10-year incidence of diabetes and associated risk factors in Greece: the ATTICA study (2002-2012).
BACKGROUND
The incidence of diabetes in the general population is increasing world-wide. The increase is attributed to the consumption of saturated fatty acids, obesity, lack of physical activity, genetic predisposition, and other factors, but knowledge about the reasons, biological mechanisms, and late complications is insufficient. It is therefore important to clarify the reasons more exactly through long-term clinical trials to stop the rise of diabetes and its complications.


OBJECTIVE
To evaluate the 10-year incidence of type 2 diabetes in apparently healthy Greek adults.


METHODS
In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study. During 2011-2012, the 10-year follow-up was performed. Patients diagnosed with diabetes at baseline (n = 210) and those lost at the 10-year follow-up (n = 1347) were excluded, yielding a final sample of 1485 participants.


RESULTS
During the period of investigation, diabetes was diagnosed in 191 cases corresponding to a 12.9% incidence (95%CI: 10.4-15.4), with 13.4% (95%CI: 10.8-16) in men and 12.4% (95%CI: 10.1-14.7) in women. A relative increase was observed in the second half of the 10-year follow-up when age became significant. Multiple logistic regression analysis revealed that age (OR = 1.14, 95%CI: 1.09-1.19), abnormal waist-to-height ratio (OR = 3.27, 95%CI: 1.07-10.0), fasting blood glucose (OR per 1 mg/dl = 0.05, 95%CI: 1.02-1.08), energy intake (OR per 500 kcal = 1.02, 95%CI: 1.01-1.35), and family history of diabetes (OR = 2.8, 95%CI: 1.30-6.03) were the most significant baseline predictors for diabetes, after adjusting for potential confounders. Waist-to-height ratio showed the best explanatory power of all anthropometric variables. Physical activity exerts an effect on risk factors. Being active was found to eliminate the aggravating effect of diabetes family history and fasting blood glucose.


CONCLUSIONS
The findings confirm the escalating increase of type 2 diabetes incidence in Greece, which is in line with global trends. A lifestyle change in individuals at risk of developing diabetes towards healthier eating and increased physical activity would be an effective and inexpensive means of reducing diabetes.
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
Efi
E
Koloverou
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
Demosthenes B
DB
Panagiotakos
First Cardiology Clinic, School of Medicine, University of Athens, Greece.
Christos
C
Pitsavos
First Cardiology Clinic, School of Medicine, University of Athens, Greece.
Christina
C
Chrysohoou
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
Ekavi N
EN
Georgousopoulou
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
Evangelia
E
Pitaraki
First Cardiology Clinic, School of Medicine, University of Athens, Greece.
Vassiliki
V
Metaxa
First Cardiology Clinic, School of Medicine, University of Athens, Greece.
Christodoulos
C
Stefanadis
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control; D002149:Energy Intake; D015444:Exercise; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D065927:Waist-Height Ratio
D001786:Blood Glucose