Epidemiology of Type 2 Diabetes. Dr Azizi

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2 Epidemiology of Type 2 Diabetes Dr Azizi

3 Epidemiology The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 30 million cases in 1985 to 285 million in International Diabetes Federation projects that 438 million individuals will have diabetes by the year Prevalence of both type 1 and type 2 DM is increasing worldwide, the prevalence of type 2 DM is rising much more rapidly, presumably because of increasing obesity, reduced activity levels as countries become more industrialized, and the aging of the population. ٣

4 Much of the increased risk of type 1 DM is believed to reflect the frequency of high-risk human leukocyte antigen (HLA) alleles among ethnic groups in different geographic locations. ٤

5 There is considerable geographic variation in the incidence of both type 1 and type 2 DM. Scandinavia has the highest incidence of type 1 DM (Finland, the incidence is 57.4/100,000 per year). Japan and China has a much lower rate of type 1 DM ( /100,000 per year); Northern Europe and the United States have an intermediate rate (8 20/100,000 per year). ٥

6 The magnitude of the healthcare problem of type 2 diabetes results not just from the disease itself but also from its association with obesity and cardiovascular risk factors, particularly dyslipidaemia and hypertension. Type 2 diabetes has now been recognized as one manifestation of the metabolic syndrome, a condition characterized by insulin resistance and associated with a range of cardiovascular risk factors. ٦

7 Various cardiovascular risk factors, including hypertension and dyslipidaemia become progressively worse with progression from normal glucose tolerance to IGT/IFG to diabetes. ٧

8 While there is good evidence for a strong genetic contribution to both obesity and diabetes, the increase in these conditions in both developed and developing countries appears to be due to a changing balance between energy intake and energy expenditure through physical activity. Physical activity levels have probably diminished by half. ٨

9 The tendency for the increased prevalence of type 2 diabetes to be concentrated in lower socioeconomic groups in developed countries and higher socioeconomic groups in developing countries probably reflects the adoption of a healthier lifestyle by better educated people in developed countries, while it is generally the affluent in developing countries who enjoy a high calorie intake and low level of physical activity. ٩

10 Approximately 1.6 million individuals (>20 years) were newly diagnosed with diabetes in DM increases with aging. In 2010, the prevalence of DM in the United Sates was estimated to be 0.2% in individuals aged <20 years and 11.3% in individuals aged >20 years. In individuals aged >65 years, the prevalence of DM was 26.9%. The prevalence is similar in men and women throughout most age ranges (11.8% and 10.8%, respectively, in individuals aged >20 years). ١٠

11 In Asia, the prevalence of diabetes is increasing rapidly and the diabetes phenotype appears to be different from that in the United States and Europe onset at a lower BMI and younger age, greater visceral adiposity, and reduced insulin secretory capacity. ١١

12 Diabetes is a major cause of mortality, but several studies indicate that diabetes is likely underreported as a cause of death. In the United States, diabetes was listed as the seventh leading cause of death in 2007; a recent estimate suggested that diabetes was the fifth leading cause of death worldwide and was responsible for almost 4 million deaths in ١٢

13 Global Prevalence of Diabetes ١٣

14 Global Prevalence Estimates, 2000 and % % 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5):

15 Diabetes in the World 31.7 India Year China 8.4 Indonesia USA millions 6.8 Japan Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): ١٥

16 Diabetes in the World 79.4 India Year China 21.3 Indonesia USA millions 8.9 Japan Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): ١٦

17 ١٧

18 P r e v a le n c e (M e a n % ) Prevalence of Diabetes in Adults United States, BRFSS * * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Atlanta, GA: United States, Department of Health and Human Services. ١٨ 7.1

19 Prevalence of Diabetes in Adults United States, BRFSS 1990 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ١٩

20 Prevalence of Diabetes in Adults United States, BRFSS No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢٠

21 Prevalence of Diabetes in Adults United States, BRFSS No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢١

22 Prevalence of Diabetes in Adults United States, BRFSS No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢٢

23 Prevalence of Diabetes in Adults United States, BRFSS 1995 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢٣

24 Prevalence of Diabetes in Adults United States, BRFSS No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢٤

25 Prevalence of Diabetes in Adults United States, BRFSS 1999 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢٥

26 Prevalence of Diabetes in Adults United States, BRFSS 2000 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢٦

27 Prevalence of Diabetes in Adults United States, BRFSS 2001 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23: ٢٧

28 Prevalence of Diabetes by Sex and Year, Puerto Rico BRFSS * 1997, Prevalence (%) Male Year Female * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Atlanta, GA: United States, Department of Health and Human Services. ٢٨

30 Problem Statement Iceberg Disease Increased prevalence in newly industrialized and developing countries. Disease acquired in the most productive period of their life.

