12no1 2

Department of Physiology, College of Health Sciences, University of Uyo, Akwa Ibom State, Nigeria
Original Research Article

Received: September 13, 2011 Accepted: March 8, 2012
GENDER AND AGE SPECIFIC PREVALENCE AND ASSOCIATED RISK FACTORS OF TYPE 2 DIABETES MELLITUS IN UYO METROPOLIS, SOUTH EASTERN NIGERIA
Chris E. Ekpenyong, U. P. Akpan, John O. Ibu, Daniel E. Nyebuk
Key words: diabetes, prevalence, risk factors, Nigeria
SUMMARY
The purpose of this work was to determine the age and sex specific prevalence of type 2 diabetes mellitus (T2DM) in South Eastern Nigeria, which hitherto has not been documented. The study population consisted of 3500 civil servants, 1532 (43.8%) male and 1968 (56.2%) female, age range 18-60 years. They were randomly selected and studied between October 2008 and November 2010. The survey instruments used were structured questionnaire, anthropometric and blood sugar measures. Chi-square test and t-test were used to compare differences in risk factors for both sexes, while logistic regression analysis was used to test the relationship between associated factors. The overall prevalence of T2DM was 10.5%, with 9.7% and 0.8% representing diagnosed and undiagnosed cases, respectively. The male and female prevalence was 9.6% and 11.2%, respectively. The age and sex specific prevalence was 2.74%, 8.50%, 16.54% and 23.70% in males aged 18-25, 26-35, 36-45 and 46-60 years, respectively. In females of the same age groups,
Corresponding author: Dr. C. E. Ekpenyong, MBBS, M.Sc., Department of Physiology, College of Health Sciences, University of Uyo, Akwa Ibom State, Nigeria E-mail: chrisvon200@yahoo.com
the prevalence was 3.95%, 9.70%, 13.01% and 29.39%, respectively. Age, poor dietary habits, high adiposity indices, physical inactivity, positive family history and educational status were significantly associated with T2DM in both sexes (P<0.05). Smoking status was only significant in males, while alcohol consumption was nonsignificant in both sexes (P<0.05). This study recorded a high prevalence of T2DM with a relatively small proportion of undiagnosed cases.
INTRODUCTION
The global burden of diabetes mellitus is enormous and glaring. The impact on health and economy is substantial, yet this disease is assuming an epidemic proportion worldwide, with its global prevalence estimated at about 366 million today, and 552 million by 2030 (1), meaning that the number of people with diabetes is increasing daily and in every country with the highest increase (80%) recorded in low and middle income countries. Currently, China has the highest estimated number of people with diabetes (90.0 million) with the projection to about 129.7 million by 2030. Diabetic populations in India, USA, Russian
Diabetologia Croatica 41-1, 2012
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C. E. Ekpenyong, U. P. Akpan, J. O. Ibu, D. E. Nyebuk / GENDER AND AGE SPECIFIC PREVALENCE AND ASSOCIATED RISK FACTORS OF TYPE 2 DIABETES MELLITUS IN UYO METROPOLIS, SOUTH EASTERN NIGERIA
Federation, Brazil, Mexico, Bangladesh, Egypt and Indonesia are as follows: 61.3, 23.7, 12.6, 12.4, 10.3, 8.4, 7.3 and 7.2 million (1). In Africa and in Nigeria, there are sparse and inadequate information on the prevalence of diabetes mellitus. However, available data suggest that the disease is emerging as a major and most challenging health problem in this region (2). Previous documentations have shown that the prevalence of the disease is on a steady increase over years. In 1971, a survey in Ibadan puts the prevalence at 0.4%, in 1989 a similar survey in Lagos metropolis puts the prevalence at 1.6%, in 1992 another group of researchers recorded the prevalence of 2.2% and in Lagos Island, the prevalence recorded was very high, about 7%. In Port Harcourt, Rivers State, according to a survey in adult population, the prevalence was 6.8%, with the male-female ratio of 1.4:1 (3). Among adults in Jos Metropolis Plateau State, the prevalence of undiscovered diabetes was found to be 3.1% in 1994 in a survey by Puepet. By 2004, a second survey in Jos put the prevalence at 10.3% (3). In Akwa Ibom State, South Eastern Nigeria, record is unavailable on the present prevalence rate of diabetes mellitus, even though the disease is on rampage and has inflicted a lot of pains on the population and the economy of the state. Diabetes mellitus is noted to increase the risk of some diseases such as coronary heart disease (CHD), stroke, peripheral arterial disease, nephropathy, retinopathy, neuropathy and cardiomyopathy (4). The effect is more on developing countries than developed countries. It is estimated that, while there will be a 42% increase in diabetes prevalence in developed countries, developing countries will go through 170% increase between 1995 and 2025 (5). This progressive increase in the prevalence of diabetes is associated with lifestyle changes, overweight and obesity, physical inactivity, alcohol consumption, poor dietary habit and cigarette smoking, factors that are potentially modifiable. Quantifying the prevalence of diabetes and the number of people affected by diabetes now and in future is important to allow for national planning and allocation
of resources (6), since the prevalence varies from country to country, state to state, races and ethnic groups. This work was therefore designed to assess the prevalence of type 2 diabetes mellitus (T2DM) and to determine the potential associated risk factors of the disease among Akwa Ibom State civil servants since they constitute about 90%-95% of the work force in the state.
SUBJECTS AND METHODS

