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OBJECTIVE--Secular trends in the epidemiology of diabetes are best described by studying the same population over time, but few such studies exist. Using surveys from Mauritius in 1987 and 2009, we examined 1) the change in the prevalence of diabetes, 2) the extent to which changes in traditional diabetes risk factors explained the increase, and 3) the change in the distribution of plasma glucose levels over time. RESEARCH DESIGN AND METHODS--Independent population-based surveys were undertaken in Mauritius in 1987 and 2009 using similar methodology in adults aged 20-74 years. Physical measurements and fasting blood samples were taken, and an oral glucose tolerance test was performed at both surveys. RESULTS--The age-standardized prevalence of diabetes in 2009 was 22.3% (95% CI 20.0-24.6) among men and 20.2%(18.3-22.3) among women, representing an increase since 1987 of 64 and 62% amongmen and women, respectively. Concurrent changes in the distribution of age, ethnicity, waist circumference, BMI, physical activity, smoking, family history of diabetes, and hypertension explained more of the increase in the prevalence of diabetes in men than in women. Increases in plasma glucose (especially fasting glucose) were seen across the population but were greater at the upper levels. CONCLUSIONS--In Mauritius, there has been a marked increase in diabetes prevalence over 22 years. This mainly results from changes in traditional risk factors, leading to population-wide increases in plasma glucose levels. Interventions to control this escalation of diabetes should focus on population-wide strategies. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- Little information is available on the impact of abnormal glucose tolerance on mortality in South Asian and African populations in the developing world. We explored this issue in a large, multiethnic cohort from the developing nation of Mauritius. RESEARCH DESIGN AND METHODS-- Population-based surveys were undertaken in 1987, 1992, and 1998. The 9,559 participants (20-82 years old) comprised 66% South Asian (Indian), 27% Creole (African), and 7% Chinese descent. Mortality was ascertained in 2007. RESULTS -- Over a median 15.1-year follow-up, 1,557 participants died. Compared with those with normal glucose tolerance, the all-cause mortality hazard ratios (HR) for known diabetes, newly diagnosed diabetes, and impaired glucose tolerance were 3.35 (95% CI 2.77-4.04), 2.11 (1.73-2.57), and 1.53 (1.26-1.87) in South Asians and 2.14 (1.65-2.79), 1.41 (1.06-1.88), and 1.08 (0.83-1.40) in Africans, respectively. Those with impaired fasting glucose were not at increased risk in either ethnicity. In the Chinese, only those with known diabetes were at increased risk of mortality with HR 3.68 (1.87-7.25). CONCLUSIONS -- This is the first study in a developing country of the impact of glucose intolerance on mortality in an African population, and one of the first studies of a South Asian population. It shows that the impact on mortality in these populations in Mauritius is comparable to that seen in developed countries. These results are important in a global context for future health policy in light of the impact of the rapid increase in prevalence of diabetes, especially in developing nations. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) as a predictor of diabetes incidence. A total of 1,841 men and 2,104 women of Mauritian Indian and Mauritian Creole ethnicity, aged 25–74 years, free of diabetes, hypertension, cardiovascular disease, and gout were seen at baseline in 1987 or 1992, and follow-up in 1992 and/or 1998. At all time points, participants underwent a 2 h 75 g oral glucose tolerance test. Hazard ratios for diabetes incidence were estimated applying an interval-censored survival analysis using age as timescale. Six hundred and twenty-eight individuals developed diabetes during the follow-up period. Multivariable adjusted hazard ratios for diabetes incidence corresponding to a 1 s.d. increase in baseline BMI, WC, WHR, and WSR for Mauritian Indians were 1.49 (1.31–1.71), 1.58 (1.38–1.81), 1.54 (1.37–1.72), and 1.61 (1.41–1.84) in men and 1.33 (1.17–1.51), 1.35 (1.19–1.53), 1.39 (1.24–1.55), and 1.38 (1.21–1.57) in women, respectively; and for Mauritian Creoles they were 1.86 (1.51–2.30), 2.07 (1.68–2.56), 1.92 (1.62–2.26), and 2.17 (1.76–2.69) in men and 1.29 (1.06–1.55), 1.27 (1.04–1.55), 1.24 (1.04–1.48), and 1.27 (1.04–1.55) in women. Paired homogeneity tests showed that there was no difference between BMI and each of the central obesity indicators (all P > 0.05). The relation of BMI with the development of diabetes was as strong as that for indicators of central obesity in this study population.Obesity (2009) 17 2, 342–348. doi:10.1038/oby.2008.503 [ABSTRACT FROM AUTHOR]

