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Glob-al prevalence of diabetes: Estimates

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Global Prevalence of Diabetes
Estimates for the year 2000 and projections for 2030
SARAH WILD,
MB BCHIR
,
PHD
1
GOJKA ROGLIC,
MD
2
ANDERS GREEN,
MD
,
PHD
,
DR MED SCI
3
RICHARD SICREE,
MBBS
,
MPH
4
HILARY KING,
MD
,
DSC
2
OBJECTIVE The goal of this study was to estimate the prevalence of diabetes and the
number of people of all ages with diabetes for years 2000 and 2030.
RESEARCH DESIGN AND METHODS Data on diabetes prevalence by age and sex
from a limited number of countries were extrapolated to all 191 World Health Organization
member states and applied to United Nations’ population estimates for 2000 and 2030. Urban
and rural populations were considered separately for developing countries.
RESULTS The prevalence of diabetes for all age-groups worldwide was estimated to be
2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise
from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men
than women, but there are more women with diabetes than men. The urban population in
developing countries is projected to double between 2000 and 2030. The most important
demographic change to diabetes prevalence across the world appears to be the increase in the
proportion of people 65 years of age.
CONCLUSIONS These findings indicate that the “diabetes epidemic” will continue even
if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that
these figures provide an underestimate of future diabetes prevalence.
Diabetes Care 27:1047–1053, 2004
T
he number of people with diabetes
is increasing due to population
growth, aging, urbanization, and in-
creasing prevalence of obesity and physi-
cal inactivity. Quantifying the prevalence
of diabetes and the number of people af-
fected by diabetes, now and in the future,
is important to allow rational planning
and allocation of resources.
Estimates of current and future dia-
betes prevalence have been published
previously (1–3). Since these reports ap-
peared, further epidemiological data have
become available for several countries in
Africa and the Middle East and for India.
The sources of these data are identified in
Table 1.
This report provides estimates of the
global prevalence of diabetes in the year
2000 (as used in the World Health Orga-
nization [WHO] Global Burden of Dis-
ease Study) and projections for 2030. It
provides a sequel to the report describing
estimates of the global burden of diabetes
in 1990 (2) using newer data and different
methods for estimating age-specific prev-
alence. As before, the estimates are based
on demographic changes alone with the
conservative assumption that other risk
factor levels such as obesity and physical
activity remain constant (in developed
countries) or are accounted for by urban-
ization (in less developed countries). The
current estimates include all age-groups,
and age-specific data are presented (on-
line appendix [available at http://care.
diabetesjournals.org]) to allow compari-
son with previous estimates that were for
adults only (2). As most data sources do
not distinguish between type 1 and type 2
diabetes in adults, it is not possible to
present data separately for subtypes of
diabetes.
RESEARCH DESIGN AND
METHODS — Diabetes prevalence
data for adults (20 years of age) were
derived from studies meeting the follow-
ing criteria: a defined, population-based
sample and diagnosis of diabetes based on
optimal WHO criteria (a venous plasma
glucose concentration of 11.1 mmol/l
2 h after a 75-g glucose tolerance test).
The exceptions to the latter criterion were
the study in China, for which a test meal
was used (4), and the study in Tanzania
(5), in which fasting glucose alone gave a
higher prevalence of diabetes than a pre-
vious study that used the optimal WHO
criteria.
Prevalence estimates for type 1 diabe-
tes for people 20 years of age for indi-
vidual countries were estimated from
available incidence data using methods
described in the International Diabetes
Federation (IDF) Diabetes Atlas 2000 (6).
Population-based data are not available
for type 2 diabetes in people 20 years of
age, and this group has been excluded
from these estimates.
Age- and sex-specific estimates for di-
abetes prevalence were extrapolated to
other countries using a combination of
criteria including geographical proximity,
ethnic, and socioeconomic similarities
applied by the authors with the advice
of the WHO regional officer and other
●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●
From the
1
Public Health Sciences, University of Edinburgh, Edinburgh, Scotland; the
2
Department of
Non-Communicable Diseases, World Health Organization, Geneva, Switzerland; the
3
Department of Epi-
demiology and Social Medicine, University of Aarhus, Aarhus, Denmark; and the
4
International Diabetes
Institute, Caulfield, Victoria, Australia.
