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Epidemiology of Diabetes - Part II, by Professor Thorkild Sørensen

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Diabetes - a Global Challenge

University of Copenhagen

4.7 (381 ratings) | 24K Students Enrolled

Diabetes and obesity are growing health problems in rich and poor countries alike. With this course you will get updated on cutting-edge diabetes and obesity research including biological, genetic and clinical aspects as well as prevention and epidemiology of diabetes and obesity. All lectures are provided by high-profile scientists from one the world's leading universities in diabetes research. This course is part of the EIT Health Campus programme. We hope you will enjoy our course. Best Wishes Jens Juul Holst, Signe Sørensen Torekov and Nicolai Wewer Albrechtsen Department of Biomedical Sciences Novo Nordisk Foundation Center for Basic Metabolic Research Faculty of Health and Medical Sciences University of Copenhagen

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4.7 (381 ratings)

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KB

Dec 05, 2017

I really enjoyed this course. It is designed with learners at heart as all difficult concepts are well explained in a manner of which everyone can understand.

PG

Jul 03, 2016

Excelent course, complete, including information about new drugs and studies for treatment, well explained, it requires time and attention, totally worth it!

From the lesson

Introduction and epidemiology of diabetes

We are delighted to be able to welcome you to Diabetes – a Global Challenge. In module 1, we will focus on the epidemiology of diabetes and obesity which we lead us to this week discussion topic: "What the greatest diabetes challenges of our time might be in your opinion?" You can either post your opinion as text or as a link to a short video statement.

Epidemiology of Diabetes - Part I, by Professor Thorkild Sørensen7:57

Epidemiology of Diabetes - Part II, by Professor Thorkild Sørensen12:21

Epidemiology of Diabetes - Part III, by Professor Thorkild Sørensen5:50

Taught By

Jens Juul Holst
Professor, MD, DMSc
Signe Sørensen Torekov
Associate Professor, MSc, PhD
Nicolai Jacob Wewer Albrechtsen
MD, GCSRT, PhD student

Transcript

[MUSIC]

[BLANK_AUDIO]

How is the distribution of diabetes?

By type, geographical regions, by ethnicity, by gender, by age.

First, how is the distribution by type?

Type one, type two.

Far the most people are suffering from type 2 diabetes.

Thus, in most populations, 90% of all people with diabetes have

type 2 diabetes, and of the remaining, most have type 1.

Although gestational diabetes is also quite frequent, it does not really count

in the setting because it is limited to the few months of pregnancy.

Other special type of diabetes are very rare.

How is the distribution by geographical region round the world?

In the lower left corner, you see the world statistics, 371 million

adult people suffer from diabetes when this map was last updated in 2012.

50% were undiagnosed.

The prevalence were 8.3%.

Prevalence is an epidemiological measure of occurrence which simply is the number

with the disease divided by the total number of people in the population.

Here about 4.5 billion adults, at a given point in time.

And this fraction isn't often as here converted to percent.

Notice that the prevalence is only apparently a simple measure of the disease

occurrence, in fact it is rather complex by being dependent on how many

new cases of the disease that emerge over time, which is called incidence,

how many die from the disease called case fatality, and how many are cured.

We will stick to the prevalence measure here.

But then note that all these factors may contribute

to the differences between prevalence figures in different populations.

In the lower right corner, there is a

note saying, all rates are presented as comparative rates.

These rates are the prevalence measure.

The point made here is, that there are

major differences between the populations, particularly in regards to

age distributions, which would greatly affect the prevalence, and

the figures have thus been adjusted for such differences.

We'll come back to the role of age later.

The map also shows how many patients of

diabetes in the various parts of the world.

Let's first look at the Norh American and Caribbean region at the upper left.

There are 38 million people out of whom 29% are undiagnosed.

There is a real remark that more health care dollars were spent in this

region than in any other One in ten adults in this region has diabetes.

The prevalence is 10.5%.

In South and Central America there were 26 million, of whom 45.5% went undiagnosed.

And the prevalence were 9.2%.

In the Middle East and North Africa, there were 34 million

with 52.9% undiagnosed and a prevalence of 10.9%.

In Africa, there were 15 million, 81.2% undiagnosed, and a prevalence of 4.3%.

However, as noted, over the next 20 years

the number of people with diabetes will almost double.

This region has a highest mortality rate due to diabetes.

In Europe, which also includes whole Russia, there were 55 million of whom

38.6% where undiagnosed, and the prevalence was 6.7%.

However far the most people with diabetes live in the Far East.

In southeast Asia, including India, 70 million had diabetes, of

whom 51.1% were undiagnosed, and the prevalence was 8.7%.

The greatest contribution came from the

region named Western Pacific, which includes China.

Here, 132 million suffered from diabetes, of whom

57.9% were undiagnosed, and the prevalence was 8%.

Information about the figures for each country is

tabulated here, where you may find your own country.

This table shows which of the regions each country or territory it belongs to.

The diabetes compared to prevalence in

percent according to the WHO standard population,

the number of diabetes-related deaths in the

same age range, the mean diabetes-related expenditure

per person with diabetes in U.S. dollars in that year, the number of people

with undiagnosed diabetes in the age range 22 through 79, in thousands also.

