How is the distribution of diabetes?

By type, geographical regions, by

ethnicity, by gender, by age. First, how is the distribution by type? Type one,
type two. Far the most people are suffering from
type 2 diabetes. Thus, in most populations, 90% of all
people with diabetes have type 2 diabetes, and of the remaining,
most have type 1. Although gestational diabetes is also
quite frequent, it does not really count in the setting because it is limited to
the few months of pregnancy. Other special type of diabetes are very
rare. How is the distribution by geographical
region round the world? In the lower left corner, you see the
world statistics, 371 million adult people suffer from diabetes when
this map was last updated in 2012. 50% were undiagnosed. The prevalence were 8.3
%. Prevalence is an epidemiological measure
of occurrence which simply is the number with the disease divided by the total
number of people in the population. Here about 4.5 billion adults, at a given
point in time. And this fraction isn't often as here
converted to percent. Notice that the prevalence is only
apparently a simple measure of the disease occurrence, in fact it is rather comp
lex
by being dependent on how many new cases of the disease that emerge over
time, which is called incidence, how many die from the disease called case
fatality, and how many are cured. We will stick to the prevalence measure
here. But then note that all these factors may
contribute to the differences between prevalence
figures in different populations. In the lower right corner, there is a note say
ing, all rates are presented as
comparative rates. These rates are the prevalence measure. The point made here i
s, that there are major differences between the populations,
particularly in regards to age distributions, which would greatly
affect the prevalence, and the figures have thus been adjusted for
such differences. We'll come back to the role of age later. The map also shows h
ow many patients of diabetes in the various parts of the
world. Let's first look at the Norh American and
Caribbean region at the upper left. There are 38 million people out of whom
29% are undiagnosed. There is a real remark that more health
care dollars were spent in this region than in any other One in ten adults
in this region has diabetes. The prevalence is 10.5%. In South and Central Ameri
ca there were 26
million, of whom 45.5% went undiagnosed. And the prevalence were 9.2%. In the Mi
ddle East and North Africa, there
were 34 million with 52.9% undiagnosed and a prevalence of
10.9%. In Africa, there were 15 million, 81.2%
undiagnosed, and a prevalence of 4.3%. However, as noted, over the next 20 years
the number of people with diabetes will
almost double. This region has a highest mortality rate
due to diabetes. In Europe, which also includes whole
Russia, there were 55 million of whom 38.6% where undiagnosed, and the
prevalence was 6.7%. However far the most people with diabetes
live in the Far East. In southeast Asia, including India, 70
million had diabetes, of whom 51.1% were undiagnosed, and the
prevalence was 8.7%. The greatest contribution came from the region named Wester
n Pacific, which
includes China. Here, 132 million suffered from diabetes,
of whom 57.9% were undiagnosed, and the prevalence
was 8%. Information about the figures for each
country is tabulated here, where you may find your
own country. This table shows which of the regions each
country or territory it belongs to. The diabetes compared to prevalence in perce
nt according to the WHO standard
population, the number of diabetes-related deaths in