Address correspondence and reprint requests to Dr. Sarah Wild, Public Health Sciences, University of
Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland. E-mail: sarah.wild@ed.ac.uk.
Received for publication 18 October 2003 and accepted in revised form 26 January 2004.
S.W. received honoraria for speaking engagements from Bayer Corporation. A.G. is a paid consultant of
Novo Nordisk.
Additional information for this article can be found in an online appendix at http://care.diabetesjournals.
org.
Abbreviations: IDF, International Diabetes Federation; WHO, World Health Organization.
A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion
factors for many substances.
© 2004 by the American Diabetes Association.
Epidemiology/Health Services/Psychosocial Research
ORIGINAL ARTICLE
DIABETES CARE,VOLUME 27, NUMBER 5, MAY 2004 1047
Table 1 List of diabetes prevalence studies by country of study giving sample size, age-group, and the countries to which the data were
extrapolated
Country of study, year, and
reference* Sample size
Age-group
(years) Additional countries that estimates were applied to
Australia, 2000 (21)11,247 25 New Zealand
Bolivia, 1998 (22)2,948 20 Ecuador, Peru
Brazil, 1988/1989 (23)2,051 3069 Argentina, Chile, Cuba, Mexico, Uruguay, Venezuela
Cameroon, published 1997 (24)1,767 2474 Angola, Central African Republic, Congo, Gabon, Guinea, Sao
Tome, and Principe
China, 1994 (4)†‡ 224,251 2564 North Korea/Democratic Peoples Republic of Korea
Colombia, 1988/1989 (25) 670 30 Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua,
Panama
Fiji, 1980 (26)1,709 20 Kiribati, Marshall Islands, Micronesia (Federated States),
Palau, Papua New Guinea, Solomon Islands, Vanuatu
Ghana, 1998 (27)4,733 25 Benin, Burkina Faso, Cape Verde, Chad, Cote dIvoire,
Equatorial Guinea, Guinea Bissau, Gambia, Liberia,
Nigeria, Senegal, Sierra Leone, Togo
India, 2000 (28)11,216 20 Bangladesh, Bhutan, Sri Lanka, Maldives, Nepal
Iran, 1999/2000 (29)9,229 20 Azerbaijan, Iraq, Yemen
Israel (30)†‡ 1,502 2564
Japan Funagata, 19901992 (31)2,624 40
Jordan (32)2,836 25 Syria, urban Egypt
Lebanon†§ 2,518 30
Malta (33)2,149 15
Mauritius (34)†‡ 4,929 2574 Seychelles
Mongolia (35)†‡ 2,449 35
Nauru (36)†‡ 1,546 20
Netherlands, 19891992 (37)2,484 5074 Austria, Belgium, Denmark, Finland, France, Germany,
Iceland, Ireland, Luxembourg, Norway, Sweden,
Switzerland, U.K.
