Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016-2017.

The second National Diabetes Survey of Pakistan (second NDSP) was planned to ascertain the updated prevalence of diabetes, pre-diabetes and associated risk factors at the national and provincial levels.The survey was conducted by using multistage clustering technique in all four provinces of Pakistan from February 2016 to August 2017. An estimated sample size of 10 800 was calculated using probability sampling and multistage stratified sampling technique. Twenty-seven clusters were selected out of total 213 clusters from all four provinces (strata) of Pakistan. A total of 46 subclusters were selected by using the 'Rule of thumb'. Out of 12 486 targeted individuals, 10 834 study subjects finally participated in the study (87% response rate). Seventeen trained teams collected data using the structured questionnaire. The clinical and anthropometric measurements included height, weight, blood pressure, waist circumference and waist-to-hip ratio while the blood tests included Oral Glucose Tolerance Test (OGTT), haemoglobin A1c and fasting lipid profiles. WHO criteria were used for the diagnosis of diabetes and pre-diabetes.Overall weighted prevalence of diabetes was 26.3%, of which 19.2% had known diabetes, and 7.1% were newly diagnosed people with diabetes. Prevalence of diabetes in urban and rural areas was 28.3% and 25.3%, respectively. Prevalence of pre-diabetes was 14.4% (15.5% in urban areas and 13.9% in rural areas). Age greater than or equal to 43 years, family history of diabetes, hypertension, obesity and dyslipidaemia were significant associated risk factors for diabetes.The findings of the 2nd NDSP imply that diabetes has reached epidemic proportion and urgently need national strategies for early diagnosis and effective management as well as cost-effective diabetes primary prevention programme in Pakistan.