Abstract number: AD-0711
Title: Knowledge and behaviors related to diabetes mellitus among adult Russian population: results of the NATION study 
Authors: Dedov I.a, Shestakova M.ab, Galstyan G.ab, Massi Benedetti M c.
a Endocrinology Research Centre, Moscow, Russia; bI.M.Sechenov First Moscow State Medical University, Moscow, Russia;c Hub for International Health Research (HIRS), Perugia, Italy

Abstract
Background: Prevalence of diabetes mellitus type 2 (T2DM) is growing worldwide and has reached epidemic proportions in many countries. The NATION study allowed to get reliable data on T2DM and pre-diabetes prevalence in Russia, and showed that T2DM was undiagnosed in 54% of people with the disease. Knowledge on risk factors and appropriate behaviors related to T2DM are keys to its proper prevention and management.
Aims: To assess knowledge on risk and preventive factors as well as health behaviors related to T2DM among adult population of  Russia depending on their diabetes status.
Methods: The NATION study is a national, epidemiological, cross-sectional study conducted from September 2013 to February 2015 across 8 federal districts and 63 regions. In adults (aged 20–79 years), recruitment was stratified by age, sex, geographic region and settlement type to obtain a representative sample. Recruitment was done in public areas with high numbers of people. T2DM was diagnosed using glycated haemoglobin A1c (HbA1c) centrally measured in whole blood (diabetes: HbA1c ≥6.5%; pre-diabetes: HbA1c ≥5.7%–<6.5%). HbA1c levels were analyzed by capillary electrophoresis (NGSP Certified method) using a Capillarys 2 Flex- Piercing instrument (Sebia Inc, Norcross, GA, USA). Socio-demographic, anthropometric, behavioral data and knowledge on DM risk and preventive factors were collected using a semi-structured questionnaire.
Results: A total of 26,620 respondents were screened. Overall 5.4% (n=1449) subjects were diagnosed with T2DM (previously known:  2.5%, n=668; newly diagnosed: 2.9%, n=781); 19.3% (n=5128) were pre-diabetic subjects; 75.3% (n=20043) had normal HbA1c level.
Differences were found in knowledge about T2DM risk factors and possible preventive measures between healthy participants (n=20043) and people with previously known diabetes (n=668).
Most frequently participants with previously known T2DM and subjects without diabetes reported the following as risk factors for DM: overweight or obesity (58.7% in the group of previously known T2DM and 63.1% in the group without diabetes, p=0.002), stress (66.0% and 55.5%, p<0.001), genetic predisposition (53.3% and 57.0%, ns) and unhealthy diet (51.2% and 52.7%, ns). While overweight or obesity was ranked first by people without diabetes, it was mentioned second after stress by people with previously diagnosed diabetes. About 1/3 of the participants perceived low physical activity as a risk factor for DM (32.8% in previously known T2DM group and 30.8% in healthy group). Knowledge of gestational diabetes as a risk factor of DM was low (12.5% and 15.6% people with diagnosed T2DM  and without disease, respectively).
Top-5 measures that can prevent diabetes reported by study participants included the same factors in both groups with previously known T2DM and without diabetes, such as: eating regimen (66.6% and 57.3%), regular physical activity (63.9% and 56.7%), weight control (61.6% and 55.6%), consumption of fruits and vegetables (61.4% and 55.2%), consumption of low fat food (56.0% and 46.7%). Interestingly, overall proportions of people who knew these factors were bigger among group with previously known diabetes vs people without diabetes (p<0.01 for all top-5 factors).
Analysis of health behavior of study participants with previously known T2DM and without diabetes showed high prevalence of low physical activity (81.6% and 78.5%). Only 2/3 of participants eat fruits and vegetables every day, with greater proportion of people with diabetes eating fruits and vegetables every day vs healthy adults (66.7% vs 60.0%, n<0.001). Proportion of smokers was lower in previously known T2DM group than among people without diabetes (14.3% vs 30.6%, n<0.001).
Conclusion: Despite rather good knowledge about the main diabetes risk and preventive factors, the majority of Russian adult population, similarly people with previously known diabetes and without T2DM, demonstrate unhealthy diabetes-related behaviors. These data emphasize the need to implement in Russia a life style intervention program in high risk population as a preventive measure for T2DM, and promotion of early treatment and education programs for people with T2DM.


 This study was funded by Sanofi