Oman, 1991 (38) 2,963 20 Qatar
Pakistan: rural Baluchistan (39)570 25 Afghanistan
Pakistan: Sindh, 1994 (40) 967 25
Paraguay, 1991/1992 (41)1,606 urban white Hispanic 2074 Suriname
Poland2,523 2574 Bosnia, Croatia, Czech Republic, Estonia, Hungary, Latvia,
Lithuania, Serbia, Slovakia, Slovenia, the Former Yugoslav
Republic of Macedonia, Ukraine
Russia1,602 2564
Samoa (42)†‡ 1,772 2574 Cook Islands, Niue, Tonga, Tuvalu
Saudi Arabia (43)†‡ 25,337 277 Bahrain, Kuwait
Singapore (44)†‡ 3,568 1869 Brunei, Indonesia, Malaysia, Philippines, Thailand
South Africa (45)729 30 Botswana, Lesotho, Namibia, Swaziland, Zimbabwe
South Korea/Republic of Korea (46)2,520 30
Spain (47)2,214 3089 Andorra, Italy, Monaco, San Marino, Portugal
Sudan (48)1,284 25 Eritrea, Ethiopia, Mali, Mauritania, Niger
Tanzania, 1996/1997 (5)1,698 15 Burundi, Comoros, Democratic Republic of the Congo,
Djibouti, Kenya, Madagascar, Malawi, Mozambique,
Rwanda, Somalia, Uganda, Zambia
Trinidad, 19771981 (49) 2,315 3569 Antigua and Barbuda, Bahamas, Barbados, Belize,
Dominica, Dominican Republic, Grenada, Guyana, Haiti,
Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and
the Grenadines
Tunisia, 1976/1977, 1980/1981 (50) 3,826 urban 20 Algeria, Libya, Morocco
1,787 rural
Turkey (51)24,788 20 Albania, Belarus, Bulgaria, Cyprus, Greece, Moldova,
Romania
United Arab Emirates, 2000†‡# 5,844 19
U.S., 19881994 (52)2,844 4074 Canada
Uzbekistan, 1996 (53)1,956 35 Armenia, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan,
Turkmenistan
Vietnam** 1,121 25 Cambodia, Laos, Myanmar
*Year indicates year of study, if given, or year of publication. Indicates data that were not used in estimates for 1990. Indicates same diabetes prevalence data used
for urban and rural populations. §I. Salti, M. Khogali, S. Alam, N. Nassar, A. Masri, personal communication. E. Shubnikov, personal communication. Z. Szybinski,
W. Zukowski, R. Rita, J. Sieradzki, I. Turska-Karbowska, M. Gizler, personal communication. #M. Malik, A. Bakir, B. Abi Saab, G.R., H.K., personal communication.
**P. Khi, personal communication.
Global prevalence of diabetes
1048 DIABETES CARE,VOLUME 27, NUMBER 5, MAY 2004
experts. Table 1 shows the studies used
and the countries to which data were
extrapolated.
Surveys were generally performed on
middle-aged populations, and data are
more limited at younger and older ages.
Data on diabetes prevalence are usually
presented in broad age bands, which sug-
gest a biologically implausible step-like
increase in diabetes prevalence with in-
creasing age. DISMOD II software (avail-
able from http://www3.who.int/whosis)
was used to produce smoothed, age-
specic estimates of diabetes prevalence
from the available data from each study.
Further details on DISMOD II have been
published elsewhere (7). In summary,
age- and sex-specic diabetes prevalence
(derived from the studies listed in Table
1), remission (assumed to be zero), and
estimates of relative risk of mortality
among people with diabetes (see below)
were entered into models. The model out-
put provides estimates of prevalence, in-
cidence, and mortality that are consistent
with one another (7).
Estimates of relative risk of all-cause
mortality among people with diabetes, by
age and sex, were derived from the lim-
ited number of cohort studies that pro-
vide this information (810). Estimated
relative risks for all-cause mortality
ranged between 1 (for the oldest age-
group, 80 years of age) and 4.1 (for
2039 years of age) for men and between
1 (for 80 years of age) and 6.7 (for
2039 years of age) for women. Further
information on the estimation of age-
specic relative risks is available in the
draft Global Burden of Disease 2000 doc-
umentation (11). Mortality data were de-
rived from developed countries (U.K.,
Sweden, and U.S.). As no information was
available for developing countries, the
same relative risks were assumed to ap-
ply. Data are required to test the validity
of this assumption. Survival is unlikely to
be better in developing countries than de-
veloped countries, and any bias in the ap-
proach we have taken would lead to
conservative estimates of incidence of di-
abetes in developing countries but would
not affect estimates of prevalence. Esti-
mates of incidence and mortality are
not presented in this report but are
available from the authors and from the
draft Global Burden of Disease 2000
documentation (11).