Study design and population
This was a cross sectional study that took place between October 2008 and November 2010 among civil servants in Uyo metropolis, South Eastern Nigeria. The actual population of civil servants was found to be 6548, spread across various ministries of the state civil service. The population was therefore stratified based on participant ministries and hence different sample sizes were drawn from the respective ministries. A total of 3542 participants were initially selected for the study, 42 (1.2%) dropped out because of declining participation, pregnancy, inappropriate age for the study and improper completion of the questionnaire. This made the actual number of participants to be 3500 (98.8%), including 1532 (43.8%) male and 1968 (56.2%) female, age range 18-60 years. Informed consent was obtained from the participants after thorough explanation of the aims, objectives, study protocols, expected outcome and implications for them, given by a research team member. Approval was also granted by medical research and ethics committee of the establishment.
Survey methods
Three instruments of survey were used in this study: a structured questionnaire, anthropometric variables (height, weight, body mass index, waist circumference, hip circumference and waist-hip ratio) and blood sugar measures (fasting blood glucose, random blood glucose and 2-hour postprandial estimation). The questionnaires sought to elicit
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information on the possible risk factors such as dietary habit, alcohol intake, sociodemographic data (age, sex, marital status, educational level achieved and work status), family history of diabetes, presence of diabetic symptoms (polyuria, polydipsia, polyphagia and weight loss) and drug history to sort out those on hypoglycemic medications. To assess physical activity status, questions were based on the 2010 US healthy people physical activity guideline/standard, which recommends 150 minutes of moderate to severe intensity aerobic physical activity per week in bouts of 10 minutes or more for adults aged between 18 and 64 years. Alcohol consumption was assessed by asking the participants to state the number of standard drinks they usually have on a weekly or daily basis. Dietary habit was assessed using a sixty-five item food frequency questionnaire to assess intake of various macronutrients (fat, carbohydrate and protein), vegetables, snacks, sweet drinks, portion size, and restaurant/fast food consumption. To calculate the intake of specific nutrients, common unit or portion size for each food was specified. The participants were asked how often they had consumed that amount during the previous years. The eight response categories ranged from never to five or more times per day. The intake of nutrient of food was computed by multiplying the frequency of consumption of each unit of food by its nutrient content. High to very high intake of macronutrient, full portion size consumption, high frequency of fast food/restaurant patronage were all regarded as poor dietary habit, while balance diet taken 2-3 times/day with a lot of vegetables and fruits in-between was regarded as good dietary habit. To assess smoking status, the participants were asked whether they had formerly smoked, currently smoking, or never smoked. Former smokers were asked whether they had quit less than a year prior to the study period. Those who said they currently smoked on the day of the study were defined as current smokers. Thus, they were classified into three groups viz. never smoked, current smokers and ex-smokers. Anthropometric variables measured were height, weight, waist circumference (WC), hip circumference (HC) and waist to hip ratio (WHR) using the standard protocols as approved by the World Health
Organization (WHO) (6). Body mass index (BMI) was calculated as weight (kg)/height (m2). Overweight was defined as BMI of 25.0-29.9 and obesity as BMI 30.0. Men and women with WC values 94 and 80 cm, respectively, were considered to have normal WC, whereas men and women with WC values >94 and >80 cm, respectively, were considered to have high WC (obesity) according to WHO and NIH cut offs (7,8). WHR was calculated using the formula WC/HC. WHR <1 in men and <0.85 in women was considered normal, while WHR 0.9 in men and 0.85 in women was considered high and indicative of central obesity (6). However, it is worth noting that the cut off for measures of abdominal obesity for predicting the risk of all-cause mortality is sex, ethnic, racial and population dependent. This is probably due to ethnic/racial and sex variation in the level and distribution of body fat and abdominal adipose tissue (7). Fasting blood sugar (FBS) test was conducted in those who presented for the test after overnight fast (at least 8 h of not eating food). Casual plasma glucose test was conducted in those who had eaten breakfast before presenting for the test, while 2-h postprandial (2hpp) glucose test was conducted in all study participants. FBS was preferred because of its convenience in a clinical setting and low cost. Casual blood glucose estimation is defined as estimation at any time of the day without regard of the time elapsed since the last meal. Two-hour postprandial glucose (2hpp) is defined as two hours since the last meal. Diabetes mellitus was diagnosed based on the 2011 revised criteria by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, which recommends the diagnosis of diabetes based on: 1. two fasting plasma glucose (2 FPG) levels of 126 mg/dL (7.0 mmol/L) or higher, 2. two 2-hours postprandial glucose (2hPPG) reading of 200 mg/dL (11.1 mmol/L) or higher after a glucose load of 75 g, or 3. two casual glucose readings of 200 mg/dL (11.1 mmol/L) or higher, 4. glycosylated hemoglobin (HbA1c) 6.5%.
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Statistical analysis
Descriptive statistics including mean (reported as mean SEM), frequencies and simple percentages was computed for continuous and categorical variables. Chi-square test for categorical variables and the independent sample t-test for continuous variables were used to compare differences in the sociodemographic variables of male and female subjects. Furthermore, the prevalence of diabetes
mellitus was computed for the overall population and was also calculated for males and females across all age groups. Logistic regression model was used to test the relationship between associated factors of diabetes mellitus and incidence of diabetes. Based on this model, odd ratios and 95% confidence intervals (CI) for odd ratios were estimated. Statistical computations were facilitated using the SPSS 17.0 (Statistical Package for Social Sciences).
Table 1. Sociodemographic characteristics of the study population (N=3500)

