Medicine:Epidemiology of diabetes

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Prevalence (per 1,000 inhabitants) of diabetes worldwide in 2000 - world average was 2.8%.
Disability-adjusted life year for diabetes mellitus per 100,000 inhabitants in 2004

Globally, an estimated 537 million adults are living with diabetes, according to 2019 data from the International Diabetes Federation.[1] Diabetes was the 9th-leading cause of mortality globally in 2020, attributing to over 2 million deaths annually due to diabetes directly, and to kidney disease due to diabetes.[2] The primary causes of type 2 diabetes is diet and physical activity, which can contribute to increased BMI, poor nutrition, hypertension, alcohol use and smoking, while genetics is also a factor.[3] Diabetes prevalence is increasing rapidly; previous 2019 estimates put the number at 463 million people living with diabetes,[4] with the distributions being equal between both sexes icidence peaking around age 55 years old.[5] The number is projected to 643 million by 2030,[1] or 7079 individuals per 100,000, with all regions around the world continue to rise.[5] Type 2 diabetes makes up about 85-90% of all cases.[6][7] Increases in the overall diabetes prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight or obese.[8] The prevalence of African Americans with diabetes is estimated to triple by 2050, while the prevalence of whites is estimated to double.[3] The overall prevalence increases with age, with the largest increase in people over 65 years of age.[3] The prevalence of diabetes in America is estimated to increase to 48.3 million by 2050.

[3]

Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, occurring in low- and middle-income countries[8] including in Asia and Africa, where most patients will probably be found by 2030.[9] The increase in incidence in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the Western pattern diet).[8][9] The risk of getting type 2 diabetes has been widely found to be associated with lower socio-economic position across countries.[10]

The WHO estimates that diabetes resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death.[8] However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of associated complications (e.g. heart disease, stroke, kidney failure), which often result in premature death and are often listed as the underlying cause on death certificates rather than diabetes.[8][11] The burden of diabetes (both type 1 and 2) has a possibility to lead to complications of multiple body systems including nephropathy, neuropathy and retinopathy.[12] About half of patients with type 2 diabetes die due to cardiovascular disease and 10% from kidney failure.[13] A study done on Gomel city population with radiation exposure after the Chernobyl incident demonstrated increased incidence of type 1 diabetes mellitus.[14][15] Women who had gestational diabetes during pregnancy have a 20-50% increased risk of developing type 2 diabetes later in life.[3]

Asia

China

Almost one Chinese adult in four has diabetes.[1] The International Diabetes Federation estimated in 2021 more than 140 million Chinese adults with diabetes.[1] The incidence of the disease is increasing rapidly: a reported 30% increase in 7 years.[16] Indigenous nomadic peoples like Tibetans and Mongols are at much higher susceptibility than Han Chinese.

India

India has the second highest number of people with diabetes.[1] Diabetes currently affects more than 74 million Indians, which is more than 8.3% of the adult population.[1] It is estimated to be around 57% of the current cases of diabetes to be undiagnosed.

[17] Among young and middle aged adults the prevalence of diabetes is 6.7% and prediabetes is 5.6% according to the National Family Health Survey-4.[18] The average age on onset is 42.5 years.[19] Nearly 1 million Indians die due to diabetes every year.[19]

According to the Indian Heart Association, India is projected to be home to 109 million individuals with diabetes by 2035.[20] A study by the American Diabetes Association reports that India will see the greatest increase in people diagnosed with diabetes by 2030.[21] The high incidence is attributed to a combination of genetic susceptibility plus adoption of a high-calorie, low-activity lifestyle by India's growing middle class.[22]

Europe

United Kingdom

In 2021 there were 4.1 million people in the UK diagnosed with diabetes, 90% of them having type 2. There were a further 1 million people with undiagnosed type 2 diabetes and 13.6 million people were at risk of developing type 2 diabetes, half of which could be prevented.[23] The charity Diabetes UK have made predictions that could become high as 6.2 million by 2035–2036. The National Health Service (NHS) spent a daily average of £2.2m (€2.6m; $3.7m) in 2013 on prescriptions for managing diabetes in primary care, and about 10% of the primary care prescribing budget is spent on treating diabetes.[24] Diabetes UK have also predicted that the NHS could be spending as much as 16.9 billion pounds on diabetes mellitus by 2035, a figure that means the NHS could be spending as much as 17% of its budget on diabetes treatment by 2035.[25][26] However, since the United Kingdom practices a national health care system with universal access, there are far fewer cases of diagnosed diabetes compared to the United States.[27]