The prevalence estimates were ap-
plied to population estimates for individ-
ual countries for 2000 and 2030, which
were produced by the United Nations
Population Division (12). Conventional,
albeit simplistic, denitions of developed
countries (Europe including former so-
cialist economies, North America, Japan,
Australia, and New Zealand) and less de-
veloped countries (all other countries)
were used. In keeping with previous esti-
mates, prevalence of diabetes was as-
sumed to be similar in urban and rural
areas of developed countries (2). For de-
veloping countries, urbanization was
used as a proxy measure of the increased
risk of diabetes associated with altered
diet, obesity, decreased physical activity,
and other factors such as stress, which are
assumed to differ between urban and ru-
ral populations. For most developing
countries, the prevalence of diabetes in
Figure 1—Global diabetes prevalence by age and sex for 2000.
Table 2 Estimated numbers of people with diabetes by region for 2000 and 2030 and summary of population changes
Region (all ages)
2000 2030 20002030
Number of
people with
diabetes
Number of
people with
diabetes
Percentage of
change in number
of people with
diabetes*
Percentage of
change in total
population*
Percentage of
change in
population 65
years of age*
Percentage of
change in urban
population*
Established market economies 44,268 68,156 54 9 80 N/A
Former socialist economies 11,665 13,960 20 14 42 N/A
India 31,705 79,441 151 40 168 101
China 20,757 42,321 104 16 168 115
Other Asia and Islands 22,328 58,109 148 42 198 91
Sub-Saharan Africa 7,146 18,645 161 97 147 192
Latin America and the Caribbean 13,307 32,959 148 40 194 56
Middle Eastern Crescent 20,051 52,794 163 67 194 94
World 171,228 366,212 114 37 134 61
*A positive value indicates an increase, a negative value indicates a decrease.
Wild and Associates
DIABETES CARE,VOLUME 27, NUMBER 5, MAY 2004 1049
rural areas was assumed to be one-half
that of urban areas, based on the ratio ob-
served in a number of population studies
and as used in previous estimates (1). For
some populations in developing coun-
tries (small islands and populations for
which prevalence data were derived from
studies combining urban and rural popu-
lations), a single estimate of diabetes prev-
alence was used. In the current estimates,
on the advice of local experts, the preva-
lence of diabetes in rural areas was as-
sumed to be one-quarter that of urban
areas for Bangladesh, Bhutan, India, the
Maldives, Nepal, and Sri Lanka (13).
To facilitate comparisons with previ-
ous estimates, the regional grouping of
countries originally used in the World
Development Report 1993 (14) and the
Global Burden of Disease 1990 study was
retained. Data on population size and es-
timated numbers of people with diabetes
for individual countries were combined
to give regional estimates of diabetes
prevalence.
RESULTS Detailed information on
the estimated number of people with di-
abetes, population size, and prevalence
for individual countries is given in the on-
line appendix. The regional summaries
are shown in Table 2.
Assuming that age-specic preva-
lence remains constant, the number of
people with diabetes in the world is ex-
pected to approximately double between
2000 and 2030, based solely upon demo-
graphic changes. The greatest relative in-
creases will occur in the Middle Eastern
Crescent, sub-Saharan Africa, and India.
The greatest absolute increase in the num-
ber of people with diabetes will be in In-
dia. Most of the expected population
growth between 2000 and 2030 will be
concentrated in the urban areas of the
world (15). The most striking demo-
graphic change in global terms will be the
increase in the proportion of the popula-
tion 65 years of age (see Table 2).
The importance of age on the preva-
lence of diabetes is illustrated in Fig. 1,
which shows sex-specic estimates of di-
abetes prevalence by age. Globally, diabe-
tes prevalence is similar in men and
women but it is slightly higher in men
60 years of age and in women at older
ages. Overall, diabetes prevalence is
higher in men, but there are more women
with diabetes than men (data available
from the authors). The combined effect
of a greater number of elderly women
than men in most populations and the
increasing prevalence of diabetes with
age is the most likely explanation for this
observation.