Variable Age (yrs) BMI (kg/m2) WC (cm) WHR Physical activity (%) Active Inactive Dietary habit (%) Good Poor Smoking habit (%) Current smoker Ex-smoker Never smoked Education (%) Lower education Higher education Alcohol intake (%) Current drinker Non-drinker Family history Yes No 579 (37.8%) 953 (62.2%) 675 (34.3%) 1293 (65.7%) 0.032* 823 (53.7%) 709 (46.3%) 559 (28.4%) 1409 (71.6%) P< 0.001** 498 (32.5%) 1034 (67.5%) 701 (35.6%) 1267 (64.4%) 0.054NS 461 (30.1%) 193 (12.6%) 878 (57.3%) 49 (2.5%) 15 (0.8%) 1904 (96.7%) P<0.001** 884 (57.7%) 648 (42.3%) 1163 (59.1%) 805 (40.9%) 0.407NS 743 (48.5%) 789 (51.5%) 492 (25%) 1476 (75%) P<0.001** Male (n=1532) 49.8 0.37 23.80 0.14 77.6 0.23 0.866 0.007 Female (n=1968) 49.7 0.34 23.70 0.17 78.4 0.22 0.871 0.004 P-value 0.412NS 0.832NS P=0.001** 0.562NS
Data are mean standard error of mean (SEM), **P<0.01 significant at 1%, *P<0.05, significant at 5%, NS = nonsignificant (P>0.05).
Table 2. Prevalence of diabetes mellitus according to gender and age groups

