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Global burden of Diabetes: Prevalence and projections

Global burden of Diabetes: Prevalence and projections. Peter H. Bennett, M.B., F.R.C.P. National Institute of Diabetes and Digestive and . Kidney Diseases,. Phoenix, Arizona, U.S.A. Belllagio, March 16 th 2004. Outline. Prevalence of Diabetes Estimates of future prevalence (projections)

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Global burden of Diabetes: Prevalence and projections

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  1. Global burden of Diabetes: Prevalence and projections Peter H. Bennett, M.B., F.R.C.P. National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, U.S.A. Belllagio, March 16th 2004

  2. Outline • Prevalence of Diabetes • Estimates of future prevalence (projections) • Mortality attributable to diabetes • Effect of the epidemic on rates of complications • Projections for ESRD

  3. Time, September 4, 2000 Newsweek, September 4, 2000

  4. Global Projections for the Diabetes Epidemic: 2000-2030 (in millions) EU 17.8 25.1 41% NA 19.7 33.9 72% China 20.8 42.3 204% MEC 20.1 52.8 263% LAC 13.3 33.0 248% SSA 7.1 18.6 261% India 31.7 79.4 251% A+NZ 1.2 2.0 65% World 2000 = 171 million 2030 = 366 million Increase 213% Wild, S et al.: Global prevalence of diabetes: Estimates for 2000 and projections for 2030 Diabetes Care 2004 In press

  5. Estimated Number of People with Diabetes in 2000 and 2030 (and % change) +176% +26% -13% Wild, S et al.: Global prevalence of diabetes: Estimates for 2000 and projections for 2030 Diabetes Care 2004. In press

  6. Estimated Number of People with Diabetes in 2000 and 2030 (and % change) +247% +308% +189% Wild, S et al.: Global prevalence of diabetes: Estimates for 2000 and projections for 2030 Diabetes Care 2004 In press

  7. Estimated Number of People with Diabetes in 2000 and 2030 +212% +242% +75% Wild, S et al.: Global prevalence of diabetes: Estimates for 2000 and projections for 2030 Diabetes Care 2004 In press

  8. Are these projections realistic? Based on: 1990s estimates of diabetes prevalence Demographic projections Assume constant (current) age-sex specific prevalence of diabetes

  9. Changing Prevalence of Type 2 Diabetes

  10. No of persons with Physician-diagnosed Diabetes in USA by year Data from the US National Health Interview Survey: http://www.cdc.gov/diabetes/statistics/prev/national/fig1.htm

  11. Diabetes in the United States1958-1993 Prevalence (%) > 65 years 55-65 years 45-54 years < 45 years Data from the US National Health Interview Survey

  12. Diabetes in the United States1980-2000 Prevalence (%) 65-74years 75+years 45-64years < 45 years Data from the US National Health Interview Survey: http://www.cdc.gov/diabetes/statistics/prev/national/fig3.htm

  13. Why were former projections inaccurate? • They were based on demographic changes (which are very predictable) • The epidemic of diabetes is driven by other factors (some or perhaps most of which may be reflected in occurrence of IGT and IFG)

  14. Importance of IGT and IFG

  15. Impaired Glucose Homeostasis 'Impaired Fasting Glucose' (IFG) FPG of 100-125mg/dl [5.6 -<7.0mmol/l] IGT 'Impaired Glucose Tolerance’ (IGT) 2h post-load Plasma Glucose of 140-199mg/dl [7.8-11.0mmol/l] and FPG <126mg/dl [<7.0mmol/l] IFG

  16. Incidence of Diabetes in people with Impaired Glucose Homeostasis

  17. Prevalence and Incidence of Diabetes (%) in Impaired Glucose Homeostasis

  18. Projections of Numbers with Diabetes* among persons aged 40-74years in USA (Millions) *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

  19. Proportion of new cases of Diabetes (%) in persons with NGT and Impaired Glucose Homeostasis

  20. Projections of Numbers with Diabetes* among persons aged 40-74years in USA (Millions) *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 Net increase = c.830,000 cases of diabetes / year

  21. Mortality attributable to diabetes

  22. Number of Deaths with Diabetes as Underlying Cause of Death,United States, 1980-1996. CDC, Diabetes surveillance, 1999