the same age range, the mean diabetes-related

expenditure per person with diabetes in U.S. dollars
in that year, the number of people with undiagnosed diabetes in the age range
22 through 79, in thousands also. In my country, Denmark, we have 302,740
cases with diabetes, a prevalence of 5.56%, 2,781
diabetes-related deaths, and we are spending about 7,000 U.S.
dollars per patient, on average, per year. And 125,850 patients remain undiagnos
ed. So, this is a very common disease, and all
the problem is worse in the Asian part of the
world. The data we have looked at, were, as
mentioned, adjusted for differences in the age distribution
between the regions and countries. But not for the level adiposity. It seems as
if the Asian's ethnicity is
much more likely to develop diabetes at any given level of
adiposity than other ethnicities. Since there is still much less adiposity
in the Asian part of the world, than, for example, the
United States of America. The prevalence of diabetes become about
the same. I'll discuss these differences in more
detail later. The risk of getting diabetes is about the
same for women and men. However, women have the extra burden of
the risk of development of gestational diabetes, which is associated
with increased risk of later development of
diabetes. It is difficult to compare the prevalence
of diabetes in men and women because of these differences, as well as difference
s in age
distribution in the general and, and in general
mortality. The figures shown earlier are adjusted for
these differences. Another very important aspect on the
distribution is by age. In this graph, you see the prevalence of
diabetes by age in four different types of countries around the world according
to
the level of income, high, upper middle, lower
middle, and low. Note that in all countries, the prevalence
is very low in the age range between 20 and 25
years. About 1 to 2%. However, in all countries, there is a
steady increase in the prevalence by advancing age, until a leveling off
began from the 60s and above. In somewhat different ages in the four
types of countries, ending at a prevalence between
10% and 24%. In the high income countries, the
prevalence continued to increase up to the oldest group here between 70 and
75 years. However, it is still a major problem, also
for those younger than 60 years. Half of the people who die from diabetes
are under age of 60 years. This graph here shows deaths attributable
to diabetes by age in the age range between 20 through 79
years. It begins with 100,000 deaths from
diabetics in the age range 20 to, through 29 years, and girls up to about the sa
me number, in
the three decade from 50 years and above. Namely 1.2 million people with diabete
s. It should be noted that these figures are
dominated by type 2 diabetes. Type 1 diabetes is as mentioned was rare,
only 10% of all patients with diabetes. And is also usually emerging in childhoo
d
or in young adulthood. It is often said that we have a global
epidemic of diabetes. What does that mean? It means that the occurrence of diabe
tes
is increasing as if it was epidemic of contagious
infectious diseases such as influenza. The quite rapidly increasing prevalence o
f
diabetes is observed almost everywhere in the
world. Let's look at the most recent data just

published by the IDF diabetes atlas, which you see

here. Since last year, the number of people with
diabetes has risen from 371 million I showed earlier, to now 382 million as
shown in the lower left corner. The major contribution to the increase
stems from Africa and Asia. What can we expect of future developments,
using the data from the trends and personal
information about determinants of the prevalence of diabetes, it is
possible to make a predicition of the future
development and prevalence. The outcome of this exercise is what you
see here. To the left, you have the column for 2013 that shows the number of peo
ple with
diabetes in the various regions of the world, with Africa on the top and Europe
at the
bottom. It sums up to the total number I've just
mentioned, the 382 million people. But then, to the right, you have the
predicted numbers in the same way in 2035, 22 years from now, and it shows that
the scary number of 592 million people, corresponding to a
55% increase. There are increases in all regions, but
there are also great differences in the relative
increase. With Africa showing 109.1% increase in the
top. And Europe, only 22.5% increase at the
bottom. There's another very important dimension
of the global epidemic of diabetes, which make the
development even worse. Namely, that the disease hits younger and
younger people. In old days, type 2 diabetes was
considered as the old man's diabetes, as opposed to type 1, showing up in the
kids and the young adults. However, type 2 diabetes is now effecting even childr
en in various parts of the
world. We can see that the diabetes epidemic is
really out of control. And huge efforts are needed those to help
those who already have diabetes and prevent even
more to get the disease. Unfortunately, the major increases occurs
in parts of the world where there are little help to get to cope with both
treatment and prevention of the disease. It is a serious challenge to the health
care systems in these regions of the lower income and middle income countries,
where so many people suffering from a chronic
health problem. So I'm convinced that you agree with me,
that there is no doubt that the global epidemic of diabetes is a
very serious global public health problem. That we need to do whatever we can to
fight against in the future. The advances in treatment of diabetes will
be dealt with in a later lecture. But, to oppose a diabetes epidemic by
prevention of the emergence of new cases, we need to know who are at risk of get
ting
the disease in the future. Knowing the causes of diabetes defined by
the exposures that transformed the healthy individual to the diabetic
patients, would have caused the ideal if it would be feasible to remove
these causes which strict the exposure to them, or block or
inhibit their action. However, we are far from having a comprehensive knowledge
about hese true
courses. But we know about so called risk factors
that may be used to identify the individuals at the highest
risk of development of diabetes in the future. A risk factor is a characteristic
of the individual, either permanent or
transitory. It may also be a cause or just an
indicator of a cause, and we are usually not able to make a definitive distincti
on
between these two alternatives. [MUSIC]