Age (yrs) 18-25 26-35 36-45 46-60 Total Male (n=1532) Diabetic Non-diabetic 17 (2.74%) 38 (8.50%) 42 (16.54%) 50 (23.70%) 147 (9.60%) 603 (97.26%) 409 (91.50%) 212 (83.46%) 161(76.30%) 1385 (90.40%) Female (n=1968) Diabetic Non-diabetic 28 (3.95%) 40 (9.70%) 76 (13.01%) 77 (29.39%) 221 (11.23%) 680 (96.05%) 374 (90.30%) 508 (86.90%) 185 (70.61%) 1747 (88.77%) All Diabetic 45 (3.39%) 78 (9.06%) 118 (14.08%) 127 (26.85%) 368 (10.51%) Non-diabetic 1283 (96.61%) 783 (90.94%) 720 (85.92%) 346 (73.15%) 3132 (89.49%)
**Prevalence of diabetes is significantly higher in females as compared to males (P=0.048 significant).
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RESULTS
Results of data collected on 3500 randomly selected civil servants showed that 43.8% were males and 56.2% were females. The mean age of males and females was 49.80.37 and 49.70.34 years, respectively. The results obtained from the independent sample t-test indicated that age and BMI of males were not significantly higher than those of females (P=0.412 for age and P=0.832 for BMI).
Also, results of chi-square test showed that males were more physically active than females, smoking and alcohol intake of males were also significantly higher than those of females (physical activity P=0.000, smoking habit P=0.000 and alcohol intake P=0.000). Results are displayed in Table 1. The overall prevalence of diabetes was 10.51%; 9.60% in males and 11.20% in females. Hence, the prevalence was significantly higher in females than
Table 3. Multiple logistic regression model showing association between diabetes mellitus and risk factors separately for male and female subjects (odds ratio and 95% confidence interval)
Male Variable Age (yrs) 18-25 26-35 36-45 46-60 Body mass index Not obese Obese Waist circumference Normal Abnormal Waist to hip ratio Normal Abnormal Dietary habit Good Poor Smoking habit Non smokers Current smokers Physical activity Active Inactive Education Low education High education Alcohol consumption (%) Non-drinkers Drinkers Family history Yes No 1.00 (reference) 1.58 1.255-9.572 0.021* 1.00 (reference) 1.50 1.022-1.935 0.036* 1.00 (reference) 1.04 0.688-1.464 0.956NS 1.00 (reference) 1.02 0.928-1.108 0.760NS 1.00 (reference) 1.51 1.248-9.563 0.033* 1.00 (reference) 1.67 1.170-2.431 0.005** 1.00 (reference) 1.98 1.185-3.336 0.009** 1.00 (reference) 2.37 1.242-5.734 0.007** 1.00 (reference) 1.74 1.081-2.832 0.023* 1.00 (reference) 1.04 0.733-1.848 0.931NS 1.00 (reference) 1.63 1.05-2.47 0.006** 1.00 (reference) 1.65 1.250-10.289 0.006** 1.00 (reference) 1.16 0.871-1.536 0.314NS 1.00 (reference) 1.88 1.423-2.475 0.002** 1.00 (reference) 1.04 0.846-1.290 0.686NS 1.00 (reference) 1.67 1.234-2.236 0.003** 1.00 (reference) 1.78 1.082-2.460 0.004** 1.00 (reference) 1.54 1.136-1.698 0.001** Odd ratio 1.00 (reference) 1.05 1.65 2.94 0.786-1.812 1.262-3.025 1.300-3.532 0.920NS 0.005** 0.003** Sex 95% confidence interval for odd ratio Female P-value Odds ratio 1.00 (reference) 1.07 1.58 2.17 0.390-4.418 1.948-2.961 1.071-3.045 0.644NS 0.043* 0.004** 95% Confidence interval for odd ratio P-value
**P<0.01 significant at 1%, *P<0.05 significant at 5% and NS P>0.05 nonsignificant at 5%.
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males (P=0.000). Also, the prevalence in relation to sex and age was as follows: 2.74%, 8.50%, 16.54% and 23.70% in males of the 18-25, 26-35, 36-45 and 46-60 age groups, respectively. In females of the same age groups, the prevalence was 3.95%, 9.70%, 13.01% and 29.39%, respectively. These results are shown in Table 2. Also, out of the total of 368 (10.5%) diabetic subjects, 337 (9.7%) were known (diagnosed) and 29 (0.8%) were unknown (undiagnosed) cases before the study. The results of multiple logistic regression analysis showed that the tendency to develop diabetes mellitus increased proportionally with age, the highest odd ratio being recorded in males and females of the 46-60 age group (males: OR=2.94, CI=1.300-3.532; females OR=2.17, CI=1.071-3.47). Both males and females with an abnormal BMI had about 2 times odds for diabetes mellitus (males: OR=1.78, CI=1.0822.460, females: OR=1.54, CI=1.136-1.698). Abnormal WC and WHR also increased the odds for diabetes in female groups, but it was nonsignificant in males as the odd ratios between males