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Diabetes mellitus statistics on prevalence and mortality: facts and fallacies

Abstract

Diabetes mellitus is one of the most important public health challenges of the twenty-first century. Until the past decade, it has been seriously underrated as a global health threat. Major gaps exist in efforts to comprehend the burden nationally and globally, especially in developing nations, due to a lack of accurate data for monitoring and surveillance. Early attempts to obtain accurate data, discussed in this article, seem to have been cast aside so, at present, these needs remain unmet. Existing international efforts to assemble information fall far short of requirements. Current estimates are imprecise, only providing a rough picture, and probably underestimate the disease burden. The methodologies that are currently used, and that are discussed in this Perspectives article, are inadequate for providing a complete and accurate assessment of the prevalence of diabetes mellitus. International consensus on uniform standards and criteria for reporting national data on diabetes mellitus prevalence as well as for common complications of diabetes mellitus and mortality need to be developed.

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Figure 1: Attendees at the historic 1978 Kroc Foundation Conference at the McDonald Ranch in the Santa Ynez Valley, California, USA12.
Figure 2: The percentage of the US population aged 20–74 years (NHANES 2005–2006, n = 2,017) with undiagnosed diabetes mellitus by three diagnostic criteria23.
Figure 3: The percentage of US adults aged >18 years (NHANES 2005–2008) with a | intermediate hyperglycaemia (WHO) or b | prediabetes (ADA, 2003 criteria)27.

References

  1. Tuomi, T. et al. The many faces of diabetes: a disease with increasing heterogeneity. Lancet 383, 1084–1094 (2014).

    Article  Google Scholar 

  2. Zimmet, P. Z., Magliano, D. J., Herman, W. H. & Shaw, J. E. Diabetes: a 21st century challenge. Lancet Diabetes Endocrinol. 2, 56–64 (2014).

    Article  Google Scholar 

  3. International Diabetes Federation. IDF Diabetes Atlas 7th edn http://www.diabetesatlas.org (2016).

  4. NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 387, 1513–1530 (2016).

  5. World Health Organiziation. Global report on diabetes http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf (2016).

  6. International Diabetes Federation. United Nations resolution 61/225: world diabetes day. https://www.idf.org/sites/default/files/UN%20Resolution%20on%20World%20Diabetes%20Day%20of%20Dec%202006.pdf (2006).

  7. United Nations General Assembly. Political declaration of the high-level meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases. http://www.un.org/ga/search/view_doc.asp?symbol=A/66/L.1 (2011).

  8. World Health Organisation. 65th World Health Assembly closes with new global health measures. http://www.who.int/mediacentre/news/releases/2012/wha65_closes_20120526/en/index.html (2012).

  9. West, K. M. Epidemiology of Diabetes and its Vascular Lesions (Elsevier, 1978).

    Google Scholar 

  10. West, K. M. Substantial differences in the diagnostic criteria used by diabetes experts. Diabetes 24, 641–644 (1975).

    Article  CAS  Google Scholar 

  11. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28, 1039–1057 (1979).

  12. [No authors listed.] Proceedings of the Kroc Foundation International Conference on Epidemiology of Diabetes and its Macrovascular Complication. Diabetes Care 2, 63–249 (1979).

  13. WHO Expert Committee on Diabetes Mellitus. Second report. Technical report series 646 (WHO, 1980).

  14. Schwartz, S. S. et al. The time is right for a new classification system for diabetes: rationale and implications of the β-cell-centric classification schema. Diabetes Care 39, 179–186 (2016).

    Article  CAS  Google Scholar 

  15. World Health Organization. Expert Committee on Diabetes Mellitus: First report. Technical report series 310 (WHO, 1965).

  16. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications; part 1: diagnosis and classification of diabetes mellitus (WHO, 1999).

  17. [No authors listed.] Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20, 1183–1197 (1997).

  18. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26, S5–S20 (2003).

  19. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation (WHO, 2006).

  20. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 32, 1327–1334 (2009).

  21. World Health Organization. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus http://www.who.int/diabetes/publications/report-hba1c_2011.pdf (2011).

  22. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 33, S62–S69 (2010).

  23. Cowie, C. C. et al. Prevalence of diabetes and high risk for diabetes using A1C criteria in the U. S. population in 1988–2006. Diabetes Care 33, 562–568 (2010).

    Article  Google Scholar 

  24. NCD Risk Factor Collaboration. Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331,288 participants. Lancet Diabetes Endocrinol. 3, 624–637 (2015).

  25. American Diabetes Association. Diagnosis and classification of diabetes mellitius. Diabetes Care 34, S62–S69 (2011).

  26. Borch-Johnsen, K. et al. Creating a pandemic of prediabetes: the proposed new diagnostic criteria for impaired fasting glycaemia. Diabetologia 47, 1396–1402 (2004).

    Article  CAS  Google Scholar 

  27. James, C. et al. Implications of alternative definitions of prediabetes for prevalence in U.S. adults. Diabetes Care 34, 387–391 (2011).

    Article  Google Scholar 

  28. Gerstein, H. C. et al. Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and meta-analysis of prospective studies. Diabetes Res. Clin. Pract. 78, 305–312 (2007).

    Article  Google Scholar 

  29. Unwin, N., Shaw, J., Zimmet, P. & Alberti, K. G. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med. 19, 708–723 (2002).

    Article  CAS  Google Scholar 

  30. Kanat, M. et al. Distinct β-cell defects in impaired fasting glucose and impaired glucose tolerance. Diabetes 61, 447–453 (2012).

    Article  CAS  Google Scholar 

  31. Saito, T. et al. Lifestyle modification and prevention of type 2 diabetes in overweight Japanese with impaired fasting glucose levels: a randomized controlled trial. Arch. Intern. Med. 171, 1352–1360 (2011).

