epidemilogy of diabetes

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  • epidemilogy of diabetes

    1. 1. Diabetes Mellitus Introduction to Diabetes Epidemiology Dr. Hamid Baradaran EDC, IUMS
    2. 2. Diabetes Mellitus <ul><li>Definition </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Associated with a risk of developing late diabetic complications including </li></ul></ul><ul><ul><ul><li>Microvascular (retinopathy, nephropathy) </li></ul></ul></ul><ul><ul><ul><li>Macrovascular (atherosclerosis) </li></ul></ul></ul><ul><ul><ul><li>Neuropathy </li></ul></ul></ul>
    3. 3. Increasing mortality from diabetes mellitus J. Olefsky, JAMA 2001:285:628-632
    4. 4. Diabetes Epidemiology <ul><li>Type 1 diabetes </li></ul><ul><li>Type 2 diabetes </li></ul><ul><li>Other specific types </li></ul><ul><li>Impaired glucose regulation (IFG & IGT) </li></ul><ul><li>Insulin Resistance & Metabolic Syndrome </li></ul>
    5. 5. Type 1 diabetes epidemiology <ul><li>Very big variation in incidence and prevalence </li></ul><ul><li>Variation in growth-rate </li></ul><ul><li>Disease process relatively well described </li></ul><ul><li>Genetic markers known </li></ul><ul><li>Weak risk factors </li></ul>
    6. 6. Incidence of type 1 diabetes Age 0-14 years IDF Diabetes Atlas 2003
    7. 7. Type 1 diabetes Increase in incidence/year
    8. 8. Type 1 diabetes epidemiology <ul><li>Very big variation in incidence and prevalence </li></ul><ul><li>Variation in growth-rate </li></ul><ul><li>Disease process relatively well described </li></ul><ul><li>Genetic markers known </li></ul><ul><li>Weak risk factors </li></ul>
    9. 9. 2 minutes
    10. 10. Diabetes Epidemiology <ul><li>Type 1 diabetes </li></ul><ul><li>Type 2 diabetes </li></ul><ul><li>Other specific types </li></ul><ul><li>Impaired glucose regulation </li></ul><ul><li>Insulin Resistance & Metabolic Syndrome </li></ul>
    11. 11. Type 2 diabetes epidemiology <ul><li>Some variation in incidence and prevalence </li></ul><ul><li>Variation in growth-rate </li></ul><ul><li>Disease process partly understood </li></ul><ul><li>Some and often weak genetic markers known </li></ul><ul><li>Strong risk factors </li></ul>
    12. 12. Prevalence of DM and IGT age 35-64 years
    13. 13. Diabetes in Denmark 1974-96 Drivsholm et al.Diabetic Medicine 201
    14. 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 1;289(1). 1990 1995 2001 No Data <4% 4%-6% 6%-8% 8%-10% >10%
    15. 15. World wide epidemic Zimmet, Nature 2001 India: 2000:32 mill 2020: 81 mill
    16. 16. 1995 2025 19 million 57 million DIABETES Top Three Countries in the world King et al, Diabetes Care, 1998
    17. 17. Type 2 DM - global epidemic - why ? <ul><li>Prevalence depends on: </li></ul><ul><li>Age </li></ul><ul><li>Residence(urban/rural) </li></ul><ul><li>Obesity </li></ul><ul><li>Physical activity </li></ul><ul><li>Ethnicity </li></ul>
    18. 18. Type 2 DM - global epidemic - why ? <ul><li>Prevalence depends on: </li></ul><ul><li>Age </li></ul><ul><li>Residence (urban/rural) </li></ul><ul><li>Obesity </li></ul><ul><li>Physical activity </li></ul><ul><li>Ethnicity </li></ul>
    19. 19. Age standardized prevalence of Type 2 DM (native and migrant Asian Indian populations)
    20. 20. Urban-Rural ratio
    21. 21. 2 minutes
    22. 22. Type 2 DM - global epidemic - why ? <ul><li>Prevalence depends on: </li></ul><ul><li>Age </li></ul><ul><li>Residence(urban/rural) </li></ul><ul><li>Obesity </li></ul><ul><li>Physical activity </li></ul><ul><li>Ethnicity </li></ul>
    23. 23. Non-pharmacological, observational <ul><li>Obesity </li></ul><ul><ul><li>RR risk of DM in females (ref. BMI < 22) </li></ul></ul><ul><ul><ul><li>22-23 3.0 </li></ul></ul></ul><ul><ul><ul><li>24-25 5.0 </li></ul></ul></ul><ul><ul><ul><li>> 31 40 </li></ul></ul></ul><ul><ul><ul><li>(Colditz & al, Ann Int Med, 1995, 122; 481-6) </li></ul></ul></ul>
    24. 24. Obesity (BMI>30) in USA 1960-2000 (males) Flegal & al, JAMA 2002, 288, 1723-7
    25. 25. Obesity children in USA 1960-2000 BMI >95-centile (boys) Ogden & al, JAMA 2002, 288, 1728-32
    26. 26. Obesity* Trends Among U.S. Adults BRFSS, 1991, 1995 and 2000 (*BMI  30, or ~ 30 lbs overweight for 5’4” person) Source: Mokdad A H, et al. JAMA 1999;282:16, 2001;286:10. No Data < 10% 10%-14% 15-19%  20% 1991 1995 2000
    27. 27. Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
    28. 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 1;289(1). 1990 1995 2001 No Data <4% 4%-6% 6%-8% 8%-10% >10%
    29. 29. Type 2 DM - global epidemic - why ? <ul><li>Prevalence depends on: </li></ul><ul><li>Age </li></ul><ul><li>Residence (urban/rural) </li></ul><ul><li>Obesity </li></ul><ul><li>Physical activity </li></ul><ul><li>Ethnicity </li></ul>
    30. 30. Non-pharmacological, observational <ul><li>Exercise </li></ul><ul><ul><li>Vigorous exercise > 1/week, 25% risk reduction (Manson & al, Lancet 1991, 338; 774-8., JAMA, 1992, 268,63-7) </li></ul></ul><ul><ul><li>Looking TV 2-10 hours per week: RR 1.66 of having DM compared with 0-1 hour per week </li></ul></ul><ul><ul><li>( HU et al; Arch Intern Med 2001;161: 1542-1548) </li></ul></ul>
    31. 34. Type 2 DM - global epidemic - why ? <ul><li>Prevalence depends on: </li></ul><ul><li>Age </li></ul><ul><li>Residence(urban/rural) </li></ul><ul><li>Obesity </li></ul><ul><li>Physical activity </li></ul><ul><li>Ethnicity </li></ul>
    32. 35. Prevalence of DM in 60 years old Men Decoda:Nakagami; Diabetologia 2003
    33. 36. Prevalence of DM in 60 years old Women Decoda:Nakagami; Diabetologia 2003

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