with abnormal and normal WC and WHR were almost the same (females: WC: OR=1.67, WHR=1.88; males: WC: OR=1.04, WHR: OR=1.16). Moreover, both male and female participants who indulged in poor dietary habit, physical inactivity, high educational level and positive family history of diabetes had about 2 times chances of being diabetic. The odds for diabetes in both males and females who drank alcohol were not significantly different from those who did not drink. The probability of developing diabetes was higher in male smokers as compared with non-smokers, while the result obtained for female participants was nonsignificant. Detailed results are displayed in Table 3.
number of elderly women than men in most populations and the increasing prevalence of diabetes with age is the most likely explanation for this observation (5). In this large cohort study of men and women, the overall prevalence of diabetes mellitus was 10.5%; 9.7% were known (diagnosed) and 0.8% unknown (undiagnosed) cases. The male and female prevalence was 9.6% and 11.2%, respectively. Hence, more females than males were diabetic in this study. In both sexes, the prevalence of diabetes was highest in the 4660 age group and lowest in the 18-25 age group. This finding is consistent with the observation reported by other researchers (5). One study found the peak incidence of diabetes in Nigeria and Tanzania to be recorded after age 45-50, and also to increase with age, similar to the findings in this study. In Nigeria, the risk of diabetes increases 3-4 times after the age of 44 years (9). Globally, the greatest numbers of people with diabetes are aged between 40 and 59 years (1), as observed in this study. The worsening of insulin resistance with age, increased inactivity and longevity of diabetes patients due to improved care were the reasons given for the rising prevalence of T2DM with age (10-12). However, it is worth noting that age related increase in insulin resistance is not a universal finding, and the reasons for the discrepant results probably include general health, physical activity, changes in liver size and delay in carbohydrate absorption (13). When confounding factors, particularly physical activity, are taken into account there appears to be little or no change in insulin action with age. In this study, men were more physically active than women and this probably could have enhanced the improved insulin sensitivity in men than women of the same age group, despite the female insulin advantage. Physical inactivity was significantly associated with the incidence of diabetes in this study. This could explain why more women than men were diabetics (14). Also, in this study, the effect of various anthropometric indices was obvious; while all anthropometric indices used were significantly
DISCUSSION
Age and sex are globally identified risk factors for diabetes mellitus (3). The worldwide diabetes prevalence is similar in men and women, but it is slightly higher in men greater than 60 years of age and women of older ages (5). Overall, diabetes prevalence is higher in men, but there are more women with diabetes than men. The combined effect of a greater
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associated with T2DM (BMI, WC, WHR) in females, only BMI was associated in males. Women therefore had a stronger predisposition to developing T2DM than men, as they had more extensive fat distribution than men. The results of this survey are consistent with those studies that emphasized the role of abdominal (central) and general obesity in causing T2DM (15). The present data support that abdominal fat localization is more important than the total amount of body fat in predicting the risk of T2DM. Previous studies have shown that central (intra-abdominal) depots of fat are more strongly linked to insulin resistance and thus T2DM than are peripheral fat depots (16). It has been postulated that expanded intraabdominal fat stores affect insulin metabolism by releasing free fatty acids (17). Free fatty acids reduce the hepatic clearance of insulin, which may lead to insulin resistance and hyperinsulinemia (18). In addition, fat cells secrete a number of signaling factors, which may be involved in the development of insulin resistance (19), e.g., leptin, adiponectin, interleukin 