global burden diabetes
TRANSCRIPT
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THE GLOBAL BURDEN OF DIABETES
World Health Organization
Geneva
Switzerland
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Values for diagnosis of diabetes mellitus and
other categories of hyperglycaemia (WHO, 1999)
Venous plasma glucose
concentration, mmol/l
Diabetes mellitus:Fastingor
2-h post 75g glucose load
>= 7.0 (126 mg/dl)
>= 11.1 (200 mg/dl)
Impaired Glucose Tolerance (IGT):
Fasting (if measured) and2-h post 75g glucose load
Impaired Fasting Glycaemia (IFG):
Fasting
and (if measured)
2-h post 75 glucose load
< 7.0 (126 mg/dl)>= 7.8 and < 11.1 (140 mg/dl and 200
mg/dl)
>= 6.1 and < 7.0 (110 mg/dl and 126
mg/dl)
< 7.8 (140 mg/dl)
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Differences in diagnostic criteria of glucose
intolerance
American DiabetesAssociation 1997
World HealthOrganization 1999
Only fasting glucose
IFG replaces IGT
Plasma glucose
Retains OGTT
IFG & IGT are twodistinct categories
Whole blood and plasmaglucose
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HOW MANY PERSONS WITH
DIABETES ARE THERE?
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Number of people with diabetes in 2000:
~171 million
Two thirds of all persons with diabetes live in thedeveloping world
In these countries, most of those who have
diabetes are in economically active age groups.
Source: Wild et al, 2004
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Global diabetes prevalence by age and sex
0
2
4
6
8
10
12
14
16
0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-70 70-74 75-79 80+
Prevalenceofdiabetes(%)
Males
Females
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Prevalence of diabetes in adults 20+ (%)
0
2
4
68
10
Est
marke
teco
Forme
rsoc
ecE India China
LatA
meric
a&Car
Middle-
EastC
res
Othe
rAsia
&I
Sub-S
ahar
anAfric
%2000
2030
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Number of persons with diabetes (millions)
0
50
100
150
200
250
300
350
400
Developed Developing World
2000
2030
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Number of persons with diabetes (millions)
0
10
20
3040
50
6070
80
90
Est market
ec
Former
soc.ec Eur
India China Latin
Amer&Car
Middle
East
Other
Asia&Isl
Sub-
Saharan
Afr
2000
2030
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Number of persons with diabetes by age group, year and region
Developed countries
0
20
40
60
80
100
120
140
20-44 45-64 65+age group (years)
million
s
2000
2030
0
2040
60
80
100
120140
160
20-44 45-64 65+
20002030
Developing countries
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135171
366
0
100
200
300
400
mil
lion
1995 2000 2030
Increase in the number of persons with
diabetes in the world, 1995-2030
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Ranking 2000 2030Country People with
diabetes
(millions)
Country People
with
diabetes
(millions)1 India 31.7 India 79.4
2 China 20.8 China 42.3
3
United Statesof America 17.7
United
States ofAmerica 30.3
4 Indonesia 8.4 Indonesia 21.3
5 Japan 6.8 Pakistan 13.9
6 Pakistan 5.2 Brazil 11.37 Russian
Federation 4.6 Bangladesh 11.1
8 Brazil 4.6 Japan 8.9
9 Italy 4.3 Philippines 7.810 Bangladesh 3.2 Egypt 6.7
Highest numbers of estimated cases of diabetes for 2000 and 2030
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Prevalence of diabetes in adults 20+ (%)
0
2
4
6
8
10
12
Chile
Chin
Cuba
Egyp
t
E
thiop
iInd
ia
Indo
nesi
M
alays
i
Tan
zani
Turke
y
U
rugu
a
Viet
Nam
%
2000
2030
N b f ith di b t ( illi
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Country Proxy 2000 2030
Chile Brazil 0.5 1
China own data 20.1 42.3Cuba Brazil 0.2 0.5
Egypt Jordan 2.6 6.7
Ethiopia Sudan 0.8 1.8
India own data 31.7 79.4
Indonesia Singapore 8.4 21.2Malaysia Singapore 0.9 2.5
Tanzania own data 0.2 0.6
Turkey own data 2.9 6.4
Number of persons with diabetes (million
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WHY THE INCREASE INDIABETES PREVALENCE?
