Diabetes and Glucose Intolerance in Turkey: Rise in Prevalence and Prospective Evaluation of Impact on Coronary Mortality and Morbidity

This study aimed to evaluate the prevalences of diabetes mellitus and of glucose intolerance and their trends among Turkish adults as well as to assess prospectively their independent effect on coronary mortality and morbidity. The population randoru sample of the Turkish Adult Risk Factor Study surveyed in year 2000 comprising 2455 participants aged 30 or over were evaluated by diabetes criteria of the World Health Organization. Criteria for the diagnosis of coronary heart disease (CHD) and death from CHD conforıned to those previously described. The overall prevalence of diabetes was 8. 1% in men and 8.9% in women, while that of glucose intolerance (Gl) was 2.2% and 2.7%, respectively. These rates allowed to estimate the presence of 1.92m cases of diabetes and 620.000 persons with Gl in Turkish adults. Among subjects <50 years of age, diabetes was more frequent in women than in men. It was furthermore estimated that the prevalence of diabetes rose at a mean annual rate of 6.7%, i.e. roughly 130.000 persons each year. Concentrations of both plasına apolipoprotein B and C-reactive protein were significantly elevated in diabetic men or women, being in line with an atherogenic dyslipidemia. When only the apparently "healthy" participants of the survey in 1990 were followed up for 1 O years, presence of diabetes at baseline was a predictor of the composite endpoint of fatal and nonfatal CHD on multiple regression analysis independent of I O other variables. The relative risk was 1.52 in women and 1.43 in women and men combined. Relative risk for newly developed CHD was approximately 1.6-fold in diabetic men or women. It was concluded that diabetes - independently from its action on systolic blood pressure, central obesity and dyslipidemia - significantly elevated the risk of cardiac events among Turkish adults, notably in women. The rapid rise of the prevalence of diabetes in Turkish adults is highly concerning, and much more organized effort is needed to ınake large sections of the comın unity adopt a healthy life-sty le.