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Outline
Prevalence of Diabetes
Estimates of future prevalence (projections)
Mortality attributable to diabetes
Effect of the epidemic on rates of complications
Projections for ESRD
Newsweek,
Newsweek,September
September4,4,
2000
2000
Time,
Time,September
September4,4,2000
2000
151million
USA
15
22
171million
USA
17.7
30.3
NA
19.7
33.9
72%
LAC
13.3
33.0
248%
SSA
7.1
18.6
261%
MEC
20.1
52.8
263%
China
20.8
42.3
204%
India
31.7
79.4
251%
World
2000 = 171 million
2030 = 366 million
Increase 213%
A+NZ
1.2
2.0
65%
+176%
+26%
-13%
Wild, S et al.: Global prevalence of diabetes: Estimates for 2000 and projections for 2030
Diabetes Care 2004. In press
+247%
+308%
+189%
+75%
45-54 years
< 45 years
45-64years
< 45 years
1991
1999
%
Increase
Men
4.1%
6.0%
46%
Women
5.6%
7.6%
36%
1991
1998
%
Increase
Men
11.7%
17.7%
51.5%
Women
12.2%
18.1%
47.4%
IFG
'Impaired Fasting Glucose' (IFG)
FPG of 100-125mg/dl [5.6 -<7.0mmol/l]
Hoorn
5-year Cumulative
Incidence of DM
19.4
29.7
19.3
24.5
15.1
24.8
19.3
? 25% ?
50-75y
Mauritius
25-74y
Pima Indians
15+y
Nhanes III
40-74y
Based on diabetes incidence (5% / year) in the 20% of persons with impaired glucose
homeostasis; 300,000 diabetes deaths / year; Net increase = c.700,000 cases of diabetes / year
Hoorn
Proportion from
those with IGT or
IFG
38%
62%
40%
60%
44%
56%
50-75y
Mauritius
25-74y
Pima Indians
15+y
Nhanes III
40-74y
? 40% ?
? 60% ?
Based on diabetes incidence (5% / year) in the 20% of persons with impaired glucose
homeostasis; 40% of new cases from persons with NGT; 450,000 diabetes deaths / year
171million
USA
17 19.4
30.3 48.9
366 million
530 million?
Men
2.5
Women
1.99
1.49 1.54
1.5
1
2.6
0.5
0
NGT
IGT
DM
2.03 x
40
2.22 x
All causes
30
20
10
0
Diabetic
Men
Non-diabetic
men
Diabetic
Women
Non-diabetic
women
AMRA
251.1
9.75%
AMRD
32.2
6.1%
AMRB
194.0
7.6%
AFR
319.2
2.6%
EMR
125.3
7.2%
SEAR
1154.1
6.9%
World
In 2000 = 3.164 million
(5.4% of all deaths)
WPR
469.3
4.1%
Consequences of Epidemic
Increase in number with diabetes
Disproportionate increase in
duration-related complications
50
40
300
30
20
150
Percent with
complications
No. of Cases
450
10
0
0
0
10
15
20
25
30
Time (years)
35
40
45
50
16 new cases/yr. Death occurs after 30y DM; Complication incidence 50% after 15y DM
After 30 years No. of new cases equals no. of deaths.
1975-85
60% increase
0
10
20
30
40
50
6
5
4
3
2
1
0
Renal disease
Cases
20
Deaths
Dialysis
15
10
5
0
1965
1970
1975
1980
Year
1985
1990 1994
1965-74
1975-84
Time Period
1985-94
http://www.cdc.gov/diabetes/statistics/esrd/Fig1Detl.htm
Year of Entry
2030
(using WHO
estimate)
2030
Revised
projections
Number
with
Diabetes
18 million 31 million
39-48
million
No with
new ESDR
40,000
86-105,000
68,000
* Assuming current incidence rates for initiating ESRD treatment remain constant
Summary
Based on demographic changes alone:
The
numbers of persons with diabetes in the world will
more than double in the next 30 years
Summary
c.3.2 million (excess) deaths were
attributable to diabetes in year 2000.
Summary
Because of the current epidemic of diabetes,
reflected in increasing age specific prevalence, the
proportion of the diabetic population with
complications will increase.
This will result in a greater relative increase in
complications than in diabetes prevalence.
Because serious complications e.g. ESRD, typically
develop after 15-20 years duration, the incidence of
ESRD due to diabetes will continue to increase for at
least the next 20 years
Conclusions
Increase in Type 2 diabetes (and obesity)
represents the major public health challenge for the
21st century
The estimates of future burden currently used
seriously underestimate what is going to happen!
Thank you
Incidence/100,000
Diabetic persons
Black male
Black female
Hispanic male
Hispanic female
White male
White female