In developing countries, the majority
of people with diabetes are in the 45- to
64-year age range, similar to the nding
reported previously (2). In contrast, the
majority of people with diabetes in devel-
oped countries are 64 years of age. By
2030, it is estimated that the number of
people with diabetes 64 years of age
will be 82 million in developing coun-
tries and 48 million in developed coun-
tries. The age distribution of the number
of people with diabetes in developed
Figure 2Estimated number of adults with diabetes by age-group, year, and countries for the
developed and developing categories and for the world.
Global prevalence of diabetes
1050 DIABETES CARE,VOLUME 27, NUMBER 5, MAY 2004
and developing countries is illustrated in
Fig. 2.
The 10 countries estimated to have
the highest numbers of people with dia-
betes in 2000 and 2030 are listed in Table
3. The top threecountries are the same
as those identied for 1995 (2) (India,
China, and U.S.). Bangladesh, Brazil, In-
donesia, Japan, and Pakistan also appear
in the lists for both 2000 and 2030. The
Russian Federation and Italy appear in the
list for 2000 but are replaced by the Phil-
ippines and Egypt for 2030, reecting an-
ticipated changes in the population size
and structure in these countries between
the two time periods.
CONCLUSIONS The number of
cases of diabetes worldwide in 2000
among adults 20 years of age is esti-
mated to be 171 million. This gure is
11% higher than the previous estimate of
154 million (2). Estimates of total popu-
lation size and proportion of people 64
years of age in 2000 used in the previous
report were higher than those used in this
report, and therefore demographic
changes cannot account for the discrep-
ancy. The higher prevalence is more likely
to be explained by a combination of the
inclusion of surveys reporting higher
prevalence of diabetes than was assumed
previously and different data sources for
some countries. The IDF Diabetes Atlas
2000 used different and less stringent cri-
teria for the inclusion of studies to esti-
mate prevalence of diabetes for 20- to 79-
year-old individuals in the 172 IDF
member countries (90% of the popula-
tion of the world) (6). It was estimated
that there were 151 million people with
diabetes in this subpopulation in 2000.
Despite methodological differences, this
was similar to the present estimate for a
comparable population of 147 million.
The IDF has subsequently released esti-
mates of the numbers of people with dia-
betes for 2003 and forecasts for 2025 of
194 million and 334 million, respec-
tively (16).
Even if the prevalence of obesity re-
mains stable until 2030, which seems un-
likely, it is anticipated that the number of
people with diabetes will more than dou-
ble as a consequence of population aging
and urbanization. In the light of the ob-
served increase in prevalence of obesity in
many countries of the world and the im-
portance of obesity as a risk factor for di-
abetes, the number of cases of diabetes in
2030 may be considerably higher than
stated here. Increasing evidence of effec-
tive interventions, including changes in
diet and physical activity or pharmacolog-
ical treatment to reduce prevalence of di-
abetes, provides an impetus for wider
introduction of preventive approaches
(1719). Furthermore, improved survival
may contribute to increasing prevalence
of diabetes in the future especially in de-
veloped countries (20).
As with previous similar studies,
these estimates are limited by a paucity of
data, particularly for Eastern Europe and
Southeast Asia, and by the assumptions
required to generate the estimates. It is
possible that individual studies are not
representative of the whole country in
which they were performed, and it is
likely that extrapolation of results to
neighboring countries may give inaccu-
rate estimates of diabetes prevalence. A
new approach to estimating age-specic
prevalence of diabetes was used for the
present estimates. For the estimates pre-
pared for the Global Burden of Disease
Study 1990, logistic regression models
with a linear factor for age were used
when data for all age-groups were not
available (2). The IDF estimates for 2000
included a quadratic regression model
for diabetes with age (6), which can result
in a marked reduction in diabetes preva-
lence at the oldest ages. DISMOD II mod-
els showed a attening or modest reduc-
tion of diabetes prevalence in the oldest
ages, which appears to be more consistent
with the pattern observed in the limited
number of studies giving information on
diabetes prevalence in the oldest age-
groups.
