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“Diabesity: Potentially the Greatest
Epidemic in World History”
Paul Zimmet AODirector Emeritus
Baker IDI Heart and Diabetes InstituteMelbourne
Studies in Migrating Populations
• Opportunity to study the genetic and
environmental determinants of disease in
different ethnic groups in same & different
locations
• Demographic issues
• Nutrition
• Physical activity
• Socio-cultural issues
• Climatic & pollution issues
• Epigenetic determinants
UN launches global campaign to curb death toll from non-communicable diseases
Secretary-General Ban Ki-moon addresses high-level meeting on the prevention and control of non-communicable diseases19 September 2011 –
The United Nations today launched an all-out attack on non-communicable diseases (NCDs) such as cancer and diabetes with a summit meeting devoted to curbing the factors, like tobacco and alcohol use, behind the often preventable scourge that causes 63 per cent of all deaths.
Obesity is driving the escalating Diabesity epidemic: The biggest epidemic in human history
OECD Predictions for Future Overweight
Rates:1970s-2020
Global Projections for the Diabetes Epidemic: 2010-2030 (millions)
Shaw J. Diab Res & Clin Practice, 2009 IDF Atlas 2009 www.idf.org
World2010 = 285 million2030 = 438 million
Increase 54%
2011- a staggering 366 million2030 – 552 million
Modernization & High Diabetes Prevalence1966-1975
Pacific – Nauru
Phoenix Arizona:Pima Indians
Australia:Indigenous
New Zealand: Maori
The 10 Top Nations forDiabetes Prevalence: 2010
0% 5% 10% 15% 20% 25% 30% 35%
Nauru
UAE
Saudi Arabia
Mauritius
Bahrain
Réunion
Kuwait
Oman
Tonga
Malaysia
Prevalence %** For 20-79 year population
Western Killer in Paradise“The Age”, May 1992
Diabetes Numbers:10 Highest Countries 2010 #
China now has over 90 million people with diabetes*
# Diabetes Atlas, 3rd edition, IDF 2006* Yang W et al NEJM April 2010
0 10 20 30 40 50
India
China
USA
Russia
Brazil
Germany
Pakistan
Japan
Indonesia
Mexico
Adult Diabetes: millions
60
Mauritius therefore became:
“the epitome of the struggle
between free labour and slavery
and the test scene for the success
of renewed Coolie immigration.”
I. M. Cumpston, Indians Overseas in British Territories, 1834-1854. Published 1969
William Wilberforce
Mauritius: Where it all started with the end of slavery
“As the first colony to undertake a
Government regulated importation of
indentured labour, Mauritius served as a
model for the Caribbean, Fiji, South Africa
and other territories which subsequently had
recourse to Indian immigrants for the
purposes of plantation production.”
S. Deerpalsingh and M. CarterSelected Documents on Indian Immigration Mauritius, 1834-1926 Mahatma Gandhi Institute 1994
Mauritius: Where it all started with the end of slavery
Mauritius: The Next Step in Predicting the Global Diabesity Epidemic
• The population consistsof Asian Indians, Blacks (Creoles) and Chinese
• These 3 ethnic groups constitute 66% of the world’s population
• Studies performed:1987, 1992, 1998, 2004 and 2009
62% increase from 1987 to 2009
Mauritius: Increase in DiabetesPrevalence over 22 yrs
Standardised to 2008 population structure of Mauritius
Prevalence of Diabetes %
0
5
10
15
20
25
30
1987 1992 1998 2004 2009
MenWomenTotal14.6%
17.4%
20.1%18.7%
23.6%
35
McDonald’s - Beijing“Coca-colonization”
Increasing Diabetes Prevalence 1980-2009: China
Life style changes
Ji Linong: Personal communication
0
2
4
6
8
10
1980 1994 1996 2002 2009
9.7
1
2.8 3.2
5.0
Coca-colonization in Jaipur, India
Prevalence of Diabetes in Urban India (Chennai)
Prevalence (%)
Prevalence 2000 – 13.9%Prevalence 2006 – 18.6%
Ramachandran et al. Diabetes Care 2008
0
10
20
30
40
50
60
20-24 25-34 35-44 45-54 55-64 65+
“If current trends continue,by 2020, diabetes will be
the leading cause of disease for men and the second
leading cause for women.”
Australia 2020: Setting ourNation's Sights for the Future
The Hon Kevin Rudd(Former) Prime Minister
April 2008
AusDiab
Aboriginal
TSI
0
10
20
30
40
50
60Prevalence %
Age group (years)
25-34 35-44 45-54 55-64 65-74 75+
Diabetes In Indigenous Australians:Age-Specific Prevalence (%)
Kerin O’Dea 2002
ATSI HAVE HIGHEST RATE OF ESRD DEATHS IN WORLD
Alice Springs has the largest dialysis unit in the
Southern Hemisphere!
ATSI HAVE ONE OF HIGHEST RATES OF DIABETES IN
WORLD
Australian Indigenous people have one of the highest rates
of diabetes in the world
They have the highest rateof end-stage renal deaths
in the world
Alice Springs has the largest renal dialysis unit in the Southern Hemisphere!
Alice Springs
The Middle East – The World’s Diabetes Epicentre?
Diabetes prevalence for adults age 20-79
UAE
0
10
20
S. Arabia
0
10
20 16.8%
18.7%
Oman
0
10
2013.4%
Kuwait
0
10
2014.6%
Bahrain
0
10
20 15.4%
ENVIRONMENT
EARLY LIFE• Low birth weight
• Poor nutrition
ADULT LIFE• Sedentary lifestyle
• Dietary factors
CARDIOVASCULAR DISEASE
GENESDIABETES +/-
THE METABOLIC SYNDROME
Genetic-Environment Interactionfor Type 2 Diabetes
Epigenetics: Foetal Programming & Intergenerational Risk
Developmental Plasticity, Foetal Programming & Intergenerational Risk
Developmental plasticity is the process where a stimulus applied in utero establishes a permanent response in the foetus leading to enhanced susceptibility to later disease, eg type 2 diabetes and cardiovascular disease
Rotterdam, 1945
The Dutch Winter Famine• At the end of WW2, West Netherlands
population suffered an acute famine • Allocated rations were 400 to 800
calories/day • Women exposed to this during
the 2nd and 3rd trimester ofpregnancy delivered small babies.
• As adults, these babies (exposed tofamine in utero) had a higher prevalence: – Type 2 diabetes– Cardiovascular disease (heart attacks, strokes)– Hypertension– Obesity– Schizophrenia
Diabetes in Cambodia:(30 years after Pol Pot) regime)
7.3%
2.9%
3.5%3.2%
7.1%7.4%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Males Females Total
Urban
Rural
Conclusions• Diabesity continues to rise exponentially globally • Ageing, lifestyle change & urbanisation have been targetted
as the main drivers but in developing nations & indigenous communities, the story may be very different
• A greater focus on epigenetics & early life risk factors eg maternal nutrition may lead to more effective strategies to halt this global “perfect storm” of Diabesity
• By 2020, Diabesity is set to bankrupt the economies of many nations unless action is taken
AcknowledgementsBaker IDI Epidemiology and key collaboratorsJonathan Shaw George Alberti Adrian Cameron
Dianna Magliano Richard Sicree David Dunstan
Stefan Soderberg Elizabeth Barr Jaakko Tuomilehto
Gary Dowse Max De Courten Jeremy Jowett
MauritiusSudhir Kowlessur
Pierrot Chitson
N Gopee
V Pauvaday
FundingNIH (USA) & NH&MRC (Australia)