North America

Canada

Almost 2.4 million Canadians (6.8%) have been diagnosed with type 1 or type 2 diabetes, based on 2009 chronic disease surveillance data. Prevalence is higher among males (7.2%) than females (6.4%).[11] However these numbers are likely an underestimate, as data obtained from blood samples indicate about 20% of diabetes cases remain undiagnosed.[28]

Accounting for the younger age structure in Aboriginal populations, the prevalence of diabetes is 2-3 times higher among First Nations and Métis, compared to the non-Aboriginal population.[11]

The prevalence of diagnosed diabetes among Canadians increased by 70% over the decade from 1999 to 2009.[11] The greatest relative increase in prevalence was seen younger adults (35 to 44 years), attributable in part to increasing rates of overweight and obesity. The Public Health Agency of Canada estimates that if current trends in diabetes continue, the number of Canadians living with diabetes will reach 3.7 million by 2019.[11]

United States

Diabetes rates at county levels 2004 - 2009.
Diabetes rates in the United States, 1994-2010

Diabetes rates in the United States, like across North America and around the world, have been increasing substantially.The diagnosis of diabetes has quadrupled in the last 30 years in America, increasing from 5.5 million in 1980 to 21.1 million in 2010.[29] From 1988-1994, about 25% of American adults, aged 40–74 years old, were classified as having prediabetes.[3] According to the 2014 Statistics Report done by the CDC it was found that, "Diabetes Mellitus affects an estimated 29.1 million people in the United States and is the 7th leading cause of death. It also increases the chances of mortality, as well as the risk for heart attack, kidney failure, and blindness"[30] While the number of people with diabetes in the US continues to grow, the number of new cases has been declining since 2009, after decades of increases in new cases.[31] In 2014, more than 29 million people had diabetes in the United States, of whom 7 million people remain undiagnosed.[32] As of 2012 another 57 million people were estimated to have prediabetes.[33][34] There were approximately 12.1 million diabetes-related emergency department (ED) visits in 2010 for adults aged 18 years or older (515 per 10,000 U.S. population), accounting for 9.4 percent of all ED visits.[35]

The Centers for Disease Control and Prevention (CDC) has called the change an epidemic.[36] Geographically, there is a U.S. diabetes belt with high diabetes prevalence estimates, which includes Mississippi and parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia.[37] The National Diabetes Information Clearinghouse estimates diabetes costs $132 billion in the United States alone every year. About 5%–10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs. Most of this difference is not currently understood. The American Diabetes Association (ADA) cites the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion (Centers for Disease Control and Prevention) that one in three Americans born after 2000 will develop diabetes in their lifetimes.[38][39]

Diabetes is also more prominent in minority groups. For example, according to the American Diabetes Association the rates of diagnosed diabetes are 12.8% of Hispanics, 13.2% of Non-Hispanic blacks, 15.9% of American Indians/Alaskan Natives. While Non-Hispanic whites are 7.6% and only 9% of Asian Americans have diagnosed diabetes.[40] 4.9% of American adults had diabetes in 1990. By 1998, that number rose by a third to 6.5%. The prevalence of diabetes increased for both sexes and every racial group. American women have suffered from diabetes at a higher rate than men, with 7.4% of women being diabetic in 1998, as opposed to only 5.5% of men. The increase in diabetes coincides with an increase in average weight across both genders. In the same time frame, average weight in both men and women increased by nearly 4 kilograms. This relates to the fact that the most common form of diabetes, type 2, is strongly associated with unhealthy weight. Older Americans have suffered from diabetes at a much higher rate than younger people, with over 12% of those in their 60s and 70s being diabetic in 1998. In the same year, less than 2% of those under 30 suffered from diabetes. Weight is also a strong factor in one's likelihood of becoming diabetic, with 13.5% of obese Americans in 1998 being diabetic. In the same year, only 3.5% of people at a healthy weight had the disease.[41]

