1. Diabetes Mellitus Introduction to Diabetes Epidemiology Dr. Hamid Baradaran EDC, IUMS

2. Diabetes Mellitus

Definition

• A metabolic disorder ofmultiple aetiologycharacterized by chronic hyperglycaemia with disturbances ofcarbohydrate, fat and protein metabolismresulting fromdefects in insulin secretion, insulin action or both

• Associated with a risk of developing late diabetic complications including

• • Microvascular (retinopathy, nephropathy)

• • Macrovascular (atherosclerosis)

• • Neuropathy

3. Increasing mortality from diabetes mellitus J. Olefsky, JAMA 2001:285:628-632 4. Diabetes Epidemiology

Type 1 diabetes

Type 2 diabetes

Other specific types

Impaired glucose regulation (IFG & IGT)

Insulin Resistance & Metabolic Syndrome

5. Type 1 diabetesepidemiology

Very big variation in incidence and prevalence

Variation in growth-rate

Disease process relatively well described

Genetic markers known

Weak risk factors

6. Incidence of type 1 diabetes Age 0-14 years IDF Diabetes Atlas 2003 7. Type 1 diabetes Increase in incidence/year 8. Type 1 diabetesepidemiology

Very big variation in incidence and prevalence

Variation in growth-rate

Disease process relatively well described

Genetic markers known

Weak risk factors

9. 2 minutes 10. Diabetes Epidemiology

Type 1 diabetes

Type 2 diabetes

Other specific types

Impaired glucose regulation

Insulin Resistance & Metabolic Syndrome

11. Type 2 diabetesepidemiology

Some variation in incidence and prevalence

Variation in growth-rate

Disease process partly understood

Some and often weak genetic markers known

Strong risk factors

12. Prevalence of DM and IGT age35-64 years 13. Diabetes in Denmark 1974-96 Drivsholm et al.Diabetic Medicine 201 14. 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 Data10% 15. World wide epidemic Zimmet, Nature 2001 India: 2000:32 mill 2020: 81 mill 16. 1995 2025 19 million 57 million DIABETES Top Three Countries in the world King et al, Diabetes Care, 1998 17. Type 2 DM - global epidemic -why ?

Prevalence depends on:

Age

Residence(urban/rural)

Obesity

Physical activity

Ethnicity

18. Type 2 DM - global epidemic -why ?

Prevalence depends on:

Age

Residence (urban/rural)

Obesity

Physical activity

Ethnicity

19. Age standardized prevalence ofType 2 DM (native and migrant Asian Indian populations) 20. Urban-Rural ratio 21. 2 minutes 22. Type 2 DM - global epidemic -why ?

Prevalence depends on:

Age

Residence(urban/rural)

Obesity

Physical activity

Ethnicity

23. 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)

24. Obesity (BMI>30) in USA 1960-2000 (males) Flegal & al, JAMA 2002, 288, 1723-7 25. Obesity children in USA 1960-2000 BMI >95-centile (boys) Ogden& al, JAMA 2002, 288, 1728-32 26. Obesity* Trends Among U.S. AdultsBRFSS, 1991, 1995 and 2000 (*BMI30, or ~ 30 lbs overweight for 54 person) Source: Mokdad A H, et al.JAMA1999;282:16, 2001;286:10. No Data< 10%10%-14%15-19% 20%1991 1995 2000 27. Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al.J Am Med Assoc1999;282:16, 2001;286:10. 28. 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 Data10% 29. Type 2 DM - global epidemic -why ?

Prevalence depends on:

Age

Residence (urban/rural)

Obesity

Physical activity

Ethnicity

30. 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)

31. 32. 33. 34. Type 2 DM - global epidemic -why ?

Prevalence depends on:

Age

Residence(urban/rural)

Obesity

Physical activity

Ethnicity

35. Prevalence of DM in 60 years old MenDecoda:Nakagami; Diabetologia 2003 36. Prevalence of DM in 60 years old Women Decoda:Nakagami; Diabetologia 2003 37.