A conservative approach to calculat-
ing estimates was taken throughout this
study. Given that several of the surveys
were performed more than a decade ago,
it is probable that this has generated un-
derestimates of diabetes prevalence. Until
more modern and nationally representa-
tive data are available, this approach pro-
vides a guide to the lower limits of the
extent of the diabetes epidemic. It is an-
ticipated that estimates will be updated
periodically as new information becomes
available.
In summary, these data provide an
updated quantication of the growing
public health burden of diabetes across
the world. The human and economic
costs of this epidemic are enormous. Mor-
tality from communicable diseases and
infant and maternal mortality in less-
developed countries are declining. In as-
sociation with increasing diabetes
prevalence, this will inevitably result in
increasing proportions of deaths from
cardiovascular disease in these countries,
as well as increased prevalence and asso-
ciated consequences of other complica-
tions of diabetes. A concerted, global
initiative is required to address the diabe-
tes epidemic.
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and 2030
Ranking
2000 2030
Country
People with
diabetes (millions) Country
People with
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Wild and Associates
DIABETES CARE,VOLUME 27, NUMBER 5, MAY 2004 1051
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Wild and Associates
DIABETES CARE,VOLUME 27, NUMBER 5, MAY 2004 1053
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... The occurrence of Diabetes Mellitus (DM) is increasing sharply worldwide. Study shows that there will be 360 million more cases of DM till 2030 [1]. DM causes severe damage to human physiology including degradation of bones, nerves and other vital organs. ...
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A total of 25 337 Saudis [11 713 males (46.2%) and 13 624 females (53.8%)] were screened for diabetes mellitus and impaired glucose tolerance using WHO criteria for diagnosis. The prevalence of insulin-dependent diabetes mellitus, non-insulin-dependent diabetes mellitus and impaired glucose tolerance in the total Saudi male population was 0.23%, 5.63% and 0.50% respectively, and in the total Saudi female population was 0.30%, 4.53% and 0.72% respectively. Differences were observed in the prevalence of diabetes mellitus and impaired glucose tolerance between the provinces. Non-insulin-dependent diabetes mellitus increased to 28.82% and 24.92% in males and females respectively over the age of 60 years, while impaired glucose tolerance increased to 1.60% and 3.56%.
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A population-based survey in 1996 and 1997 of 770 adults (aged ⩾ 15 years) from an urban district of Dar es Salaam and 928 from a village in rural Kilimanjaro district (Tanzania) revealed that the prevalence of diabetes, impaired fasting glucose (IFG), overweight, obesity, and physical inactivity was higher in the urban area for men and women. The difference between urban and rural prevalence of diabetes was 3.8 [1.1–6.5]% for men and 2.9 [0.8–4.9]% for women. For IFG, the difference was 2.8 [0.3–5.3]% for men and 3.9 [1.4–6.4]% for women; for overweight and obesity, the difference was 21.5 [15.8–27.1]% and 6.2 [3.5–8.9]% for men and 17.4 [11.5–23.3]% and 12.7 [8.5–16.8]% for women, respectively. The difference in prevalence of physical inactivity was 12.5 [7.0–18.3]% for men and 37.6 [31.9–43.3]% for women. For men with diabetes, the odds for being overweight, obese and having a large waist:hip ratio were 14.1, 5.3 and 12.5, respectively; for women the corresponding values were 9.0, 10.5 and 2.4 (the last not significant) with an attributable fraction for overweight between 64% and 69%. We conclude that diabetes prevalence is higher in the urban Tanzanian community and that this can be explained by differences in the prevalence of overweight. The avoidance of obesity in the adult population is likely to prevent increases in diabetes incidence in this population.