As of 2006, about 18.3% (8.6 million) of Americans age 60 and older had diabetes, according to the ADA.[42] Diabetes mellitus prevalence increases with age, and the numbers of older persons with diabetes are expected to grow as the elderly population increases in number. The National Health and Nutrition Examination Survey (NHANES III) from 1988 to 1994 demonstrated, in the population over 65 years old, 18% to 20% had diabetes, with 40% having either diabetes or its precursor form of impaired glucose tolerance.[43] Older individuals are also more likely to be seen in the emergency department (ED) for diabetes. A study by the Agency for Healthcare Research and Quality (AHRQ) found that in 2010, diabetes-related ED visit rates were highest for patients aged 65 and older (1,307 per 10,000 population), compared with 45- to 64-year-olds (584 per 10,000 population) and 18- to 44-year-olds (183 per 10,000 population).[35]

A second study by AHRQ found that diabetes with complications was one of the twenty most expensive conditions seen in U.S. inpatient hospitalizations in 2011, with an aggregate cost of nearly $5.4 billion for 561,000 stays. It was among the top five most expensive conditions for uninsured patients, at an aggregate cost of $440 million for 62,000 hospitalizations.[44]

Oceania and the Pacific

Australia

An estimated 1.5 million Australians have diabetes.[1] Indigenous populations in developed countries generally have higher prevalence and incidence of diabetes than their corresponding nonindigenous populations. In Australia, the age-standardised prevalence of self-reported diabetes in indigenous Australians is almost four times that of nonindigenous Australians.[45] Reasons include higher rates of obesity, physical inactivity, and living in poor housing and environments among Indigenous peoples.[7] Preventative community health programs are showing some success in tackling this problem.[citation needed]

Africa

The International Diabetes Federation (IDF) estimates that 23.6 million are living with diabetes in Africa.[1] The region of Africa has the highest percentage of undiagnosed diabetes cases reaching 53.6%s.[1]

