Epidemiology of Diabetes Mellitus Global Scenario Diabetes and other chronic non-communicable diseases (NCDs) are significant public health challenges in the 21st century. It is estimated that 3. 8 million deaths were attributable to diabetes in 2007, equivalent to 6% of all deaths globally. India, which has the largest population of diabetes patients of any country, diabetes accounts for 9. 7% of these deaths. The prevalence of diabetes is rapidly rising all over the globe at an alarming rate.
The prevalence of type 2 diabetes is increasing dramatically across the globe and in some areas has reached epidemic proportions.
Over the past 30 yr, the status of diabetes has changed from being considered as a mild disorder of the elderly to one of the major causes of morbidity and mortality affecting the youth and middle aged people. It is important to note that the rise in prevalence is seen in all six inhabited continents of the globe.
The International Diabetes Federation has predicted that the number of individuals with diabetes will increase from 240 million in 2007 to 380 million in 2025, with 80% of the disease burden in low and middle-income countries.
2 More than 60% of the world’s population with diabetes will come from Asia, because it remains the world’s most populous region. [pic] The 10 countries estimated to have the highest numbers of people with diabetes in 2000 and 2030 are listed in Table. The “top three” countries are the same as those identified for 1995 (India, China, and U. S. ).
Bangladesh, Brazil, Indonesia, Japan, and Pakistan also appear in the lists for both 2000 and 2030. The Russian Federation and Italy appear in the list for 2000 but are replaced by the Philippines and Egypt for 2030, reflecting anticipated changes in the population size and structure in these countries between the two time periods. [pic] In developing countries, the majority of people with diabetes are in the 45- to 64-year age range, similar to the finding reported previously (2). In contrast, the majority of people with diabetes in developed countries are _64 years of age.
By 2030, it is estimated that the number of people with diabetes _64 years of age will be _82 million in developing countries and_48 million in developed countries. The age distribution of the number of people with diabetes in developed and developing countries is illustrated in above figure. . Regional scenario (South East Asia) The prevalence of diabetes in Asian populations has increased rapidly in recent decades. In 2007, more than 110 million individuals in Asia were living with diabetes, with a disproportionate burden among the young and middle aged.
More than 95% of these people have type 2 diabetes, which comprises 20% of the current total world prevalence. Presently, India has the largest number of people with diabetes in the world, over 40 million. The sharp rise in the prevalence of diabetes is seen mainly in type 2 diabetes, as the prevalence of type 1 diabetes in the region is 1-2%. Similarly, rates of overweight and obesity are increasing sharply, driven by economic development, nutrition transition, and increasingly sedentary lifestyles.
The “metabolically obese” phenotype (ie, normal body weight with increased abdominal adiposity) is common in Asian populations. The increased risk of gestational diabetes, combined with exposure to poor nutrition in utero and overnutrition in later life in some populations, may contribute to the increasing diabetes epidemic in Asia. [pic] Individual countries cannot tackle the growing epidemic of NCDs alone and there is a strong need for collaborative action.
In close consultation with Member States, the WHO Regional Office for SEA Region has developed a regional framework for prevention and control of NCDs with focus on epidemiological assessment and co-ordinated public health intervention targeting major risk factors for NCDs and their socioeconomic, cultural, political and physical determinants. As part of this response, NCD surveillance using the STEPS methodology has revealed a high prevalence of risk factors in the Region (Table 1). There is a need to support public health messages with intervention at policy, health system, community and individual level.
A program for capacity strengthening of policy makers and NCD program managers is under way in the region. [pic] NCD risk factors in STEPS surveys in SEA Region 2003–2005 (25–64 years, both sexes) India leads the world with largest number of diabetic subjects earning the dubious distinction of being termed the “diabetes capital of the world”. In India as the World Health Organization (WHO) reports show that 32 million people had diabetes in the year 20002. In 2006, The International Diabetes Federation (IDF) estimates the total number of diabetic subjects to be around 40. 9 million in India and this is further set to rise to 69. million by the year 2025 unless urgent preventive steps are taken. In urban Indian adults, diabetes prevalence increased from 3% in the early 1970s to 12% in 2000, with a narrowing rural-urban gradient. In 2006, the rate of type 2 diabetes in rural South India was 9. 2%, compared with an increase in urban South India from 13. 9% in 2000 to 18. 6% in 2006. Population aging, younger age at onset and decreasing mortality account for only 25% of the observed increase in diabetes prevalence. WHO estimates that 2. 9 million people died in 2000 as a result of diabetes, equivalent to 5. 2% of global mortality.
In China, the prevalence of diabetes increased from 1% in 1980 to 5. 5% in 2001, with much higher rates in urban areas such as Shanghai. Nearly 10% of Chinese adults residing in affluent regions such as Hong Kong and Taiwan have diabetes. Among individuals with diabetes, two-thirds in Mainland China and one-half in Hong Kong and Taiwan remain undiagnosed. Pakistan is a South-Asian country with a population of approximately 150 million. Pakistan alone currently counts 6. 2 million people with diabetes and estimated figures for 2025 suggest that this will almost double and reach 11. million people. Diabetes prevalence in Pakistan is high: 12% of people above 25 years of age suffer from the condition and 10% have impaired glucose tolerance (IGT). When one considers the associated risk factors present in Pakistani society, the large number of people with diabetes is no surprise. Obesity tops the list. According to a Diabetic Association of Pakistan study into chronic complications, involving 500 people with diabetes, eye damage (retinopathy) affected 43% of the people, kidney disease (nephropathy) 20%, and nerve damage (neuropathy) 40%.
In rural Bangladesh, prevalence of diabetes increased from 2. 3% to 6. 8% between 1999 and 2004. In a national survey in 2001, 8% of Korean adults had diabetes, with little difference between urban and rural areas. In a study conducted in Sri Lanka, the prevalence of overall, urban and rural pre-diabetes was 11. 5% (10. 5-12. 5%), 13. 6% (11. 2-16. 0%) and 11. 0% (10. 0-12. 0%), respectively. Overall, 21. 8% (20. 5-23. 1%) had some form of dysglycaemia. The projected diabetes prevalence for the year 2030 is 13. 9%. In a nationwide survey in Singapore in 1998, Indians had the highest prevalence of diabetes (12. %), followed by Malays (11. 3%) and Chinese (8. 4%). Similarly, 11% of Malays living in Malaysia have diabetes. Other Asian countries including Japan, Sri Lanka, Indonesia, Thailand, and Vietnam also have experienced a marked increase in prevalence of diabetes. While some Asian countries like China and India have a very large number of patients with diabetes, the prevalence of diabetes can be as high as 40% in some Pacific Island populations. References: 1. http://www. ncbi. nlm. nih. gov/pubmed/19470990 2. http://www. ncbi. nlm. nih. gov/pubmed/15111519 3. http://www. cbi. nlm. nih. gov/pubmed/19183311 4. http://medind. nic. in/iby/t07/i3/ibyt07i3p217. pdf 5. http://jama. ama-assn. org/cgi/reprint/301/20/2129 6. http://www. idf. org/SEA 7. http://care. diabetesjournals. org/content/27/5/1047. full. pdf+html 8. http://www. worlddiabetesfoundation. org/media(7196,1033)/Report. Summit. India. pdf 9. http://www. diabetessrilanka. org/ 10. http://diabetessrilanka. org/latest_figures. php 11. http://www. diabetesvoice. org/en/articles/diabetes-in-pakistan 12. http://www. worlddiabetesfoundation. org/media(7196,1033)/Report. Summit. India. pdf
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