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Mauritius, a multiethnic island nation in the southwestern Indian Ocean, has one of the world's highest diabetes mortality rates. The prevalence of both impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) was investigated in 5080 Muslim and Hindu Indian, Creole (mixed African, European, and Indian origin), and Chinese Mauritian adults aged 25-74 yr who were selected by random cluster sampling. Based on a 75-g oral glucose tolerance test and World Health Organization criteria, the age-standardized prevalence of IGT was significantly greater in women (19.7%, 95% confidence interval [CI] 18.1-21.2) than in men (11.7%, CI 10.5-12.8). By contrast, the prevalence of NIDDM was similar in men (12.1%, CI 10.9-13.4) and women (11.7%, CI 10.5-12.8) for all ethnic groups combined. The sex difference in IGT prevalence was seen in all ethnic groups, but for NIDDM, the sex difference was not consistent across ethnic groups. However, age- and sex-standardized prevalence of IGT and NIDDM was remarkably similar across ethnic groups (16.2 and 12.4% in Hindu Indians, 15.3 and 13.3% in Muslim Indians, 17.5 and 10.4% in Creoles, and 16.6 and 11.9% in Chinese, respectively). Three new cases of diabetes were diagnosed for every two known cases. The high prevalence of abnormal glucose tolerance in Indian subjects is consistent with studies of other migrant Indian communities, but the findings in Creole and, in particular, Chinese subjects are unexpected. Potent environmental factors shared between ethnic groups in Mauritius may be responsible for the epidemic of glucose intolerance.
Article
A population-based longitudinal study of abnormal glucose tolerance in the adult Maltese, carried out within the WHO-assisted National Diabetes Programme, has recently been completed. During the 6-year interval abnormal as compared to normal glucose tolerance was found to be related to a significantly higher mortality: the age-adjusted relative risks of death were 3.3 times in diabetic females and greater than 2 times in IGT and diabetic males. In the repeat epidemiological survey 1422 subjects (66.8% of the initial sample) were reinvestigated with the oral GTT being interpreted according to WHO's 1985 recommendations. The age-standardised prevalence rates, in the 35-69-year-old males and females, were respectively 12.89% and 13.24% for IGT and 9.07% and 10.77% for diabetes. These gradually increased after age 40, IGT peaking in the 60+ year groups and diabetes 10 years later. Heredity (especially diabetes in close relatives) seemed a major influence, whilst excess body weight appeared the more important associated environmental factor. The incidence levels (% per annum) of diabetes during the interval were 0.71 for normoglycaemics and 5.1 for IGTs; this seven times higher risk in the latter was slightly lower in females than males, but significantly higher in the less than 60-year-olds compared to older subjects. Of the initial IGTs 36% remained IGT and 33% reverted to normal glucose tolerance, whilst 11% of the initial normoglycaemics deteriorated to IGT. The determinants more strongly influencing worsening of glucose tolerance were age (greater than 50 years), baseline glycaemia (fasting greater than 5.5 mmol/l and a 2-h post-load glycaemia greater than 9.5 mmol/l) and initial body mass index (greater than 27 kg/m2). In conclusion the data permit a better insight into the natural history of, and risk factors for, disturbed glucose tolerance in this community.
Article
A prevalence survey of diabetes mellitus was carried out in Tunisia on two random samples of households. The first sample (3826 adult subjects) was drawn from the Gouvernorat of Tunis, the second one (1787 adult subjects), was drawn from a rural area, the Gouvernorat of Siliana. The families were investigated at home and diabetes assessed on the basis of an interview (to determine known cases) and of fasting blood glucose level in subjects having no personal history of diabetes (new cases). Prevalence rates were estimated considering known cases and newly found ones together. Overall, the age-standardized prevalence rate was found to be much higher in the urban sample compared to the rural one, especially for women (4.6% versus 2.3% in men, 3.5% versus 0.6% in women). Diabetes was often associated with obesity, especially in men. Within the urban sample, the prevalence rate was similar in subjects born in Tunis and in those born in the rest of the country, thus mainly of rural extraction. In contrast, a family history of diabetes was more often reported in the former group. The results are consistent with other epidemiological findings, showing that a dramatic increase in diabetes morbidity parallels the rapid westernization of urban centres in developing countries.
