Download Epidemiology of diabetes: prevalence, complications and health

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Epidemiology of
Type 2 Diabetes
Dr Ghadiri
Diabetes
Primary Goal for 2010

Through prevention programs, reduce the disease
incidence, its complications and its economic
impact, in addition, to improve quality of life for
all those persons that had diabetes or that are at
risk to develop the disease.
Reference: U.S. Department of Health and Human Services. Healthy People 2010:
Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing
Office, November 2000.
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Epidemiology

The worldwide prevalence of DM has risen dramatically over the
past two decades, from an estimated 30 million cases in 1985 to
285 million in 2010. International Diabetes Federation projects
that 438 million individuals will have diabetes by the year 2030 .

Prevalence of both type 1 and type 2 DM is increasing
worldwide, the prevalence of type 2 DM is rising much more
rapidly, presumably because of increasing obesity, reduced
activity levels as countries become more industrialized, and the
aging of the population.
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
The magnitude of the healthcare problem of
type 2 diabetes results not just from the disease
itself but also from its association with obesity
and cardiovascular risk factors, particularly
dyslipidaemia and hypertension.
 Type 2 diabetes has now been recognized as
one manifestation of the “metabolic syndrome”,
a condition characterized by insulin resistance
and associated with a range of cardiovascular
risk factors.
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 Various cardiovascular risk factors, including
hypertension and dyslipidaemia become
progressively worse with progression from normal
glucose tolerance to IGT/IFG to diabetes.
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While there is good evidence for a strong genetic
contribution to both obesity and diabetes, the increase in
these conditions in both developed and developing
countries appears to be due to a changing balance
between energy intake and energy expenditure through
physical activity.

 Physical activity levels have probably diminished by
half.
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The tendency for the increased prevalence of
type 2 diabetes to be concentrated in lower
socioeconomic groups in developed countries
and higher socioeconomic groups in developing
countries probably reflects the adoption of a
“healthier” lifestyle by better educated people in
developed countries, while it is generally the
affluent in developing countries who enjoy a
high calorie intake and low level of physical
activity.
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Approximately 1.6 million individuals (>20 years) were
newly diagnosed with diabetes in 2010. DM increases
with aging.
In 2010, the prevalence of DM in the United Sates was
estimated to be 0.2% in individuals aged <20 years and
11.3% in individuals aged >20 years.
In individuals aged >65 years, the prevalence of DM
was 26.9%.
The prevalence is similar in men and women
throughout most age ranges (11.8% and 10.8%,
respectively, in individuals aged >20 years).
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
In Asia, the prevalence of diabetes is increasing
rapidly and the diabetes phenotype appears to be
different from that in the United States and
Europe—onset at a lower BMI and younger age,
greater visceral adiposity, and reduced insulin
secretory capacity.
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
Diabetes is a major cause of mortality, but
several studies indicate that diabetes is likely
underreported as a cause of death. In the United
States, diabetes was listed as the seventh leading
cause of death in 2007; a recent estimate
suggested that diabetes was the fifth leading
cause of death worldwide and was responsible
for almost 4 million deaths in 2010 .
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Global Prevalence of
Diabetes
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Global Prevalence Estimates, 2000 and 2030
4.4 %
2030
2000
0.0%
2.8 %
1.0%
2.0%
3.0%
4.0%
5.0%
Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
Diabetes in the World
31.7
India
Year
2000
20.8
China
17.7
USA
8.4
Indonesia
6.8
millions
Japan
Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
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Diabetes in the World
79.4
India
Year
2030
42.3
China
30.3
USA
21.3
Indonesia
8.9
millions
Japan
Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
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Prevalence of Diabetes in Adults
United States, BRFSS* 1998 - 2003
Prevalence (Mean %)
8.0
7.1
7.0
6.0
5.0
4.0
5.4
5.6
6.1
6.5
6.7
3.0
2.0
1.0
0.0
1998
1999
2000
2001
2002
2003
* BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral
Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services.
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Prevalence of Diabetes in Adults
United States, BRFSS
1990
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
1991-92
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
1993-94
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
1995-96
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
1995
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
1997-98
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
1999
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
2000
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults
United States, BRFSS
2001
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
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Prevalence of Diabetes in Adults,
United States and territories, BRFSS* 2002
* BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral
Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services.
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Prevalence of Diabetes by Sex and Year,
Puerto Rico BRFSS* 1997, 2001 - 2003
Prevalence (%)
11.1
10.5
9.5
9.0
1997
2001
11.2
10.5 10.4 10.8
2002
2003
Year
Male
Female
* BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral
Risk Factor Surveillance System 1997-2003. Atlanta, GA: United States, Department of Health and Human Services.
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Prevalence of Total Diabetes (diagnosed and undiagnosed diabetes)
in the U.S. Adult Population, age ≥ 20,
1988-1994 to 2005-2006
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18
16
14
12
10
8
6
Undiagnosed
Diagnosed
4
2
0
1988- 200594
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Overall
Cowie et al., 2008;
1988- 200594
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1988- 200594
06
1988- 200594
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Non-Hispanic
Whites
Non-Hispanic
Blacks
MexicanAmericans
Problem Statement

