An Epidemiologic Study on the Prevalence of Diabetes, Glucose Intolerance, and Metabolic Syndrome in the Adult Population of the Republic of Cyprus

The study was conducted in Cyprus (November 2003 through January 2005). Stratified random sampling was used to select 1,200 individuals aged 20–80 years (from a total population of 477,000). In all subjects, anthropometrical measurements were taken, fasting lipids were measured, eating habits were evaluated according to a standardized questionnaire, and an oral glucose tolerance test (OGTT) was performed (except in known diabetic patients).

In the absence of OGTT-diagnosed diabetes or impaired glucose tolerance (IGT), impaired fasting glucose (IFG) was defined by fasting plasma glucose ≥110 mg/dl and <126 mg/dl, whereas “new” IFG was defined by fasting plasma glucose ≥100 and <126 mg/dl. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.

Of the 1,200 subjects, 78 (6.5%) had known diabetes and 45 (3.8%) were newly diagnosed by the OGTT, which brought the total prevalence of diabetes to 123 (10.3%). Another 78 (6.5%) subjects had IGT, 36 (3.0%) had IFG, and 171 (14.2%) had “new” IFG. Logistic regression showed that significant risk factors for diabetes were age, male sex, family history of diabetes (P < 0.001), hypertension (P = 0.004), and obesity (P = 0.003). Risk factors for IGT were age and family history of diabetes (P < 0.01). Risk factors for IFG and “new” IFG were age and obesity (P < 0.01).

The prevalence of metabolic syndrome was 22.2% overall, 68.5% among subjects with diabetes, 43.6% among those with IGT, 86.1% among subjects with IFG, 35.7% with “new” IFG, and 12.3% among subjects with normal glucose tolerance. The prevalence of metabolic syndrome increases with age, is higher in men than in women (26.5 vs. 18.3%, respectively, P = 0.001), and is higher in rural than in urban areas (26.0 vs. 20.6%, respectively, P = 0.037).

The average daily energy intake was 2,509 kcal, to which carbohydrates contributed 53.3%, fats contributed 31.8%, and proteins contributed 14.9%. Comparing the OGTT(−) group with the three groups of various degrees of glucose intolerance, after age and sex adjustment, no differences were found regarding energy intake (range 2,551–2,231 kcal) or the qualitative composition of the diet (carbohydrates 53.1–54.9%, proteins 14.4–15.4%, and fats 30.7–32.1%). Moreover, the above parameters did not differ between subjects with or without metabolic syndrome.

In conclusion, the study revealed a very high prevalence of diabetes and IGT in Cyprus, among the highest in Europe, compared with five centers of the DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) study (1) and higher than in the U.S. (2), while the prevalence of metabolic syndrome is comparable with that of other Western countries (3). Dietary habits, evaluated by cross-sectional analysis, do not seem to contribute to the development of glucose intolerance. Interventions aimed at IGT and the components of metabolic syndrome are urgently needed in order to reduce the incidence of diabetes.