{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T12:48:38Z","timestamp":1793278118654,"version":"4.5.0"},"reference-count":29,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,12,19]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design, settings and participants<\/jats:title>\n                  <jats:p>Multistaged stratified cluster sampling was used for the representative selection of people aged \u226520 years, residing in 378 sampled clusters of 16 randomly selected districts, in this cross-sectional study. Eligible participants had blood drawn for HbA1c analyses at field clinics near to their homes. The oral glucose tolerance test (OGTT) was conducted on a subsample of the participants. Overall and stratified prevalence of type 2 diabetes and its association with risk factors were estimated using logistic regression models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Prevalence of prediabetes and type 2 diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 18\u2009856 eligible participants the prevalence of prediabetes was 10.91% (95% CI 10.46 to 11.36, n=2057) and type 2 diabetes was 16.98% (95% CI 16.44 to 17.51, n=3201). Overall, the mean HbA1c level was 5.62% (SD 1.96), and among newly diagnosed was 8.56% (SD 2.08). The prevalence was highest in age 51\u201360 years (26.03%, p&lt;0.001), no formal education (17.66%, p&lt;0.001), class III obese (35.09%, p&lt;0.001), family history (31.29%, p&lt;0.001) and female (17.80%, p=0.009). On multivariate analysis, there was a significant association between type 2 diabetes and older age, increase in body mass index and central obesity, positive family history, and having hypertension and an inverse relation with education as a categorical variable. On a subsample (n=1027), summary statistics for diagnosis of diabetes on HbA1c showed a sensitivity of 84.7%, specificity of 87.2% and area under the receiver operating characteristic curve 0.86, compared with OGTT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The prevalence of type 2 diabetes and prediabetes is much higher than previously thought in Pakistan. Comprehensive strategies need to be developed to incorporate screening, prevention and treatment of type 2 diabetes at a community level.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-025300","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T06:36:10Z","timestamp":1550817370000},"page":"e025300","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":144,"title":["Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan"],"prefix":"10.1136","volume":"9","author":[{"given":"Azizul Hasan","family":"Aamir","sequence":"first","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad Medical Complex, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia","family":"Ul-Haq","sequence":"additional","affiliation":[{"name":"Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan"},{"name":"Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed A","family":"Mahar","sequence":"additional","affiliation":[{"name":"Endocrinology, National Institute of Cardiovascular Diseases, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal Masood","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Endocrinology, Al-Khaliq Hospital, Multan, Multan, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrar","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Endocrinology Ward, Lady Reading Hospital, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Jawa","sequence":"additional","affiliation":[{"name":"Endocrinology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Sheikh","sequence":"additional","affiliation":[{"name":"Endocrinology, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Raza","sequence":"additional","affiliation":[{"name":"Endocrinolgy, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheraz","family":"Fazid","sequence":"additional","affiliation":[{"name":"Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahid","family":"Jadoon","sequence":"additional","affiliation":[{"name":"Hayatabad Medical Complex Department of Ophthalmology, Epidemiology, Peshawar, KP, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Ishtiaq","sequence":"additional","affiliation":[{"name":"Endocrinology, Shifa College of Medicine, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nauman","family":"Safdar","sequence":"additional","affiliation":[{"name":"Social Work, Social and Health Inequalities Network, Islamabad, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussain","family":"Afridi","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad Medical Complex, Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-4050","authenticated-orcid":false,"given":"Adrian H","family":"Heald","sequence":"additional","affiliation":[{"name":"The School of Medicine and Manchester Academic Sciences Centre, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,2,21]]},"reference":[{"key":"2025101814220504000_9.2.e025300.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.02.023"},{"key":"2025101814220504000_9.2.e025300.2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.9.2130"},{"key":"2025101814220504000_9.2.e025300.3","unstructured":"Provisional summary results of 6th population and housing census-2017. 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