High prevalence of prediabetic states in Primary Care in Spain: the Desire study

Abstract

Aim: To assess the prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in the population older than 45 years assigned to Primary Care in Spain, and to evaluate whether the combination of both level of fasting glucose and central obesity could be useful to identify people with diabetes, IFG, IGT and insulin resistance (IR). Methods: An observational, multicentre, cross-sectional study including 4231 subjects. According to the presence of a fasting glucose equal to or higher than 90 mg/dl and waist circumference >= 94/80 cm (men/women) or known type 2 diabetes (T2DM), subjects were divided in two groups: study and control groups. Study group subjects and a subset of the control group were referred to hospital for classification according to presence of T2DM, HOMA-IR, fasting plasma glucose and oral glucose tolerance test results. Results: Prevalence of known T2DM: 11.3% [95% CI 10.5-12.1]. Prevalence of unknown T2DM, impaired glucose tolerance, impaired fasting glucose and insulin resistance (IR): 5.4% [4.1-78], 13.5% [10.7-17.1], 3.9% [2.7-6.2] and 17.9% [14.5-22.1] respectively. The sensitivity of the screening test for any glucose metabolism alteration was 86.5%. Conclusions: We have found that in Spain the prevalence of IFG and IGT in population older than 45 years assigned to Primary Care is high, and similar to the French population. This prevalence predicts higher rates of diabetes prevalence than WHO's estimation. The combination of fasting glucose and waist circumference measurement could be an easy to use tool to identify those subjects at risk of having diabetes, IFG, IGT and IR.