Iceberg Disease

Increased prevalence in newly
industrialized and developing countries.

Disease acquired in the most productive
period of their life.

Undiagnosed or inadequately treated
patients develop multiple chronic
complications.

Lack of awareness about interventions
for prevention and management of
complications.
Age Distribution of Diabetes Mellitus
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Age Distribution of Diabetes Mellitus
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Prevalence of diabetes in the WHO South-East Asia Region
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Eastern Mediterranean Health Journal, Vol. 15, No. 3, 2009 591
٣ ‫ العدد‬،‫ المجلد الخامس عشر‬،‫ منظمة الصحة العالمية‬،‫ المجلة الصحية لشرق المتوسط‬، ٢٠٠٩
Prevalence of type 2 diabetes in the
Islamic Republic of Iran: systematic
review and meta-analysis
A.A Haghdoost,1,2 M. Rezazadeh-Kermani,1 B. Sadghirad 3 and H.R. Baradaran4
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Between 1996 and 2004. In those > 40 years the
prevalence was 24% and it increased by 0.4%
with each year after 20 years of age. The risk of
type 2 diabetes was1.7% greater in women than
men
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Province
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Bushehr
Qazvin
Gilan
Isfahan
Kerman
Khorasan
Kordestan
Tehran
Yazd
Prevalence
12.62 (7.62–17.63)
13.09 (7.93–18.25)
5.45 (1.78–9.13)
8.20 (5.23–11.17)
13.16 (7.55–18.77)
9.09 (2.28–15.89)
3.35 (0–7.36)
7.43 (4.04–10.81)
14.01 (10.75–17.27)
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Prevalence of diabetes in I.R.IRAN
Year
2000
2030
Diabetic patients
2,103,000
6,421,000
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Prevalence of diabetes in Yazd Province
Year
2000
2030
Diabetic patients
145,000
442,722
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Prevalence of Type 2 Diabetes
Complications in Yazd Province
In this study 1000 type 2 diabetic patients (457
male, 543 female) were studied .
 Nephropathy : 285 (28.5%)
 Retinopathy : 519 (51.9%)
 CAD : 251 (25.1%)
 PVD : 143 (14.3%)
 CVA :109 (10.9%)
 Foot ulcer : 84 (8.4%)
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THANKS
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Estado Libre Asociado
de Puerto Rico
Estado Libre Asociado
de Puerto Rico
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
There is considerable geographic variation in the
incidence of both type 1 and type 2 DM.
Scandinavia has the highest incidence of type 1
DM (Finland, the incidence is 57.4/100,000
per year).

Japan and China has a much lower rate of type 1
DM (0.6–2.4/100,000 per year); Northern
Europe and the United States have an
intermediate rate (8–20/100,000 per year).
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
Much of the increased risk of type 1 DM is
believed to reflect the frequency of high-risk
human leukocyte antigen (HLA) alleles among
ethnic groups in different geographic locations.
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