6, and tumor necrosis factor . The results of this study underscored the risk detecting value of more than one adiposity index, as no single index can be identified as optimal choice for diabetic risk detection on its own. To this effect, the US National Institutes of Health (NIH) recommends the use of WC in conjunction with BMI as a complementary indicator of health risk among normal and overweight subjects (20). The sensitivity of such a combination was obvious in this study. The high adiposity indices and high prevalence of T2DM observed among women in this survey could therefore be explained by the fact that women are more obese than men, they gain more weight during pregnancy, which is not entirely shed afterwards (21), and they have body proportions and fat distribution different from men due to estrogen effect on fat metabolism (22). The biochemical and physiological changes in pregnancy predispose them to gestational diabetes mellitus and subsequent development of diabetes in older age (23). A contrasting observation was made in a study by Wang et al. (24). In this study, WC and WHR (measures of central obesity) were more positively and more significantly associated with
T2DM than BMI in men. Ethnic differences in body composition rules and constants as well as different lifestyle factors may probably explain this disparity (25). The present study also showed a significant association between family history and incident T2DM, with no remarkable sex difference in the association. These findings are in agreement with previous findings (26,27). However, excess female associations have been shown by few other studies (28,29). The differences could be due to genetic, environmental or other confounders. Dietary habits also demonstrated a significant association with incident T2DM in this study. Poor dietary habits (in both sexes) were associated with 2 times odds for incident T2DM compared with those with good dietary habits. In this study, the combination of this with a low level of physical activity, central and general obesity and positive family history in women explain strongly why more women than men were found to be diabetic. This is consistent with a recent finding in US and Canadian studies, in which old age, positive family history, low gross annual household income and obesity were the most significant risk factors for developing T2DM (23). Alcohol consumption showed a nonsignificant association with incident T2DM in this study. This finding is in line with studies from different populations found to consume mild to moderate levels of alcohol, with moderate drinkers having 43% to 46% reduction in the risk of diabetes (30-32). However, heavy alcohol users have been shown to have a higher tendency to developing T2DM (33). This is probably due to the development of insulin resistance, which is a key factor in the pathogenesis of T2DM among heavy alcohol drinkers and this has been shown by some studies to be mediated by increased obesity, especially abdominal obesity. Light to moderate drinking has been associated with enhanced insulin sensitivity in several observational studies (34,35). The study participants in this survey may have been made up of mainly mild to moderate drinkers, hence the nonsignificant association.
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A significant association between smoking and incident T2DM was seen only in male current smokers but was absent in females. This finding agrees with several other cohort studies (36,37). However, others failed to show such a relationship with significant association seen more in women than men. The Nurses Health study, a study of 114,247 US female nurses aged 30-35 (38), the Cancer Prevention Study 1 and the study of 433,637 women aged 30 years or more (39) have reported a significant 20%-70% excess risk among women. A significant association between educational level (index of socioeconomic position) and incident T2DM was also recorded in this study. Individuals in higher educational class had 1.5 to 1.67 odds for incident T2DM. More men were found to belong to the higher educational class (although sex differences were statistically nonsignificant), but women had higher odds for incident T2DM. This could probably be due to the effect of other confounders such