Underestimation of prevalence of raised blood sugar from history compared to biochemical estimation: support for the WHO rule of halves in a population based survey in Eritrea of 2009

To ascertain the prevalence of diabetes mellitus from history and biochemical estimation so as to attest the WHO Rule of halves in a lean population. A population based national survey on diabetes mellitus was carried out in 2009. History and fingerpicks blood analysis were examined according to recommended procedures of the WHO STEPwise approach and the WHO recommended automated machine to compare the two modalities of estimating diabetes prevalence. Over 6000 people with a response rate of 95 % and a prevalence of raised blood glucose of 5.0 %. The prevalence from history of raised blood sugar was 2.2 %. Less than half (47 %) of the persons with high blood glucose were aware of their status with less than half on treatment. Of those on treatment less than half (30 %) were well controlled. Prevalence of raised fasting blood glucose was more than double that estimated from history, with less than half of the people aware of their status and of those on treatment nearly half are under good control. The underestimation of the disease through history supports the WHO rule of halves and calls for the use of biochemical tests when estimating prevalence of diabetes in the general population or at least doubling the rate from history alone.

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