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epidemilogy of diabetes
 

epidemilogy of diabetes

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epidemilogy of diabetes epidemilogy of diabetes Presentation Transcript

  • Diabetes Mellitus Introduction to Diabetes Epidemiology Dr. Hamid Baradaran EDC, IUMS
  • 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
  • Increasing mortality from diabetes mellitus J. Olefsky, JAMA 2001:285:628-632
  • Diabetes Epidemiology
    • Type 1 diabetes
    • Type 2 diabetes
    • Other specific types
    • Impaired glucose regulation (IFG & IGT)
    • Insulin Resistance & Metabolic Syndrome
  • 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
  • Incidence of type 1 diabetes Age 0-14 years IDF Diabetes Atlas 2003
  • Type 1 diabetes Increase in incidence/year
  • 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
  • 2 minutes
  • Diabetes Epidemiology
    • Type 1 diabetes
    • Type 2 diabetes
    • Other specific types
    • Impaired glucose regulation
    • Insulin Resistance & Metabolic Syndrome
  • 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
  • Prevalence of DM and IGT age 35-64 years
  • Diabetes in Denmark 1974-96 Drivsholm et al.Diabetic Medicine 201
  • 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%
  • World wide epidemic Zimmet, Nature 2001 India: 2000:32 mill 2020: 81 mill
  • 1995 2025 19 million 57 million DIABETES Top Three Countries in the world King et al, Diabetes Care, 1998
  • Type 2 DM - global epidemic - why ?
    • Prevalence depends on:
    • Age
    • Residence(urban/rural)
    • Obesity
    • Physical activity
    • Ethnicity
  • Type 2 DM - global epidemic - why ?
    • Prevalence depends on:
    • Age
    • Residence (urban/rural)
    • Obesity
    • Physical activity
    • Ethnicity
  • Age standardized prevalence of Type 2 DM (native and migrant Asian Indian populations)
  • Urban-Rural ratio
  • 2 minutes
  • Type 2 DM - global epidemic - why ?
    • Prevalence depends on:
    • Age
    • Residence(urban/rural)
    • Obesity
    • Physical activity
    • Ethnicity
  • Non-pharmacological, observational
    • Obesity
      • RR risk of DM in females (ref. BMI < 22)
        • 22-23 3.0
        • 24-25 5.0
        • > 31 40
        • (Colditz & al, Ann Int Med, 1995, 122; 481-6)
  • Obesity (BMI>30) in USA 1960-2000 (males) Flegal & al, JAMA 2002, 288, 1723-7
  • Obesity children in USA 1960-2000 BMI >95-centile (boys) Ogden & al, JAMA 2002, 288, 1728-32
  • 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
  • Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
  • 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%
  • Type 2 DM - global epidemic - why ?
    • Prevalence depends on:
    • Age
    • Residence (urban/rural)
    • Obesity
    • Physical activity
    • Ethnicity
  • Non-pharmacological, observational
    • Exercise
      • Vigorous exercise > 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 2001;161: 1542-1548)
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  • Type 2 DM - global epidemic - why ?
    • Prevalence depends on:
    • Age
    • Residence(urban/rural)
    • Obesity
    • Physical activity
    • Ethnicity
  • Prevalence of DM in 60 years old Men Decoda:Nakagami; Diabetologia 2003
  • Prevalence of DM in 60 years old Women Decoda:Nakagami; Diabetologia 2003
  •