In my country, Denmark, we have 302,740 cases with diabetes,

a prevalence of 5.56%, 2,781 diabetes-related deaths,

and we are spending about 7,000 U.S. dollars per patient, on average, per year.

And 125,850 patients remain undiagnosed.

So, this is a very common disease, and all the

problem is worse in the Asian part of the world.

The data we have looked at, were, as mentioned, adjusted

for differences in the age distribution between the regions and countries.

But not for the level adiposity.

It seems as if the Asian's ethnicity is much more likely

to develop diabetes at any given level of adiposity than other ethnicities.

Since there is still much less adiposity in the Asian part

of the world, than, for example, the United States of America.

The prevalence of diabetes become about the same.

I'll discuss these differences in more detail later.

The risk of getting diabetes is about the same for women and men.

However, women have the extra burden of the risk of development of

gestational diabetes, which is associated with

increased risk of later development of diabetes.

It is difficult to compare the prevalence of

diabetes in men and women because of these

differences, as well as differences in age distribution

in the general and, and in general mortality.

The figures shown earlier are adjusted for these differences.

Another very important aspect on the distribution is by age.

In this graph, you see the prevalence of diabetes by age in four different types of

countries around the world according to the level

of income, high, upper middle, lower middle, and low.

Note that in all countries, the prevalence is very

low in the age range between 20 and 25 years.

About 1 to 2%.

However, in all countries, there is a steady increase in the prevalence

by advancing age, until a leveling off began from the 60s and above.

In somewhat different ages in the four types of

countries, ending at a prevalence between 10% and 24%.

In the high income countries, the prevalence continued to increase

up to the oldest group here between 70 and 75 years.

However, it is still a major problem, also for those younger than 60 years.

Half of the people who die from diabetes are under age of 60 years.

This graph here shows deaths attributable to diabetes by

age in the age range between 20 through 79 years.

It begins with 100,000 deaths from diabetics in

the age range 20 to, through 29 years,

and girls up to about the same number, in the three decade from 50 years and above.

Namely 1.2 million people with diabetes.

It should be noted that these figures are dominated by type 2 diabetes.

Type 1 diabetes is as mentioned was rare, only 10% of all patients with diabetes.

And is also usually emerging in childhood or in young adulthood.

It is often said that we have a global epidemic of diabetes.

What does that mean?

It means that the occurrence of diabetes is increasing as

if it was epidemic of contagious infectious diseases such as influenza.

The quite rapidly increasing prevalence of diabetes

is observed almost everywhere in the world.

Let's look at the most recent data just published

by the IDF diabetes atlas, which you see here.

Since last year, the number of people with diabetes has risen from 371 million

I showed earlier, to now 382 million as shown in the lower left corner.

The major contribution to the increase stems from Africa and Asia.

What can we expect of future developments, using the

data from the trends and personal information about determinants

of the prevalence of diabetes, it is possible to

make a predicition of the future development and prevalence.

The outcome of this exercise is what you see here.

To the left, you have the column for

2013 that shows the number of people with diabetes

in the various regions of the world, with

Africa on the top and Europe at the bottom.

It sums up to the total number I've just mentioned, the 382 million people.

But then, to the right, you have the predicted numbers in the same way in

2035, 22 years from now, and it shows that the scary number

of 592 million people, corresponding to a 55% increase.

There are increases in all regions, but there

are also great differences in the relative increase.

With Africa showing 109.1% increase in the top.

And Europe, only 22.5% increase at the bottom.

There's another very important dimension of the global

epidemic of diabetes, which make the development even worse.

Namely, that the disease hits younger and younger people.

In old days, type 2 diabetes was considered as the old man's diabetes,

as opposed to type 1, showing up in the kids and the young adults.

However, type 2 diabetes is now effecting

even children in various parts of the world.

We can see that the diabetes epidemic is really out of control.

And huge efforts are needed those to help those who

already have diabetes and prevent even more to get the disease.

Unfortunately, the major increases occurs in parts of the world where there are

little help to get to cope with both treatment and prevention of the disease.

It is a serious challenge to the health care systems in these regions of the

lower income and middle income countries, where so

many people suffering from a chronic health problem.

So I'm convinced that you agree with me, that there is no doubt

that the global epidemic of diabetes is a very serious global public health problem.

That we need to do whatever we can to fight against in the future.

The advances in treatment of diabetes will be dealt with in a later lecture.

But, to oppose a diabetes epidemic by prevention of the emergence of new cases,

we need to know who are at risk of getting the disease in the future.

Knowing the causes of diabetes defined by the exposures that transformed

the healthy individual to the diabetic patients, would have caused the

ideal if it would be feasible to remove these causes which

strict the exposure to them, or block or inhibit their action.

However, we are far from having

a comprehensive knowledge about hese true courses.

But we know about so called risk factors that may be used to

identify the individuals at the highest risk

of development of diabetes in the future.

A risk factor is a characteristic

of the individual, either permanent or transitory.

It may also be a cause or just an indicator of a cause, and we are usually

not able to make a definitive distinction between these two alternatives.

[MUSIC]

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