Epidemiology diabetes

1

Diabetes: epidemiology Mr. Riyaz KhanVI th SemsterDept. of Community Medicine,NGMC, Kohalpur

3

GLOBAL BURDEN Diabetes is an “Iceberg” disease .Prevalence rate and incidence of Type-2 DM increases

globally in newly industrialized countries & developing countries. Currently the number of cases of diabetes worldwide is estimated to be around 415 millions. Prevalence rate is 8.8% with the greatest no. of cases in China and India. Type-2 DM affect all age group, however younger and adolescents are in high risk population.

Prevalence is rising with industrialization(20%) & socio-economic development. Diabetes will affect the South East Asia (140.2 millions) by 2040 which is very high due to

• Life style• Dietary Habits• Genetic

With these projected increase in the diabetic population in future, SEA countries will become the most challenged Region in the world and the Region will bear the maximum global burden of the disease in the initial decades of the 21st century.

4

An analysis of age-specific prevalence rates of DM consistently showed an increase in prevalence with increasing age.

The prevalence of DM is approximately twice in urban areas than in rural population. The percentage of diabetic cases residing in urban areas is projected to increase from 54% in 1995 to 73% by the year 2025.

The age-adjusted mortality rates among the people with diabetes are 1.5 to 2.5 times higher than in the general population.

Prevalence of type 1 diabetes in Asia is relatively low accounting for about 9.7 percent of all DM cases in the Region.

5

Burden at a glance

IDF Diabetes Atlas, 2015

6

Number of diabetics globally


7

Prevalence of diabetes globally


8

Mortality due to diabetes


9

Trends in diabetes burden

Burden in Nepal

Diabetes In Nepal-2015Total adult population (20-79 years) 15,750,000

Prevalence of diabetes in adults (20-79 years) ( %) 3.3%

Total Cases of adults (20-79 years) with diabetes 526,000

Number of deaths in Adults due to diabetes 11,700

Cost per person with diabetes(USD) 68.5

No. of cases of diabetes in adults that are undiagnosed 323,700


The population in Nepal has an increased susceptibility to DM.

12The Lancet 2011 378, 31-40DOI: (10.1016/S0140-6736(11)60679-X)

Drag picture to placeholder or click icon to addThe figure describes which age groups in the population have the highest proportions of diabetes. The dotted line is the distribution of diabetes prevalence by age for the world; the black line is the distribution for the region; and the country distribution is plotted in the red line. Many middle-and low-income countries have more people under the age of 60 with diabetes compared to the world average. Meanwhile, for high-income countries, a growing population over the age of 60 makes up the largest proportion of diabetes prevalence.

13

Top 10 countries with diabetics


14

Gender & residence


15

Epidemiological Determinants 1. AGENT 2. HOST FACTORS 3. ENVIRONMENTAL RISK FACTORS

16

Underlying cause of DM:

Mechanisms1. Pancreatic disorders2. Defect in the formation of insulin3. Destruction of beta cells4. Decreased Insulin Sensitivity5. Genetic Defect(e.g mutaion of insulin gene)6. Auto Immunity

The overall effect of these mechanisms is to reducced utilization of glucose which leads to hyperglycemia accompanied by glycosuria.

Insulin Deficiency

Absolute Insulin Deficiency

IDDM

Partial Insulin Deficiency

NIDDM1. Agent

17

2. Host Factor

Age - occurs at any age but prevalence rises steeply with age.

SexIn UK M=F In SEA M>F

Genetic factorstwin studies showed that in identical twins who developed i)NIDDM- concordance was approximately 90%. ii) IDDM- concordance was about 50%

Genetic markers IDDM is associated with HLA-B8 and B15, and more powerfully with HLA-DR3 and DR4. The highest risk of IDDM is carried by individuals with both DR3 & DR4.NIDDM: Not HLA associated.

immune mechanism ( both cell mediated n humeral activity against islet cells)

Obesity Maternal diabetes

18

3. Environmental Risk Factors

a. Sedentary lifestyle b. Dietc. Dietary fiberd. Malnutritione. Alcoholf. Viral infectionsg. Chemical agentsh. Stress

19

Complications

20

Complications of DM

Short term effects of diabetes

Ketoacidosis Recurrent or persistent infections (including tuberculosis)

Both hyperglycaemia and hypoglycaemia may cause coma

21

Complications of DM

Long term effects of diabetes1. MicrovascularRenal disease, retinopathy

& neuropathy

2. Macrovascular

22

Complications of DM

Prevalence & timeline

DM is listed among the five most important determinants of the cardiovascular disease epidemic in Asia.

23

Complications of DM

Continuum of CVD risk

REMEMBER….TAKE CONTROL OF YOUR LIFE!

DON’T LET DIABETES CONTROL YOU!

Thank you

Health & Medicine

Epidemiology diabetes