for 2035. , 2014, Diabetes Research and Clinical Practice.

[39]  N. Steel,et al.  Undiagnosed diabetes—data from the English longitudinal study of ageing , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[40]  Dorte Vistisen,et al.  Global healthcare expenditure on diabetes for 2010 and 2030. , 2010, Diabetes research and clinical practice.

[41]  P. Raskin,et al.  Treatment of hypertension in adults with diabetes. , 2003, Diabetes care.

[42]  R. Giugliano,et al.  Prevalence and clinical outcomes of undiagnosed diabetes mellitus and prediabetes among patients with high-risk non-ST-segment elevation acute coronary syndrome. , 2013, American heart journal.

[43]  A. Newman,et al.  Type 2 diabetes in older well-functioning people: who is undiagnosed? Data from the Health, Aging, and Body Composition study. , 2001, Diabetes care.

[44]  P. Kearney,et al.  Prevalence of Diabetes in the Republic of Ireland: Results from the National Health Survey (SLAN) 2007 , 2013, PloS one.

[45]  S. Klarenbach,et al.  Socio-economic status and undiagnosed diabetes. , 2005, Diabetes research and clinical practice.

[46]  J. Shaw,et al.  Current controversies in the use of haemoglobin A1c , 2012, Journal of internal medicine.

[47]  J. Neel Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? , 1962, American journal of human genetics.

[48]  T. Fahey,et al.  Hypertension prevalence, awareness, treatment and control in the over 50s in Ireland: evidence from The Irish Longitudinal Study on Ageing. , 2016, Journal of public health.