Type 2 diabetes: A 21st century epidemic

doi:10.1016/j.beem.2016.05.003

Best Practice & Research Clinical Endocrinology & Metabolism

Volume 30, Issue 3, June 2016, Pages 331-343

https://doi.org/10.1016/j.beem.2016.05.003 Get rights and content

Around 415 million people around the world have diabetes (9% of adults), and the vast majority live in low- and middle-income countries. Over the next decade, this number is predicted to increase to 642 million people. Given that diabetes is a major cause of mortality, morbidity, and health care expenditures, addressing this chronic disease represents one of the greatest global health challenges of our time. The objectives of this article are three-fold: (1) to present data on the global burden of type 2 diabetes (which makes up 87–91% of the total diabetes burden), both in terms of prevalence and incidence; (2) to give an overview of the risk factors for type 2 diabetes, and to describe obesity and the developmental origins of disease risk in detail; and (3) to discuss the implications of the global burden and point out important research gaps.

Introduction

Nine percent of adults around the world – 415 million people – have diabetes and nearly half of them are undiagnosed [1]. By 2040, the number of individuals affected by diabetes is predicted to increase to be 642 million people, with the largest increases seen in low- and middle-income countries [1]. Diabetes, a major cause of death, morbidity, and health care expenditures, now represents one of the greatest threats to global health and development.

The objectives of this article are three-fold: (1) to present data on the global burden of type 2 diabetes (which makes up 87–91% of the total diabetes burden); (2) to give an overview of the risk factors for type 2 diabetes; and (3) to discuss the implications of the global burden and point out important research gaps.

Section snippets

Global burden of type 2 diabetes

The spectrum from normal glucose tolerance (NGT) through abnormal glucose regulation to overt type 2 diabetes has two distinct, though to some extent overlapping, intermediate hyperglycemic states (Table 1): impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). IFG is primarily the result of hepatic insulin resistance and an early-phase defect in beta-cell function [2], and is diagnosed as a fasting plasma glucose ≥5.6 mmol/l and <7.0 mmol/l [3]. IGT is primarily the result of

Risk factors for diabetes

Physical activity and diet have long been regarded as the primary modifiable risk factors for diabetes (Table 2), but research on novel risk factors ranging from short sleep duration [47] to noise pollution [48] to environmental toxins [49] has shown that the causal pathways leading to diabetes may be much more complex. While societal-level factors, including policies that govern trade and agricultural production, are thought to contribute to individual-level risk factors [50], investment and

Implications

The prevalence of diabetes is increasing everywhere except a select few countries. In high-income countries, this increase likely reflects more of a success story for treating people with diabetes: people with diabetes are living longer in the face of relatively stable or small increases in incidence leading to an increase in prevalence. A recent analysis of lifetime risk of type 2 diabetes in the U.S. suggests that over 85% of the increase is due to survival and only 12% due to increasing

Summary

The prevalence of diabetes is increasing everywhere except for a select few countries. In high-income countries, this increase likely reflects a success story for treating people with diabetes: people with diabetes are living longer in the face of relatively stable or small increases in incidence leading to an increase in prevalence. Data on the incidence of type 2 diabetes in low- and middle-income countries is sorely lacking, and portends a huge gap in knowledge. Evidence is accumulating that

Conflict of interest statement

LMJ, KRS, UPG, and KMVN have no conflicts of interest to disclose.

Acknowledgments

We would like to thank Bendix Carstensen, PhD, Senior Statistician, Steno Diabetes Center, for sharing yearly point estimates of diabetes incidence for Denmark.

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1Type 2 diabetes: A 21st century epidemic

Introduction

Section snippets

Global burden of type 2 diabetes

Risk factors for diabetes

Implications

Summary

Conflict of interest statement

Acknowledgments

Lancet

Lancet

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Cell

IDF diabetes Atlas

Contributions of β-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose

Diabetes Care

Impaired fasting glucose and impaired glucose tolerance: implications for care

Diabetes Care

Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter?

Diabet Med

Full accounting of diabetes and pre-diabetes in the US population in 1988–1994 and 2005–2006

Diabetes Care

Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia

Diabetes 1994 to 2010: global estimates and projections

Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections

Diabetes Care

The rising global burden of diabetes and its complications: estimates and projections to the year 2010

Diabet Med

IDF diabetes Atlas

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants

Lancet

IDF diabetes Atlas

Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies

Diabetes, Obes Metabolism

Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012

J Am Med Assoc

Trends in diabetes incidence among 7 million insured adults, 2006–2011 the SUPREME-DM Project

Am J Epidemiol

Trends in diabetes incidence: the Framingham Heart study

Diabetes Care

Elevated rates of diabetes in Pacific Islanders and Asian Subgroups The Diabetes Study of Northern California (DISTANCE)

Diabetes Care

Changing patterns of type 2 diabetes incidence among Pima Indians

Diabetes Care

The incidence of type 2 diabetes in the United Kingdom from 1991 to 2010

Diabetes, Obes Metabolism

The Danish National Diabetes Register: trends in incidence, prevalence and mortality

Diabetologia

Prevalence, incidence and mortality of diagnosed diabetes: evidence from an Italian population-based study

Diabet Med

The burden and treatment of diabetes in France

Glob Health

Population-based incidence of type 2 diabetes in Northern Spain The Asturias Study

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Incidence of type 2 diabetes in southern Spain (Pizarra Study)

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Type 2 diabetes: A 21st century epidemic