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at: https://www.diabetesatlas.org.
  2. ↑ "Diabetes" (in en). 2022-09-16. https://www.who.int/news-room/fact-sheets/detail/diabetes. 
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Deshpande, Anjali D; Harris-Hayes, Marcie; Schootman, Mario (November 2008). "Epidemiology of Diabetes and Diabetes-Related Complications". Physical Therapy 88 (11): 1254–1264. doi:10.2522/ptj.20080020. ISSN 0031-9023. PMID 18801858. 
  4. ↑ "International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: 2019.". 
  5. ↑ 5.0 5.1 Khan, Moien Abdul Basith; Hashim, Muhammad Jawad; King, Jeffrey Kwan; Govender, Romona Devi; Mustafa, Halla; Al Kaabi, Juma (2020-03-10). "Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends". Journal of Epidemiology and Global Health 10 (1): 107–111. doi:10.2991/jegh.k.191028.001. ISSN 2210-6014. PMID 32175717. 
  6. ↑ Williams textbook of endocrinology (12th ed.). Philadelphia: Elsevier/Saunders. 2011. pp. 1371–1435. ISBN 978-1-4377-0324-5. 
  7. ↑ 7.0 7.1 Australian Indigenous HealthInfoNet, Chronic conditions: Diabetes. Accessed 31 August 2016.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 World Health Organization, Global Report on Diabetes. Geneva, 2016. Accessed 30 August 2016.
  9. ↑ 9.0 9.1 "Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030". Diabetes Care 27 (5): 1047–53. 2004. doi:10.2337/diacare.27.5.1047. PMID 15111519. 
  10. ↑ Agardh, E (2011). "Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis". International Journal of Epidemiology 40 (3): 804–818. doi:10.1093/ije/dyr029. PMID 21335614. 
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Public Health Agency of Canada, Diabetes in Canada: Facts and figures from a public health perspective. Ottawa, 2011.
  12. ↑ Forouhi, Nita Gandhi; Wareham, Nicholas J. (2014-12-01). "Epidemiology of diabetes". Medicine 42 (12): 698–702. doi:10.1016/j.mpmed.2014.09.007. ISSN 1357-3039. PMID 25568613. 
  13. ↑ van Dieren, Susan; Beulens, Joline W. J.; van der Schouw, Yvonne T.; Grobbee, Diederick E.; Neal, Bruce (2010-05-17). "The global burden of diabetes and its complications: an emerging pandemic". European Journal of Cardiovascular Prevention and Rehabilitation 17 (Suppl 1): S3–8. doi:10.1097/01.hjr.0000368191.86614.5a. ISSN 1741-8275. PMID 20489418. 
  14. ↑ "Did the Chernobyl incident cause an increase in Type 1 diabetes mellitus incidence in children and adolescents?". Diabetologia 47 (1): 147–148. 2004. doi:10.1007/s00125-003-1271-9. ISSN 0012-186X. PMID 14658035. 
  15. ↑ Venturi, Sebastiano (January 2021). "Cesium in Biology, Pancreatic Cancer, and Controversy in High and Low Radiation Exposure Damage—Scientific, Environmental, Geopolitical, and Economic Aspects" (in en). International Journal of Environmental Research and Public Health 18 (17): 8934. doi:10.3390/ijerph18178934. PMID 34501532. 
  16. ↑ Grens, Kerry (April 4, 2012). "Diabetes continuing to spike in China". Reuters. https://www.reuters.com/article/us-diabetes-china-idUSBRE83317H20120404. 
  17. ↑ Pradeepa, Rajendra; Mohan, Viswanathan (2012-11-01). "Epidemiology of type 2 diabetes in India". Indian Journal of Ophthalmology 69 (11): 2932–2938. doi:10.4103/ijo.IJO_1627_21. ISSN 1998-3689. PMID 34708726. 
  18. ↑ Chandrupatla, Siddardha Gowtam; Khalid, Isma; Muthuluri, Tejdeep; Dantala, Satyanarayana; Tavares, Mary (2020-09-18). "Diabetes and prediabetes Prevalence Among Young and Middle Aged Adults, And Geographic Differences In India- National Family Health Survey". Epidemiology and Health 42: e2020065. doi:10.4178/epih.e2020065. ISSN 2092-7193. PMID 32972049. 
  19. ↑ 19.0 19.1 Gale, Jason (November 7, 2010). "India's Diabetes Epidemic Cuts Down Millions Who Escape Poverty". Bloomberg. https://www.bloomberg.com/news/2010-11-07/india-s-deadly-diabetes-scourge-cuts-down-millions-rising-to-middle-class.html. 
  20. ↑ "Overview" (in en-US). http://indianheartassociation.org/why-indians-why-south-asians/overview/. 
  21. ↑ Wild, Sarah, Gojka Roglic, Anders Green, Richard Sicree, and Hilary King. "Global Prevalence of Diabetes." Diabetes Care. American Diabetes Association, 26 January 2004. Web. 22 April 2014.
  22. ↑ Kleinfield, N. R. (September 13, 2006). "Modern Ways Open India's Doors to Diabetes". New York Times. https://www.nytimes.com/2006/09/13/world/asia/13diabetes.html?pagewanted=all. 
