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
Epidemiology of Diabetes - Part II, by Professor Thorkild Sørensen
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From the course by University of Copenhagen
Diabetes - a Global Challenge
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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.
Meet the Instructors
Jens Juul HolstProfessor, MD, DMSc
Department of Biomedical Sciences & NNF Center for Basic Metabolic Research
Signe Sørensen TorekovAssociate Professor, MSc, PhD
Department of Biomedical Sciences & NNF Center for Basic Metabolic Research
Nicolai Jacob Wewer AlbrechtsenMD, GCSRT, PhD student
Department of Biomedical Sciences & NNF Center for Basic Metabolic Research
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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.
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