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Diabetes Mellitus

Introduction to DiabetesEpidemiologySTAR-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 proteinmetabolism resulting from defects in insulin secretion,insulin action or both

± Associated with a risk of developing late diabeticcomplications including

� Microvascular (retinopathy, nephropathy)

� Macrovascular (atherosclerosis)

� Neuropathy

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Increasing mortality from diabetes mellitusIncreasing mortality from diabetes mellitus

J. Olefsky, JAMA 2001:285:628-632

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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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Type 1 diabetes

Increase in incidence/year

1

23

4

5

6

7

8

9

1

eden

en ar

U

e Zea and

Canada

Fin and

apan

C ina

U

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� 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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� 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 IGT

age 35-64 years

0

5

10

15

20

25

3035

40

45

50

Diabetes IGT

Poland

Denmark

Brazil

USA (white)

Alaska (inuit)

US rural hisp.

US urban hisp

Nauru

Pima(US)

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Diabetes in Denmark 1974-96

0

5

10

15

20

Males

DM

Males

IGT

Females

DM

Females

IGT

1974

1996

1974

1996

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

1990 1995

2001

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes,and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

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World wide epidemic

Zimmet, Nature 2001

India:

2000:32 mill

2020: 81 mill

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0

10

20

30

40

50

60

D i

t i

t i

t

i M

i l l i

U.S. CHINA INDIA U.S. CHINA INDIA1995 2025

19 milli

57 milli

DIABETEST Thr C u tri i th w rld

Ki g t l, Di t C r , 1998

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Type 2 DM - global epidemic -

why ?


why ?

Prevalence depends on:

� Age

� Residence(urban/rural)� Obesity

� Physical activity

� Ethnicity

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why ?


why ?


� Age

� Residence (urban/rural)� Obesity


� Ethnicity

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Age standardized prevalence of Type 2 DM(native and migrant Asian Indian populations)

Rur l ut r I i 2%

il N u (ur ) 5% (x 2.5)

M r 7% (x 3.5)

Dar- -Salaam ( anzania) % (x 4)

Dur an (S ut Afri a) 12% (x 6)

Mauritius 14% (x 7)

iji 17% (x ,5)

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rban-Rural ratio

Fiji 4 (8 / 2)

Kiribati 3 (12 / 4)

Vest-Samoa 1.8 (15 / 8)

Papua NyGuinea 2.8 (35 / 13)

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2 minutes

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why ?


why ?


� Age

� Residence(urban/rural)� Obesity


� Ethnicity

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Non-pharmacological,

observational

� Obesity

± RR risk of DM in females (ref. BMI < 22)

� 22-23 3.0

� 24-25 5.0

� > 31 40( olditz & al, Ann Int Med, 1995, 122; 481-6)

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Obesity (BMI>30) in SA

1960-2000 (males)

0

5

10

15

20

25

30

35

40

20-39y 40-59y 60-74y

1960-62

1971-74

1976- 0

1988-94

1999-2000

Flegal & al, JAMA 2002, 288, 1723-7

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Obesity children in SA 1960-2000

BMI >95-centile (boys)

0

2

4

6

8

10

12

14

16

2-5y 6-11y 12-19y

1963-651966-70

1971-74

1976-80

1988-94

1999-2000

Ogden & al, JAMA 2002, 288, 1728-32

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Obesity* Trends Among U.S. AdultsBRFSS, 1991, 1995 and 2000

(*BMI u 30, or ~ 30 lbs overweight for 5·4µ person)

1991 1995

2000

Source: Mokdad A H, et al. JAMA 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

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Obesity Trends* Among .S. Adults

BRFSS, 2001

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,

2001;286:10.

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Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1990, 1995 and 2001

1990 1995

2001

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes,and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

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why ?


why ?


� Age

� Residence (urban/rural)� Obesity


� Ethnicity

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Non-pharmacological,

observational

� Exercise

± Vigorous exercise > 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( H et al; Arch Intern Med 2001;161: 1542-1548)

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Netherlands 30 18 5 45

Germany 12 22 16 49

England 8 12 14 62

Italy 5 28 16 42

Canada 1 10 14 74

USA 1 9 3 84

Netherlands 30 18 5 45

Germany 12 22 16 49

England 8 12 14 62

Italy 5 28 16 42

Canada 1 10 14 74

USA 1 9 3 84

Modal Travel in Urban Areas:

Europe and North America Percent of Trips byMode

Modal Travel in Urban Areas:

Europe and North America Percent of Trips byMode

Transportation Quarterly 1997; 51:31Transportation Quarterly 1997; 51:31

Public

Country Bicycle Walking Transport Car

Public

Country Bicycle Walking Transport Car

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0

5

10

15

20

25

30

35

Percent

DistributionNHES 1967-70

NLSY 1990

Distribution of Hours of TV Per Day:

NHES Youth Aged 12-17 in 1967-70 andNLSY Youth Aged 12-17 in 1990

Distribution of Hours of TV Per Day:

NHES Youth Aged 12-17 in 1967-70 andNLSY Youth Aged 12-17 in 1990

0-10-1 1-21-2 2-32-3 3-43-4 4-54-5 5+5+

TV Hours (Youth Report)TV Hours (Youth Report)

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why ?


why ?


� Age

� Residence(urban/rural)

� Obesity


� Ethnicity

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0

20

40

60

80

15 20 25 30 35

BMI (kg/m2)

P r e v a l e n c e o

f D M ( %

)

Europe

Malta

India

hina

Japan

Prevalence of DM in 60 years old Men

Decoda:Nakagami; Diabetologia 2003

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0

0

40

60

80

15 20 5 30 35

I (k /2)

P r

l

c

f

( % )

r lt

I i

i

J

Pr l c f i 60 y rs l W

c :N k i; i b t l i 2003

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