    Article  Google Scholar 

  32. Morris, D. H. et al. Progression rates from HbA1c 6.0–6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia 56, 1489–1493 (2013).

    Article  CAS  Google Scholar 

  33. Davies, J., Yudkin, J. S. & Atun, R. Liberating data: the crucial weapon in the fight against NCDs. Lancet Diabetes Endocrinol. 4, 197–198 (2016).

    Article  Google Scholar 

  34. Diabetes Epidemiology Research International Group. Geographic patterns of childhood insulin-dependent diabetes mellitus. Diabetes 37, 1113–1119 (1988).

  35. Karvonen, M. et al. Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 23, 1516–1526 (2000).

    Article  CAS  Google Scholar 

  36. Harjutsalo, V., Sjoberg, L. & Tuomilehto, J. Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet 371, 1777–1782 (2008).

    Article  Google Scholar 

  37. Hamman, R. F. et al. The SEARCH for Diabetes in Youth study: rationale, findings, and future directions. Diabetes Care 37, 3336–3344 (2014).

    Article  Google Scholar 

  38. SEARCH Study Group. SEARCH for Diabetes in Youth: a multicenter study of the prevalence, incidence and classification of diabetes mellitus in youth. Control Clin. Trials 25, 458–471 (2004).

  39. Carstensen, B., Kristensen, J. K., Ottosen, P. & Borch-Johnsen, K. The Danish National Diabetes Register: trends in incidence, prevalence and mortality. Diabetologia 51, 2187–2196 (2008).

    Article  CAS  Google Scholar 

  40. Tseng, C. H. Mortality and causes of death in a national sample of diabetic patients in Taiwan. Diabetes Care 27, 1605–1609 (2004).

    Article  Google Scholar 

  41. Zimmet, P. & McCarty, D. The NIDDM epidemic: global estimates and projections — a look into the crystal ball. IDF Bull. 40, 8–16 (1995).

    Google Scholar 

  42. King, H., Aubert, R. E. & Herman, W. H. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21, 1414–1431 (1998).

    Article  CAS  Google Scholar 

  43. Wild, S., Roglic, G., Green, A., Sicree, R. & King, H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27, 1047–1053 (2004).

    Article  Google Scholar 

  44. Guariguata, L. et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res. Clin. Pract. 103, 137–149 (2014).

    Article  CAS  Google Scholar 

  45. Makaroff, L. E. & Cavan, D. Which biochemical assay is best for measuring diabetes prevalence? Lancet Diabetes Endocrinol. 3, 582–583 (2015).

    Article  Google Scholar 

  46. [No authors listed.] STEPS country reports. World Health Organization http://www.who.int/chp/steps/reports/en/ (2014).

  47. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117–171 (2015).

  48. Goldacre, M. J. Cause-specific mortality: understanding uncertain tips of the disease iceberg. J. Epidemiol. Commun. Health 47, 491–496 (1993).

    Article  CAS  Google Scholar 

  49. Tancredi, M. et al. Excess mortality among persons with type 2 diabetes. N. Engl. J. Med. 373, 1720–1732 (2015).

    Article  CAS  Google Scholar 

  50. Roglic, G. et al. The burden of mortality attributable to diabetes: realistic estimates for the year 2000. Diabetes Care 28, 2130–2135 (2005).

    Article  Google Scholar 

  51. The DECODE Study Group & the European Diabetes Epidemiology Group. Is the current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular diseases? Diabetes Care 26, 688–696 (2003).

  52. An, Y. et al. Cardiovascular and all-cause mortality over a 23-year period among chinese with newly diagnosed diabetes in the Da Qing IGT and Diabetes Study. Diabetes Care 38, 1365–1371 (2015).

    Article  Google Scholar 

  53. Barr, E. L. et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 116, 151–157 (2007).

    Article  CAS  Google Scholar 

  54. Roper, N. A., Bilous, R. W., Kelly, W. F., Unwin, N. C. & Connolly, V. M. Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. BMJ 322, 1389–1393 (2001).

    Article  CAS  Google Scholar 

  55. Magliano, D. J. et al. Lifetime risk and projected population prevalence of diabetes. Diabetologia 51, 2179–2186 (2008).

    Article  CAS  Google Scholar 

  56. Magliano, D. J. et al. Mortality, all-cause and cardiovascular disease, over 15 years in multiethnic Mauritius: impact of diabetes and intermediate forms of glucose tolerance. Diabetes Care 33, 1983–1989 (2010).

    Article  Google Scholar 

  57. Salles, G. F., Bloch, K. V. & Cardoso, C. R. Mortality and predictors of mortality in a cohort of Brazilian type 2 diabetic patients. Diabetes Care 27, 1299–1305 (2004).

    Article  Google Scholar 

  58. World Health Organization. Deaths by cause, age, sex and country 2000–2012. (WHO, 2014).

  59. Gregg, E. W. et al. Changes in diabetes -related complications in the United States, 1990–2010. N. Engl. J. Med. 370, 1514–1523 (2014).

    Article  CAS  Google Scholar 

  60. Gregg, E. W., Sattar, N. & Ali, M. K. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 4, 537–547 (2016).

    Article  Google Scholar 

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P.Z., K.G.A. and P.H.B. researched data for the article, contributed to discussion of the content, wrote the article and reviewed and/or edited the article before submission. D.J.M. contributed to discussion of the content and reviewed and/or edited the article before submission.

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Correspondence to Paul Zimmet.

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Zimmet, P., Alberti, K., Magliano, D. et al. Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nat Rev Endocrinol 12, 616–622 (2016). https://doi.org/10.1038/nrendo.2016.105

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