as adiposity indices, lifestyle and genetic predisposition. Unlike previous studies in other parts of Nigeria and Sub-Saharan Africa (3,40-42), this study recorded a relatively low level of undiagnosed diabetes mellitus (0.8%). This could partly be due to differences in the composition of study population and the recently increased level of awareness created by several diabetes health awareness campaign programs launched by the State Ministry of Health and other non-governmental agencies in the metropolis. The participants in this study were mainly educated government employees (civil servants), with average monthly emolument, well enlightened, with high level of health awareness, clinical consultation, early diagnosis and treatment of ailment, and an average standard of living. These are the main factors that relate socioeconomic position to health and diabetes mellitus (43). It is an established fact that there is a significant correlation between factors that depict the socioeconomic status of individuals as mentioned above, and their health awareness and practices. Socioeconomically disadvantaged populations are more likely to be unaware, and strongly affected by
various health problems such as diabetes mellitus, cancers, hypertension and respiratory disorders (4449). This assertion is corroborated by several other studies in Europe that have shown a consistent relationship between health and socioeconomic inequalities and diseases or mortality (43,50-53). Worse health indicators (e.g., high population of undiagnosed diabetes) are common among populations of disadvantaged socioeconomic positions. Some community factors such as availability of healthy foods, availability of places to exercise, healthy behaviors (e.g., diet, physical activity), access to health care and process of diabetes care (e.g., timely measurement of blood glucose, HbA1c and smoking) have all been implicated in the process by which socioeconomic inequalities affect disease awareness and outcome (54). Based on the characteristics of our study population, one could describe the participants as being socioeconomically advantaged, hence the low incidence of undiagnosed diabetes mellitus recorded in this survey. The strength and precision of this study came from the fact that the anthropometric variables under study were actually measured and calculated by a trained member of the study team. Also, the diagnosis of diabetes mellitus was based on the analysis of the participant blood samples. This eliminated error or inaccuracy of self reported anthropometric variables and blood sugar levels (49). Also, the large cohort of men and women gave a fair representation of the entire population of the study area. Even so, this study had a limitation that warrants recognition, the effects of some confounding factors that were not completely excluded.
CONCLUSION
This study recorded a high prevalence rate of T2DM and a relatively small proportion of undiagnosed cases. The trend was observed to be influenced by age, sex, social class, genetic predisposition and other modifiable lifestyle factors. Intervention program should emphasize lifestyle modification.
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Acknowledgment We acknowledge the priceless support given by all who participated in this study, especially the civil servants, paramedical staff, the technical crew, the clerical staff and the statisticians who handled data analysis.
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Department of Physiology, College of Health Sciences, University of Uyo, Akwa Ibom State, Nigeria

Original Research Article

Key words: diabetes, prevalence, risk factors, Nigeria

Diabetologia Croatica 41-1, 2012

SUBJECTS AND METHODS

Diabetologia Croatica 41-1, 2012

Table 1. Sociodemographic characteristics of the study population (N=3500)

Table 2. Prevalence of diabetes mellitus according to gender and age groups

**Prevalence of diabetes is significantly higher in females as compared to males (P=0.048 significant).

**P<0.01 significant at 1%, *P<0.05 significant at 5% and NS P>0.05 nonsignificant at 5%.

Diabetologia Croatica 41-1, 2012

Diabetologia Croatica 41-1, 2012

Diabetologia Croatica 41-1, 2012

Diabetologia Croatica 41-1, 2012

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