Diabetes Mellitus Introduction to Diabetes Epidemiology

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Diabetes MellitusIntroduction to Diabetes
Epidemiology

• STAR-initiative
• Knut Borch-Johnsen

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Diabetes Mellitus

• Definition
• A metabolic disorder of multiple aetiology
  characterized by chronic hyperglycaemia with
  disturbances of carbohydrate, fat and protein
  metabolism resulting from defects in insulin
  secretion, insulin action or both
• Associated with a risk of developing late
  diabetic complications including
• Microvascular (retinopathy, nephropathy)
• Macrovascular (atherosclerosis)
• Neuropathy

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Increasing mortality from diabetes mellitus
J. Olefsky, JAMA 2001285628-632
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Diabetes Epidemiology

• Type 1 diabetes
• Type 2 diabetes
• Other specific types
• Impaired glucose regulation (IFG IGT)
• Insulin Resistance Metabolic Syndrome

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Type 1 diabetes epidemiology

• Very big variation in incidence and prevalence
• Variation in growth-rate
• Disease process relatively well described
• Genetic markers known
• Weak risk factors

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Incidence of type 1 diabetesAge 0-14 years
IDF Diabetes Atlas 2003
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Type 1 diabetesIncrease in incidence/year
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Type 1 diabetes epidemiology

• Very big variation in incidence and prevalence
• Variation in growth-rate
• Disease process relatively well described
• Genetic markers known
• Weak risk factors

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2 minutes
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Diabetes Epidemiology

• Type 1 diabetes
• Type 2 diabetes
• Other specific types
• Impaired glucose regulation
• Insulin Resistance Metabolic Syndrome

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Type 2 diabetes epidemiology

• Some variation in incidence and prevalence
• Variation in growth-rate
• Disease process partly understood
• Some and often weak genetic markers known
• Strong risk factors

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Prevalence of DM and IGTage 35-64 years
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Diabetes in Denmark 1974-96
Drivsholm et al.Diabetic Medicine 201
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1990, 1995 and 2001
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
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World wide epidemic

India 200032 mill 2020 81 mill
Zimmet, Nature 2001
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DIABETES
Top Three Countries in the world
57 million
19 million
1995
2025
King et al, Diabetes Care, 1998
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Type 2 DM - global epidemic - why ?

• Prevalence depends on
• Age
• Residence(urban/rural)
• Obesity
• Physical activity
• Ethnicity

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Type 2 DM - global epidemic - why ?

• Prevalence depends on
• Age
• Residence (urban/rural)
• Obesity
• Physical activity
• Ethnicity

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Age standardized prevalence of Type 2 DM(native
and migrant Asian Indian populations)
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Urban-Rural ratio
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2 minutes
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Type 2 DM - global epidemic - why ?

• Prevalence depends on
• Age
• Residence(urban/rural)
• Obesity
• Physical activity
• Ethnicity

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Non-pharmacological, observational

• Obesity
• RR risk of DM in females (ref. BMI lt 22)
• 22-23 3.0
• 24-25 5.0
• gt 31 40
• (Colditz al, Ann Int Med, 1995, 122 481-6)

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Obesity (BMIgt30) in USA1960-2000 (males)
Flegal al, JAMA 2002, 288, 1723-7
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Obesity children in USA 1960-2000BMI gt95-centile
(boys)
Ogden al, JAMA 2002, 288, 1728-32
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Obesity Trends Among U.S. Adults BRFSS, 1991,
1995 and 2000
(BMI ³ 30, or 30 lbs overweight for 54
person)
No Data lt10 10-14
15-19 ³20
Source Mokdad A H, et al. JAMA 199928216,
200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 2001
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1990, 1995 and 2001
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
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Type 2 DM - global epidemic - why ?

• Prevalence depends on
• Age
• Residence (urban/rural)
• Obesity
• Physical activity
• Ethnicity

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Non-pharmacological, observational

• Exercise
• Vigorous exercise gt 1/week, 25 risk reduction
  (Manson al, Lancet 1991, 338 774-8., JAMA,
  1992, 268,63-7)
• Looking TV 2-10 hours per week RR 1.66 of having
  DM compared with 0-1 hour per week
• ( HU et al Arch Intern Med 2001161 1542-1548)

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Type 2 DM - global epidemic - why ?

• Prevalence depends on
• Age
• Residence(urban/rural)
• Obesity
• Physical activity
• Ethnicity

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Prevalence of DM in 60 years old Men
DecodaNakagami Diabetologia 2003
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Prevalence of DM in 60 years old Women
DecodaNakagami Diabetologia 2003
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