Type 2 diabetes

Epidemiology and prevention

R. Erol Sezer

«Diabetes can be classified into the following general categories:1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency)2. Type 2 diabetes (due to a progressive insulin secretory defect on the background of insulin resistance)3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes)4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes)» Uptodate

Self-reported Prevalence of diabetes in Turkey:

Among people aged ≥15 years in 2012 : 6.7% (6.1% in males, 8.3% in females)National Health Survey 2012, Turkish Statistical Institute.

Among people aged ≥18 years in 2003: 5.6% (4.7% in males, 6.3 in females). Aged (years) 18-24 : %0.2 25-34 : %1,0 35-44 : % 2.6 45-54 : %7.6, 55-64 : %14.5 65+: %16.0 T.C. Sağlık Bakanlığı Hıfzıssıhha Mektebi Müdürlüğü, Başkent Üniversitesi. Ulusal Hastalık Yükü ve Maliyet Etkililik Çalışması Hane Halkı Araştırması Ara Raporu. 2003, Ankara.

TURDEP I among aged ≥20, in (1997-98): % 4.9

Satman I et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol (2013) 28:169–180.

«A cross-sectional, population-based survey, ‘TURDEP-II’ included 26,499 randomly sampled adults aged ≥20 years (response rate:87 %). Fasting glucose and biochemical parameters were measured in all; then a OGTT was performed to identify diabetes and prediabetes in eligible participants.

The prevalence of diabetes was 16.5 % (new 7.5 %), translating to 6.5 million adults with diabetes in Turkey. It was higher in women than men (p = 0.008).»

However, if the same diagnostic definition at the time of TURDEP-I was applied in the current survey and the population’s age distribution was standardized to TURDEP-I population, the prevalence of diabetes in TURDEP II should be 11.4 % .

The prevalence of diabetes in TURDEP I (carriedout from September 1997 to March 1998) was 7.2% (self-reported 4.9%, previously undiagnosed, 2.3%)

The prevalence of diabetes appears to increase by 58% over 12 years based on TURDEP I and TURDEP II.

Diabetes and Prediabetes Prevalence in Turkey in 2010 by age, gender, and place

TURDEP II research article

Diabetes prevalence in Ontario, Canada, 1995 to 2005

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Trends in CVD Mortality Rates among the U.S. Population with and without Diabetes

No Diabetes Diabetes

Source: Edward Gregg. Epidemiology of Type 2 Diabetes. 2009 Middle Eastern Region Epidemiology Supercourse Bibliotheca Alexandria, Egypt .

Morbidity from diabetes is a consequence of both macrovascular disease (atherosclerosis) and microvascular disease (retinopathy, nephropathy, and neuropathy).

In type 2 diabetes, disease onset is insidious, and diagnosis is often delayed. As a result, diabetic complications may be present at the time of diagnosis of diabetes , and their frequency increases over time.

in the 2012 Annual Report from the United States Renal Data System (USRDS), the most common ascribed causes of end stage renal disease were:

diabetes 44%hypertension/nephrosclerosis  28%

glomerulonephritis 6%cystic kidney disease 2%

Diabetic nephropathy and hypertensive nephrosclerosis are also the most common causes of non-end-stage CKD in the United States. Uptodate

….Prof. Demirbaş ile bu işin ekonomisi üzerinde yoğunlaşacağımız için buluşmamıza elinde somut verilerle geldi..…

13 BİN DİYALİZ MAKİNESİ

Bu rakam nereden çıkıyor derseniz:Türkiye’de halen 350’si özel olmak üzere 792 diyaliz merkezi varmış. Bu merkezlerdeki toplam makine sayısı ise 13 bin. Türkiye’deki kronik böbrek hastası sayısı 60 bin. Bu sayıya her yıl 10 bin ekleniyor. Bir diyaliz hastasının yıllık masrafı 30 bin dolar civarında. Hasta yaşadığı sürece bu masraf devam ediyor.

Gila Benmayor,. Sağlıkta 3 milyar dolarlık kayıp: KONUMUZ organ nakli. Hürriyet Gazetesi, 12.Şubat 2012.

Several prospective, large, population-based cohort studies have found that diabetes is associated with an increased risk of cognitive decline and dementia.

A systematic review of 14 studies found that diabetes is associated with a 50 to 100 percent increase in risk of Alzheimer’s disease and of dementia overall.

Uptodate

Because of the associated microvascular and macrovascular disease, diabetes accounts for almost 14 percent of United States health care expenditures.

Uptodate: Overview of medical care in adults with diabetes mellitus (2015)

Taylor R. Type 2 Diabetes: Etiology and reversibility. Diabetes Care; 36: 1047-1055.

Some new facts about type 2 diabetes:

• Type 2 diabetes has long been regarded as inevitably progressive, requiring increasing numbers of oral hypoglycemic agents and eventually insulin, but it is now certain that the disease process can be halted with restoration of normal carbohydrate and fat metabolism.

• Type 2 diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intra organ fat.

• Within 7 days of instituting a substantial negative calorie balance by either dietary intervention or bariatric surgery, fasting plasma glucose levels can normalize. This rapid change relates to a substantial fall in liver fat content and return of normal hepatic insulin sensitivity.

• Over 8 weeks, first phase and maximal rates of insulin secretion steadily return to normal, and this change is in step with steadily decreasing pancreatic fat content.

Increased levels of daily activity bring about decreases in liver fat stores , and a single bout of exercise substantially decreases both de novo lipogenesis and plasma VLDL .

Several studies demonstrated that calorie control combined with exercise is much more successful than calorie restriction alone.

Taylor R. Type 2 Diabetes: Etiology and reversibility. Diabetes Care; 36: 1047-1055

Categories of increased risk for diabetes (prediabetes):*

Impaired Fasting GlucoseFPG 100 mg/dL (5.6mmol/L) to 125 mg/dL (6.9 mmol/L)ORImpaired Glucose Tolerance 2-h PG in the 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) ()ORA1C 5.7–6.4%

*For all three tests, risk is continuous, extending below the lower limit of the range and becoming disproportionately greater at higher ends of the range.

In a systematic review of 44,203 individuals from 16 cohort studies with a follow-up interval averaging 5.6 years (range 2.8–12 years), those with an A1C between 5.5–6.0% had a substantially increased risk of diabetes (5-year incidence from 9 to 25%). An A1C range of 6.0–6.5% had a 5-year risk of developing diabetes between 25–50% and a relative risk 20 times higher compared with an A1C of 5.0%.

Zhang X, Gregg EW, Williamson DF, et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care 2010;33:1665–1673

Years of diagnosis or end of follow up-14 -12 -10 -8 -6 -4 -2 0

Tabak AG et al. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet 2009;373: 2215–2221

About the nature of the disease and its prevention and treatment:

You tubeJason Fung Two big lies

Taylor R. Type 2 Diabetes: Etiology and reversibility. Diabetes care 2013; 36: 1047-1055