Global Burden Diabetes

8/2/2019 Global Burden Diabetes

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THE GLOBAL BURDEN OF DIABETES

World Health Organization

Geneva

Switzerland


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Values for diagnosis of diabetes mellitus and

other categories of hyperglycaemia (WHO, 1999)

Venous plasma glucose

concentration, mmol/l

Diabetes mellitus:Fastingor

2-h post 75g glucose load

>= 7.0 (126 mg/dl)

>= 11.1 (200 mg/dl)

Impaired Glucose Tolerance (IGT):

Fasting (if measured) and2-h post 75g glucose load

Impaired Fasting Glycaemia (IFG):

Fasting

and (if measured)

2-h post 75 glucose load

< 7.0 (126 mg/dl)>= 7.8 and < 11.1 (140 mg/dl and 200

mg/dl)

>= 6.1 and < 7.0 (110 mg/dl and 126

mg/dl)

< 7.8 (140 mg/dl)


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Differences in diagnostic criteria of glucose

intolerance

American DiabetesAssociation 1997

World HealthOrganization 1999

Only fasting glucose

IFG replaces IGT

Plasma glucose

Retains OGTT

IFG & IGT are twodistinct categories

Whole blood and plasmaglucose


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HOW MANY PERSONS WITH

DIABETES ARE THERE?


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Number of people with diabetes in 2000:

~171 million

Two thirds of all persons with diabetes live in thedeveloping world

In these countries, most of those who have

diabetes are in economically active age groups.

Source: Wild et al, 2004


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Global diabetes prevalence by age and sex

0

2

4

6

8

10

12

14

16

0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-70 70-74 75-79 80+

Prevalenceofdiabetes(%)

Males

Females


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Prevalence of diabetes in adults 20+ (%)

0

2

4

68

10

Est

marke

teco

Forme

rsoc

ecE India China

LatA

meric

a&Car

Middle-

EastC

res

Othe

rAsia

&I

Sub-S

ahar

anAfric

%2000

2030


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Number of persons with diabetes (millions)

0

50

100

150

200

250

300

350

400

Developed Developing World

2000

2030


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Number of persons with diabetes (millions)

0

10

20

3040

50

6070

80

90

Est market

ec

Former

soc.ec Eur

India China Latin

Amer&Car

Middle

East

Other

Asia&Isl

Sub-

Saharan

Afr

2000

2030


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Number of persons with diabetes by age group, year and region

Developed countries

0

20

40

60

80

100

120

140

20-44 45-64 65+age group (years)

million

s

2000

2030

0

2040

60

80

100

120140

160

20-44 45-64 65+

20002030

Developing countries


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135171

366

0

100

200

300

400

mil

lion

1995 2000 2030

Increase in the number of persons with

diabetes in the world, 1995-2030


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Ranking 2000 2030Country People with

diabetes

(millions)

Country People

with

diabetes

(millions)1 India 31.7 India 79.4

2 China 20.8 China 42.3

3

United Statesof America 17.7

United

States ofAmerica 30.3

4 Indonesia 8.4 Indonesia 21.3

5 Japan 6.8 Pakistan 13.9

6 Pakistan 5.2 Brazil 11.37 Russian

Federation 4.6 Bangladesh 11.1

8 Brazil 4.6 Japan 8.9

9 Italy 4.3 Philippines 7.810 Bangladesh 3.2 Egypt 6.7

Highest numbers of estimated cases of diabetes for 2000 and 2030


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Prevalence of diabetes in adults 20+ (%)

0

2

4

6

8

10

12

Chile

Chin

Cuba

Egyp

t

E

thiop

iInd

ia

Indo

nesi

M

alays

i

Tan

zani

Turke

y

U

rugu

a

Viet

Nam

%

2000

2030

N b f ith di b t ( illi


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Country Proxy 2000 2030

Chile Brazil 0.5 1

China own data 20.1 42.3Cuba Brazil 0.2 0.5

Egypt Jordan 2.6 6.7

Ethiopia Sudan 0.8 1.8

India own data 31.7 79.4

Indonesia Singapore 8.4 21.2Malaysia Singapore 0.9 2.5

Tanzania own data 0.2 0.6

Turkey own data 2.9 6.4

Number of persons with diabetes (million


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WHY THE INCREASE INDIABETES PREVALENCE?