31 Undiagnosed or inadequately treated patients develop multiple chronic complications. Lack of awareness about interventions for prevention and management of complications.

32 Age Distribution of Diabetes Mellitus 32

33 Age Distribution of Diabetes Mellitus 33

34 Prevalence of diabetes in the WHO South-East Asia Region ٣٤

35 ٣٥

36 ٣٦

37 Eastern Mediterranean Health Journal, Vol. 15, No. 3, 2009 Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis analysis ٣٧

38 Between 1996 and In those > 40 years the prevalence was 24% and it increased by 0.4% with each year after 20 years of age. The risk of type 2 diabetes was1.7% greater in women than men ٣٨

39 Province Prevalence Bushehr ( ) Qazvin ( ) Gilan 5.45 ( ) Isfahan 8.20 ( ) Kerman ( ) Khorasan 9.09 ( ) Kordestan 3.35 (0 7.36) Tehran 7.43 ( ) Yazd ( ) 17.27) ٣٩

40 Prevalence of diabetes in I.R.IRAN Year Diabetic patients 2,103,000 6,421,000 Prevalence of diabetes in Yazd Province Year Diabetic patients 145, ,722 ٤٠

41 Prevalence of Type 2 Diabetes Complications in Yazd Province In this study 1000 type 2 diabetic patients (457 male, 543 female) were studied. Nephropathy : 285 (28.5%) Retinopathy : 519 (51.9%) CAD : 251 (25.1%) PVD : 143 (14.3%) CVA :109: (10.9%) Foot ulcer : 84 (8.4%) ٤١

42 Prevalence of Diabetes in People aged 30 years: The Results of Screening Program of Yazd Province, Iran, in 2012 Cross-sectional sectional study, subjects were randomly selected and enquired by a pretested questionnaire. Prevalence rate of known diabetes and impaired fasting glucose was 16.3% & 11.9% respectively. Journal of Research in Health Sciences ٤٢

43 Female gender, increasing age, high blood pressure, increased BMI and positive family history, are independent risk factor for diabetes. ٤٣

44 Eastern Mediterranean Health Journal, Vol. 21, No. 6, 2015 Prevalence and risk factors of diabetes mellitus in a central district in Islamic Republic of Iran: a population-based study on adults aged years ٤٤

45 The age- and sex-standardized standardized prevalence of diabetes in 2090 individuals participants was 24.5% (95% CI: %), 26.8%), including 10.5% new cases For each year of ageing, the prevalence of diabetes increased significantly by 4% and this trend was more pronounced in females than males ٤٥

46 ٤٦

47 Risk Factors o Physical inactivity o 1st degree relative with diabetes o High risk ethnic groups(african-american, Latino-Asian- Amer, Pacific Islanders) o Women who delivered a baby >9lbs +GDM o Hypertension o HDL<35 or TG >250 o Women with PCOS o IGT or IFG on previous testing o Hx CVD o Severe obesity or acanthosis nigricans ٤٧

48 THANKS ٤٨

49 ٤٩

50 Estado Libre Asociado de Puerto Rico Estado Libre Asociado de Puerto Rico ٥٠

51 ٥١

52 ٥٢

53 There is considerable geographic variation in the incidence of both type 1 and type 2 DM. Scandinavia has the highest incidence of type 1 DM (Finland, the incidence is 57.4/100,000 per year). Japan and China has a much lower rate of type 1 DM ( /100,000 per year); Northern Europe and the United States have an intermediate rate (8 20/100,000 per year). ٥٣

54 Much of the increased risk of type 1 DM is believed to reflect the frequency of high-risk human leukocyte antigen (HLA) alleles among ethnic groups in different geographic locations. ٥٤

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