Prevalence of diabetes mellitus among adults aged 45 years and above in rural Sidama, Ethiopia: a two-step community-based cross-sectional study.

OBJECTIVE: To determine the prevalence of undiagnosed diabetes and identify associated factors using a two-step diagnostic method combining fasting blood sugar with confirmatory glycated haemoglobin A1c (HbA1c) testing among adults 45 years and above in rural Sidama, Ethiopia. DESIGN: A community-based cross-sectional design was conducted from 1 April to 31 July 2024. Data were collected through a census of adults aged 45 years and above using a pretested WHO-STEPwise questionnaire. Physical and biochemical tests were performed following standard protocols. Data were analysed using Stata V.17. SETTING: Selected rural kebeles of Shebedino district, Sidama, Ethiopia. PARTICIPANTS: 2875 adults aged 45 years and above. PRIMARY OUTCOME MEASURES: Undiagnosed diabetes confirmed by HbA1c levels (≥48 mmol/mol or ≥6.5%). RESULTS: The prevalence of undiagnosed diabetes confirmed by HbA1c was 1.2% (35 of 2871; 95% CI: 0.9% to 1.7%). Previously diagnosed diabetes was found in 0.5% (14 of 2875; 95% CI: 0.3% to 0.8%). The total diabetes prevalence, confirmed by HbA1c or prior diagnosis, was 1.7% (49 of 2871; 95% CI: 1.3% to 2.3%). A total of 1327 out of 2875 (46%) participants were undernourished. Advanced age (β=0.21; 95% CI: 0.08 to 0.32, p=0.001), and estimated annual income (β=0.15; 95% CI: 0.02 to 0.28; p=0.029) were significantly associated with elevated fasting blood sugar levels. CONCLUSION: The prevalence of undiagnosed diabetes among rural adult population was low. Older age and higher income were significantly associated with elevated fasting blood sugar. Routine community-based diabetes screening among older population, health education and nutrition-focused interventions are recommended to sustain the low burden and address undernutrition.