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IMPROVED SURVIVAL OFPERSONS WITH DIABETES?

Stvring et al, Lancet 2003


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THE WORLD IS GETTINGOLD

Th ld l i i i


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The world population is ageingPopulation Pyramid in

1995 and 2025

00-04

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80+

Millions

Age

MALEMALE FEMALEFEMALE

300 300200 100 100 200

UN Population Division, 1998 Revision

Lif bi h i


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Life expectancy at birth is

increasing in all regions

Source: UN Population Division, 1998 Revision

30

40

50

60

70

80

90

1950-55 1970-75 1990-95 2010-15 2030-35

Years

Africa Asia Europe Latin America and Caribbean Northern America

Japan

Sierra Leone


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The population in developing countries is fast

increasing - particularly the agedPopulat ion 2000 2025 2050( in bil l ion)

Total 6.0 7.8 8.9

More

developed countries 1.2 1.2 1.2Lessdeveloped countries 4.7 6.6 7.8

65+ 0.4 0.8 1.5Moredeveloped countries 0.2 0.3 0.3

Lessdeveloped countries 0.2 0.5 1.2


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THE WORLD IS GETTINGFAT


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Per capita food consumption (kcal per capita

per day)

1500

2000

2500

3000

3500

4000

1964-

66

1974-

76

1984-

86

1997-

99

2015 2030

Year

kcal/ca

pita/day

World

DevelopingcountriesIndustrialized

countriesTransition

Adapted from Diet, Nutrition and the preventionof Chronic Diseases, WHO TRS 916, Geneva

2003


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Trends in Obesity (BMI>30)

Brazil 1974 -1996

8.0

13.0

5.7

8.1

3.2 2.6

1.20.8

12.9

10.1

7.3

3.7

0

2

4

6

8

10

12

1416

18

20

1974 1989 1996

Prevalence(%)

Urban, M

Rural, M

Urban, FRural, F

Source: WHO Global NCD Infobase

P l f i h d b i i 10 ld i l d b

P l f i ht d b it i


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Malta

Italy

USA

Chile

AustraliaGermany

Venezuela

Japan

Singapore

FranceUK

Hungary

Slovakia

China

Hong KongSweden

Brazil

Netherlands

Overweight girls

Overweight boys

30 20 10 0 10 20 3040 40

%

Prevalence of overweight and obesity in 10-year old girls and boysin selected countries.

Prevalence of overweight and obesity in 10-year old girls and boysin selected countries.

Prevalence of overweight and obesity in

10-year old girls and boys in selected countries.


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Africa & Middle East: 4 year oldsAfrica & Middle East: 4 year olds

25%

Morocco

Egypt

Niger

Nigeria

Senegal

Cameroon

Uganda

Tanzania

Kenya

Madagascar

Zimbabwe

Zambia

Burkina

Faso

Namibia

Rwanda

Yemen

IOTF unpublished data


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Odds ratios for diabetes with increasing

weight (Must et al, 1999)

02

4

6

8

10

12

14

16

1820

25-29.9 30-34.9 35-39-9 40+

Body mass index

Oddsr

atio

=55 years

NHANES III,USA men


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Duration of obesity and risk of Type 2 diabetes

(Everhart al, 1992)

0

1

23

4

56

7

10 years

Duration of BMI>=30.0

Annualincidenceofdiabetes


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THE EARTH DOES NOTMOVE!


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Physical inactivity in selected

countries

36

28

6

12

46

3330

10

0

510

15

20

25

30

35

40

45

50

Chile Canada India Mauritius

Agestandard

ized(%)

Male

Female

Source: WHO Global NCD Infobase


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Relative risk of Type 2 diabetes by

different levels of occupational physicalactivity (from Hu et al, Diabetologia 2003)

Physical activity Relative risk (95% CI)*

LIGHT 1.00 (reference category)MODERATE 0.70 (0.52-0.96)

ACTIVE 0.74 (0.57-0.95)P- value for trend 0.02

* adjusted for age, sex, BMI, systolic BP, smoking, education, other physical

activity (n= 6898 Men+7392 women, 35-64 years old)


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In the year 2000 there were 3.2million deaths attributable to

diabetes

Global Burden Diabetes

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