AbstractObjectives: To describe changes in the prevalence of cigarette smoking in the middle income country of Mauritius from 1987 to 1998, and to relate these changes to legislative and health promotion efforts over the same period.Design: Questionnaire survey.Setting: Mauritius, an island in the Indian Ocean with a population of about 1.2 million (about 70% south Asian, 2% Chinese, and 28% Creole).Participants: Data were obtained from 5072 participants in 1987, 6573 in 1992, and 6281 in 1998.Main outcome measures: Prevalence of current smoking in 1987, 1992, and 1998, sales of cigarettes in Mauritius, and information on activities for control of tobacco.Results: Self reported cigarette smoking has been decreasing in Mauritius since 1987, with the largest decrease between 1987 and 1992. From 1987 to 1998 smoking prevalence decreased by 23% in men and 61% in women. Smoking decreased across all age and ethnic groups and across different levels of income and education. Sales of cigarettes also decreased in line with smoking prevalence.Conclusions: The introduction of cigarette taxes, a limited health promotion programme, and the absence of massive promotional campaigns by the sole tobacco company on Mauritius have led to a striking and continued decrease in smoking prevalence and cigarette consumption on the island. [ABSTRACT FROM AUTHOR]

This study examined the relation between occupation and cardiovascular disease (CVD) risk factors in 2,795 individuals between ages 35 and 54 years from the rapidly developing island nation of Mauritius. Participants attended a 1992 population-based survey of noncommunicable disease (89.1% response rate). Occupational status, physical activity in the previous year, cigarette smoking, and alcohol consumption were assessed by questionnaire. Anthropometric and metabolic measures included body mass index (kg/m2), waist-to-hip ratio, fasting serum high density lipoprotein cholesterol and low density lipoprotein cholesterol (LDL cholesterol), triglycerides, 2-hour postload plasma glucose and serum insulin concentrations, and blood pressure. In comparison with professional/skilled workers, age-adjusted means of insulin and glucose, LDL cholesterol, triglycerides, and systolic and diastolic blood pressures were significantly (p < 0.05) lower, and the age-adjusted mean for high density lipoprotein cholesterol was significantly higher for unskilled men. In women, risk factors other than LDL cholesterol varied significantly (p < 0.05) across occupational categories, with homemakers tending to have the least favorable profile. Unskilled workers reported significantly more physical activity (p < 0.01), alcohol consumption, and cigarette smoking (men only) (p < 0.05) than did the other groups. Adjustment for multiple covariates revealed an independent association between occupational status and most CVD risk factors, with physical activity attenuating this association. These results elucidate mediating behaviors of CVD risk across occupational categories that could be applied to intervention strategies in Mauritius. Am J Epidemiol 1998; 148: 148–59. [ABSTRACT FROM AUTHOR]

There are accumulating data describing the association between diabetes and cancer mortality from Westernised populations. There are no data describing the relationship between diabetes and cancer mortality in African or South Asian populations from developing countries. We explored the relationship of abnormal glucose tolerance and diabetes on cancer mortality risk in a large, multi-ethnic cohort from the developing nation of Mauritius. Population-based surveys were undertaken in 1987, 1992 and 1998. The 9559 participants comprised 66% of South Asian (Indian), 27% of African (Creole), and 7% of Chinese descent. Cox's proportional hazards model with time varying covariates was used to obtain hazard ratios (HRs) and 95% confidence intervals (95% CI) for risk of cancer mortality, after adjustment for confounding factors. In men, but not women, cancer mortality risk increased with rising 2h-PG levels with HR for the top versus bottom quintile of 2.77 (95%CI: 1.28 to 5.98). South Asian men with known diabetes had a significantly greater risk of cancer mortality than those with normal glucose tolerance (NGT) HR: 2.74 (95%CI: 1.00-7.56). Overall, impaired glucose tolerance was associated with an elevated risk of cancer mortality compared to NGT (HR: 1.47, 95% CI: 0.98-2.19), though this was not significant. We have shown that the association between abnormal glucose tolerance and cancer extends to those of African and South Asian descent. These results highlight the importance of understanding this relationship in a global context to direct future health policy given the rapid increase in type 2 diabetes, especially in developing nations., (Copyright © 2012 UICC.)

Aims: To determine the incidence, progression and risk factors for diabetic retinopathy in the multiethnic population of Mauritius., Method: A longitudinal, population-based study was conducted in Mauritius, during 1987, 1992 and 1998. Participants identified through the study as having diabetes (both known and newly diagnosed, by self-report and oral glucose tolerance test) and one in four participants with impaired glucose tolerance (IGT) underwent complications screening in 1992 and 1998. Retinal photographs were taken using a TRC-50VT retinal camera in three fields of the right eye (centred on the optic disc; macula (temporal to the optic disc); and nasal to disc). Photographs were graded according to a simplified version of the Wisconsin grading system., Results: The 6-year incidence of diabetic retinopathy was 23.8% (sight-threatening in 0.4%). Among those with known diabetes mellitus (KDM) and free of retinopathy at baseline the incidence of non-proliferative diabetic retinopathy (NPDR) was 29.2% and proliferative diabetic retinopathy (PDR) was 1.0%. Among those with newly diagnosed diabetes mellitus (NDM) at baseline the incidence of NPDR was 19.1% (no incident cases of PDR were found). Independent risk factors for retinopathy using the baseline population characteristics were duration of diabetes and fasting plasma glucose., Conclusions: This is one of the few recent population-based studies of diabetic retinopathy undertaken in a developing nation. The incidence of retinopathy in Mauritius was high among those with NDM at baseline, with one in five developing retinopathy over 6 years. These results support the concept that screening for diabetes is important.