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Diabetes Mellitus Introduction to Diabetes Epidemiology

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... metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia ... Associated with a risk of developing late diabetic complications including ... – PowerPoint PPT presentation

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Title: Diabetes Mellitus Introduction to Diabetes Epidemiology


1
Diabetes MellitusIntroduction to Diabetes
Epidemiology
  • STAR-initiative
  • Knut Borch-Johnsen

2
Diabetes Mellitus
  • Definition
  • A metabolic disorder of multiple aetiology
    characterized by chronic hyperglycaemia with
    disturbances of carbohydrate, fat and protein
    metabolism resulting from defects in insulin
    secretion, insulin action or both
  • Associated with a risk of developing late
    diabetic complications including
  • Microvascular (retinopathy, nephropathy)
  • Macrovascular (atherosclerosis)
  • Neuropathy

3
Increasing mortality from diabetes mellitus
J. Olefsky, JAMA 2001285628-632
4
Diabetes Epidemiology
  • Type 1 diabetes
  • Type 2 diabetes
  • Other specific types
  • Impaired glucose regulation (IFG IGT)
  • Insulin Resistance Metabolic Syndrome

5
Type 1 diabetes epidemiology
  • Very big variation in incidence and prevalence
  • Variation in growth-rate
  • Disease process relatively well described
  • Genetic markers known
  • Weak risk factors

6
Incidence of type 1 diabetesAge 0-14 years
IDF Diabetes Atlas 2003
7
Type 1 diabetesIncrease in incidence/year
8
Type 1 diabetes epidemiology
  • Very big variation in incidence and prevalence
  • Variation in growth-rate
  • Disease process relatively well described
  • Genetic markers known
  • Weak risk factors

9
2 minutes
10
Diabetes Epidemiology
  • Type 1 diabetes
  • Type 2 diabetes
  • Other specific types
  • Impaired glucose regulation
  • Insulin Resistance Metabolic Syndrome

11
Type 2 diabetes epidemiology
  • Some variation in incidence and prevalence
  • Variation in growth-rate
  • Disease process partly understood
  • Some and often weak genetic markers known
  • Strong risk factors

12
Prevalence of DM and IGTage 35-64 years
13
Diabetes in Denmark 1974-96
Drivsholm et al.Diabetic Medicine 201
14
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1990, 1995 and 2001
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
15
World wide epidemic

India 200032 mill 2020 81 mill
Zimmet, Nature 2001
16
DIABETES
Top Three Countries in the world
57 million
19 million
1995
2025
King et al, Diabetes Care, 1998
17
Type 2 DM - global epidemic - why ?
  • Prevalence depends on
  • Age
  • Residence(urban/rural)
  • Obesity
  • Physical activity
  • Ethnicity

18
Type 2 DM - global epidemic - why ?
  • Prevalence depends on
  • Age
  • Residence (urban/rural)
  • Obesity
  • Physical activity
  • Ethnicity

19
Age standardized prevalence of Type 2 DM(native
and migrant Asian Indian populations)
20
Urban-Rural ratio
21
2 minutes
22
Type 2 DM - global epidemic - why ?
  • Prevalence depends on
  • Age
  • Residence(urban/rural)
  • Obesity
  • Physical activity
  • Ethnicity

23
Non-pharmacological, observational
  • Obesity
  • RR risk of DM in females (ref. BMI lt 22)
  • 22-23 3.0
  • 24-25 5.0
  • gt 31 40
  • (Colditz al, Ann Int Med, 1995, 122 481-6)

24
Obesity (BMIgt30) in USA1960-2000 (males)
Flegal al, JAMA 2002, 288, 1723-7
25
Obesity children in USA 1960-2000BMI gt95-centile
(boys)
Ogden al, JAMA 2002, 288, 1728-32
26
Obesity Trends Among U.S. Adults BRFSS, 1991,
1995 and 2000
(BMI ³ 30, or 30 lbs overweight for 54
person)
No Data lt10 10-14
15-19 ³20
Source Mokdad A H, et al. JAMA 199928216,
200128610.
27
Obesity Trends Among U.S. AdultsBRFSS, 2001
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
28
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1990, 1995 and 2001
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
29
Type 2 DM - global epidemic - why ?
  • Prevalence depends on
  • Age
  • Residence (urban/rural)
  • Obesity
  • Physical activity
  • Ethnicity

30
Non-pharmacological, observational
  • Exercise
  • Vigorous exercise gt 1/week, 25 risk reduction
    (Manson al, Lancet 1991, 338 774-8., JAMA,
    1992, 268,63-7)
  • Looking TV 2-10 hours per week RR 1.66 of having
    DM compared with 0-1 hour per week
  • ( HU et al Arch Intern Med 2001161 1542-1548)

31
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32
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34
Type 2 DM - global epidemic - why ?
  • Prevalence depends on
  • Age
  • Residence(urban/rural)
  • Obesity
  • Physical activity
  • Ethnicity

35
Prevalence of DM in 60 years old Men
DecodaNakagami Diabetologia 2003
36
Prevalence of DM in 60 years old Women
DecodaNakagami Diabetologia 2003
37
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