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IMPROVED SURVIVAL OFPERSONS WITH DIABETES?
Stvring et al, Lancet 2003
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THE WORLD IS GETTINGOLD
Th ld l i i i
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The world population is ageingPopulation Pyramid in
1995 and 2025
00-04
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80+
Millions
Age
MALEMALE FEMALEFEMALE
300 300200 100 100 200
UN Population Division, 1998 Revision
Lif bi h i
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Life expectancy at birth is
increasing in all regions
Source: UN Population Division, 1998 Revision
30
40
50
60
70
80
90
1950-55 1970-75 1990-95 2010-15 2030-35
Years
Africa Asia Europe Latin America and Caribbean Northern America
Japan
Sierra Leone
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The population in developing countries is fast
increasing - particularly the agedPopulat ion 2000 2025 2050( in bil l ion)
Total 6.0 7.8 8.9
More
developed countries 1.2 1.2 1.2Lessdeveloped countries 4.7 6.6 7.8
65+ 0.4 0.8 1.5Moredeveloped countries 0.2 0.3 0.3
Lessdeveloped countries 0.2 0.5 1.2
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THE WORLD IS GETTINGFAT
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Per capita food consumption (kcal per capita
per day)
1500
2000
2500
3000
3500
4000
1964-
66
1974-
76
1984-
86
1997-
99
2015 2030
Year
kcal/ca
pita/day
World
DevelopingcountriesIndustrialized
countriesTransition
Adapted from Diet, Nutrition and the preventionof Chronic Diseases, WHO TRS 916, Geneva
2003
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Trends in Obesity (BMI>30)
Brazil 1974 -1996
8.0
13.0
5.7
8.1
3.2 2.6
1.20.8
12.9
10.1
7.3
3.7
0
2
4
6
8
10
12
1416
18
20
1974 1989 1996
Prevalence(%)
Urban, M
Rural, M
Urban, FRural, F
Source: WHO Global NCD Infobase
P l f i h d b i i 10 ld i l d b
P l f i ht d b it i
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Malta
Italy
USA
Chile
AustraliaGermany
Venezuela
Japan
Singapore
FranceUK
Hungary
Slovakia
China
Hong KongSweden
Brazil
Netherlands
Overweight girls
Overweight boys
30 20 10 0 10 20 3040 40
%
Prevalence of overweight and obesity in 10-year old girls and boysin selected countries.
Prevalence of overweight and obesity in 10-year old girls and boysin selected countries.
Prevalence of overweight and obesity in
10-year old girls and boys in selected countries.
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Africa & Middle East: 4 year oldsAfrica & Middle East: 4 year olds
25%
Morocco
Egypt
Niger
Nigeria
Senegal
Cameroon
Uganda
Tanzania
Kenya
Madagascar
Zimbabwe
Zambia
Burkina
Faso
Namibia
Rwanda
Yemen
IOTF unpublished data
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Odds ratios for diabetes with increasing
weight (Must et al, 1999)
02
4
6
8
10
12
14
16
1820
25-29.9 30-34.9 35-39-9 40+
Body mass index
Oddsr
atio
=55 years
NHANES III,USA men
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Duration of obesity and risk of Type 2 diabetes
(Everhart al, 1992)
0
1
23
4
56
7
10 years
Duration of BMI>=30.0
Annualincidenceofdiabetes
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THE EARTH DOES NOTMOVE!
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Physical inactivity in selected
countries
36
28
6
12
46
3330
10
0
510
15
20
25
30
35
40
45
50
Chile Canada India Mauritius
Agestandard
ized(%)
Male
Female
Source: WHO Global NCD Infobase
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Relative risk of Type 2 diabetes by
different levels of occupational physicalactivity (from Hu et al, Diabetologia 2003)
Physical activity Relative risk (95% CI)*
LIGHT 1.00 (reference category)MODERATE 0.70 (0.52-0.96)
ACTIVE 0.74 (0.57-0.95)P- value for trend 0.02
* adjusted for age, sex, BMI, systolic BP, smoking, education, other physical
activity (n= 6898 Men+7392 women, 35-64 years old)
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In the year 2000 there were 3.2million deaths attributable to
diabetes