  23. Excess Deaths attributable to Diabetes • Excess mortality =No of deaths in DMs – Expected no. if not DM • No of DM deaths = (RR of death in DM x No. with DM) • Expected No. = Mortality rate in non DMs*No. with DM • Mortality rate; RR of death in DM; No. with diabetes

  24. Global Projections of Excess Deaths attributable to Diabetes (in 000’s) and percent of all deaths in year 2000 EUR 609.0 6.4% AMRA 251.1 9.75% EMR 125.3 7.2% SEAR 1154.1 6.9% AMRD 32.2 6.1% WPR 469.3 4.1% AFR 319.2 2.6% AMRB 194.0 7.6% World In 2000 = 3.164 million (5.4% of all deaths) Roglic et al.: Burden of mortality attributable to diabetes: Estimates for the year 2000. In preparation

  25. Consequences of the Epidemic

  26. Consequences of Epidemic • Increase in number with diabetes • Disproportionate increase in duration-related complications

  27. Effect of Epidemic of Diabetes on Duration-related complications Cumulative No. of DM cases % with DM>15y duration Prevalence of complications (%) among those with DM 50 450 40 300 30 No. of Cases Percent with complications 20 150 10 0 0 0 5 10 15 20 25 30 35 40 45 50 Time (years) 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.

  28. Incidence of Type 2 Diabetes in Pima Indians in two time periods Time Period 1965-75 1975-85 60% increase 0 10 20 30 40 50 Incidence per 1000 person-years Age-sex adjusted rates

  29. Age-standardized mortality from Ischemic Heart Disease in diabetic and non-diabetic Pima Indians aged 35+ years, (30 year follow-up) 6 5 4 /1000 person-years Mortality 3 2 1 0 1965-74 1975-84 1985-94 1965-74 1975-84 1985-94 Non-diabetic Diabetic

  30. Renal disease

  31. Frequency of Renal Failure among Pima Indians 25 Deaths 20 Dialysis 15 Cases 10 5 0 1965 1970 1975 1980 1985 1990 1994 Year

  32. Incidence of Renal Failure 12 8 Cases per 1000/year 4 0 1965-74 1975-84 1985-94 Time Period

  33. Number of persons beginning treatment for ESRD attributable to diabetes in USA by year http://www.cdc.gov/diabetes/statistics/esrd/Fig1Detl.htm

  34. DIABETES IN END-STAGE RENAL FAILURE: AUSTRALIA 1980 - 2000 Number of Diabetics Number of New Patients Year of Entry

  35. Crude and Age-adjusted incidence of ESRD related to diabetes in the United States1984-2001 Incidence/100,000 Diabetic persons Crude rate Age-adjusted rate Data from the US Renal Data System: http://www.cdc.gov/diabetes/statistics/esrd/fig7.htm

  36. Projections for number of patients with diabetes initiating ESRD treatment in USA* * Assuming current incidence rates for initiating ESRD treatment remain constant

  37. Summary • Based on demographic changes alone: The numbers of persons with diabetes in the world will more than double in the next 30 years • In developed countries they will increase by 30-70% (mostly in older persons) • In developing countries they will increase by c. 250% (mostly in 45-64y age group) • These projections do not take into account any increase that is attributable to future increases in obesity

  38. Summary • c.3.2 million (excess) deaths were attributable to diabetes in year 2000. • In the USA this is 9% of all deaths • e.g. In USA c.200,000 excess deaths vs. 14,500 for AIDs • The numbers of deaths attributable to diabetes in future years will increase especially in developing countries

  39. 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

  40. Thank you

  41. Age-adjusted incidence of ESRD related to diabetes in the United States1984-2001 Incidence/100,000 Diabetic persons Amer. Indian male Amer. Indian female Black male Black female Hispanic male Hispanic female White male White female Data from the US Renal Data System: http://www.cdc.gov/diabetes/statistics/esrd/fig5.htm

  42. Are there better ways to predict future trends? • Incidence = No. of new cases/ period of time • Mortality = No. of deaths/ period of time • Prevalence=Cumul.incidence – Cumul. Mortality • = Number of cases at a point in time • Future no. of cases = No. of prevalent cases + no. of new cases- No. of deaths(among all cases)

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