  23. ↑ "Diabetes: putting people at the heart of services" (in en). NIHR Evidence. 2022-07-26. doi:10.3310/nihrevidence_52026. https://evidence.nihr.ac.uk/collection/diabetes-putting-people-at-the-heart-of-services/. 
  24. ↑ Iacobucci, G. (2014). "Diabetes prescribing in England consumes nearly 10% of primary care budget". BMJ 349: g5143. doi:10.1136/bmj.g5143. PMID 25121512. 
  25. ↑ "NHS spending on diabetes 'to reach £16.9 billion by 2035'". 2012-04-25. http://www.diabetes.org.uk/About_us/News_Landing_Page/NHS-spending-on-diabetes-to-reach-169-billion-by-2035/. 
  26. ↑ "Diabetes: cases and costs predicted to rise" (in en). 2012-04-25. https://www.nhs.uk/news/diabetes/diabetes-cases-and-costs-predicted-to-rise/. 
  27. ↑ Mainous, Arch G; Diaz, Vanessa A; Saxena, Sonia; Baker, Richard; Everett, Charles J; Koopman, Richelle J; Majeed, Azeem (September 2006). "Diabetes management in the USA and England: comparative analysis of national surveys". Journal of the Royal Society of Medicine 99 (9): 463–469. doi:10.1177/014107680609900918. ISSN 0141-0768. PMID 16946390. 
  28. ↑ Rosella, LC (2015). "Prevalence of Prediabetes and Undiagnosed Diabetes in Canada (2007-2011) According to Fasting Plasma Glucose and HbA1c Screening Criteria". Diabetes Care 38 (7): 1299–305. doi:10.2337/dc14-2474. PMID 25852207. 
  29. ↑ Forouhi, Nita Gandhi; Wareham, Nicholas J. (2014-12-01). "Epidemiology of diabetes" (in en). Medicine. Diabetes Part 1 of 2 42 (12): 698–702. doi:10.1016/j.mpmed.2014.09.007. ISSN 1357-3039. PMID 25568613. 
  30. ↑ "2014 Statistics Report | Data & Statistics | Diabetes | CDC". https://www.cdc.gov/diabetes/data/statistics/2014StatisticsReport.html. 
  31. ↑ Shute, Nancy. "Fewer People Are Getting Diabetes, But The Epidemic Isn't Over". https://www.npr.org/sections/health-shots/2015/12/01/458024442/fewer-people-are-getting-diabetes-but-the-epidemic-isnt-over. 
  32. ↑ "CDC Features - Diabetes Latest". https://www.cdc.gov/features/diabetesfactsheet/. 
  33. ↑ "Number of Americans with Diabetes Rises to Nearly 26 Million" (Press release). Centers for Disease Control and Prevention. 2011-01-26. Retrieved 2012-05-27.
  34. ↑ "National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011". Centers for Disease Control and Prevention. 2011. https://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 
  35. ↑ 35.0 35.1 Washington R.E., Andrews R.M., Mutter R.L. Emergency Department Visits for Adults with Diabetes, 2010. HCUP Statistical Brief #167. November 2013. Agency for Healthcare Research and Quality, Rockville, MD. [1] .
  36. ↑ "Diabetes Rates Rise Another 6 Percent in 1999 — January 26, 2001". https://www.cdc.gov/Diabetes/news/docs/010126.htm. 
  37. ↑ Barker, LE; Kirtland, KA; Gregg, EW; Geiss, LS; Thompson, TJ (2011). "Geographic distribution of diagnosed diabetes in the U.S.: a diabetes belt". Am J Prev Med 40 (4): 434–9. doi:10.1016/j.amepre.2010.12.019. PMID 21406277.  quoted in Ward, Brian W.; Black, Lindsey I. (2016). "State and Regional Prevalence of Diagnosed Multiple Chronic Conditions Among Adults Aged ?18 Years — United States, 2014". Morbidity and Mortality Weekly Report 65 (29): 735–738. doi:10.15585/mmwr.mm6529a3. PMID 27467707. 
  38. ↑ "Lifetime risk for diabetes mellitus in the United States". JAMA 290 (14): 1884–90. October 2003. doi:10.1001/jama.290.14.1884. PMID 14532317. 
  39. ↑ "Total Prevalence of Diabetes & Pre-diabetes". American Diabetes Association. 2005. http://www.diabetes.org/diabetes-statistics/prevalence.jsp. 
  40. ↑ "Statistics About Diabetes". http://www.diabetes.org/diabetes-basics/statistics/. 
  41. ↑ Mokdad, A.; Ford, E.; Bowman, B.; Nelson, D.; Engelgau, M.; Vinicor, F.; Marks, J. (2000). "Diabetes trends in the U.S.: 1990-1998". Diabetes Care 23 (9): 1278–1283. doi:10.2337/diacare.23.9.1278. PMID 10977060. 
  42. ↑ "Seniors and Diabetes". Elderly And Diabetes-Diabetes and Seniors. LifeMed Media. 2006. http://www.dlife.com/dLife/do/ShowContent/daily_living/seniors/. 
  43. ↑ "Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988–1994". Diabetes Care 21 (4): 518–24. April 1998. doi:10.2337/diacare.21.4.518. PMID 9571335. 
  44. ↑ Torio CM, Andrews RM. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. HCUP Statistical Brief #160. Agency for Healthcare Research and Quality, Rockville, MD. August 2013. [2]
  45. ↑ Australian Institute for Health and Welfare. "Diabetes, an overview". http://www.aihw.gov.au/indigenous/health/diabetes.cfm. 



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