title: High prevalence of diabetes and intermediate hyperglycemia - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: BACKGROUND
  The global burden of diabetes mellitus and other chronic diseases is high, and 80% of those with diabetes now live in low and middle income countries. Yet, little information is available regarding prevalence of diabetes and intermediate hyperglycemia in these countries, especially when a full range of diagnostic tests is employed. The purpose of this study is to provide a full accounting of these prevalences in a large, free-living Brazilian population.
  
  
  METHODS
  We report baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 civil servants aged 35-74 years. Diabetes mellitus was ascertained by self-report of diagnosis, medication use, fasting glucose, an oral glucose tolerance test, and/or glycated hemoglobin. Cut-offs for diabetes and intermediate hyperglycemia followed the recommendations of the World Health Organization and the American Diabetes Association. Adjusted prevalences were estimated through logistic regression.
  
  
  RESULTS
  With this full accounting, 19.7% (19.0%-20.3%) had diabetes mellitus, 50.4% being previously undiagnosed. Frequencies of intermediate hyperglycemia according to various criteria ranged from 16.1% to 52.6%. Diabetes or intermediate hyperglycemia was present in 79.1% of participants when using the most comprehensive definitions. The burden was greatest in the elderly, the obese, non-whites, and those with less formal education (p < 0.001).
  
  
  CONCLUSIONS
  That four of every five free-living individuals aged 35-74 years working in selected public institutions in six Brazilian state capitals presented either diabetes or intermediate hyperglycemia highlights the advanced stage of the obesity - diabetes epidemic in urban Brazil and indicates the need for urgent action.
authors: Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Av. Ramiro Barcelos, 2600/414, 90035-003 Porto Alegre, RS Brazil.
authors: Maria Inês
authors: MI
authors: Schmidt
authors: Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Av. Ramiro Barcelos, 2600/414, 90035-003 Porto Alegre, RS Brazil.
authors: Juliana F
authors: JF
authors: Hoffmann
authors: Faculdade de Medicina, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors: Maria
authors: M
authors: de Fátima Sander Diniz
authors: Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil.
authors: Paulo A
authors: PA
authors: Lotufo
authors: Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors: Rosane Härter
authors: RH
authors: Griep
authors: Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil.
authors: Isabela M
authors: IM
authors: Bensenor
authors: Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil.
authors: José G
authors: JG
authors: Mill
authors: Faculdade de Medicina, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors: Sandhi Maria
authors: SM
authors: Barreto
authors: Instituto Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Estela M L
authors: EM
authors: Aquino
authors: Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Av. Ramiro Barcelos, 2600/414, 90035-003 Porto Alegre, RS Brazil.
authors: Bruce B
authors: BB
authors: Duncan
keywords: Brazil; Diabetes mellitus; Hyperglycemia; Prediabetic state; Prevalence