Article
A population survey in 1982 has confirmed that Nauruan adults suffer from an extremely high prevalence of Type 2 (noninsulin-dependent) diabetes mellitus. The crude population prevalence of Type 2 diabetes was 24%. Abnormal glucose tolerance (impaired glucose tolerance and diabetes) was present in over 40% of the adult population and exceeded 80% in both sexes after the age of 55 yr. Diabetic retinopathy was present in 24% of diabetic patients, confirming that this Micronesian population is susceptible to the microvascular consequences of hyperglycaemia. Subjects with impaired glucose tolerance had a prevalence of retinopathy three times that of normal subjects, though the difference did not reach statistical significance. Prevalence of retinopathy was substantially higher in diabetic patients than either normal subjects or those with impaired glucose tolerance.
Article
Zimmet P. (WHO Collaborating Centra for the Epidemiology of Diabetes Mel-Iitus, Melbourne, Australia), R. Taylor, P. Ram, H. King, G. Sloman, L R. Raper and D. Hunt. Prevalence of diabetes and Impaired glucose tolerance In the blraclal (Melaneslan and Indian) population of FIJI: a rural-urban comparison. Am J Epidemiol 1983; 116: 673–88. Rural-urban and ethnic comparisons of impaired glucose tolerance and diabetes mellitus were made in the biracial population of FIJI in 1980. No statistically significant differences existed In age-standardized impaired glucose tolerance prevalence between rural and urban groups or between Melaneslans and Indians. The age-standardized prevalence of diabetes in the rural Melanesian male population was one-third that of the urban male population (1.1 vs. 3.5%). In females, there was a sixfold rural-urban difference (1.2 vs. 7.1%). By contrast, rural and urban Indians had similar rates (12.1 vs. 12.9% for males; 11.3 vs. 11.0% for females). Standardization of two-hour plasma glucose for age and obesity did not eliminate the rural-urban difference in plasma glucose concentration for Melaneslan males and females. The results in Melaneslans confirm previously reported rural-urban diabetes prevalence differences, and suggest that factors other than obesity, such as differences in physical activity, diet, stress, or other, as yet undetermined, factors contribute to this difference. The absence of a rural-urban difference in diabetes prevalence in Indians may suggest that genetic factors are more Important for producing diabetes in this ethnic group, or that causative environmental factors such as diet operate similarly upon both the rural and the urban populations.
Article
A survey of noncommunicable diseases (NCD) in the Pacific island population of Western Samoa in 1978 (n = 1,206) documented a relatively high prevalence of non-insulin-dependent diabetes mellitus (NIDDM) and obesity. A follow-up survey was performed in 1991 (n = 1,776) to assess changes in NCD prevalence and risk factor distribution over 13 years. In both surveys, the same representative villages from one urban and two rural areas were studied, and the survey procedure included an oral glucose tolerance test, anthropometric and blood pressure measurements, and physical activity assessment (1991 only). The age-standardized prevalence of NIDDM in 1991 was 9.5 and 13.4% in Apia (urban) for men and women, respectively. In Poutasi (rural), 5.3% of men and 5.6% of women had NIDDM, and in Tuasivi (rural) the prevalence was 7.0 and 7.5% for men and women, respectively. Age, body mass index (BMI), waist-to-hip circumference ratio, physical inactivity, and family history of diabetes all showed independent association with NIDDM and impaired glucose tolerance. Living in Apia (compared with Poutasi) was also associated with NIDDM. Between 1978 and 1991, the age-standardized prevalence of NIDDM in Apia increased from 8.1 to 9.5% in men and 8.2 to 13.4% in women. In Poutasi, a dramatic increase occurred in prevalence from 0.1 to 5.3% in men, but little change in women was noted (5.4 to 5.6%). In Tuasivi, the increases were 2.3 to 7.0% in men and 4.4 to 7.5% in women. In combined survey areas, increases were observed in the age-standardized prevalence of obesity and mean levels of total cholesterol, fasting triglycerides, and uric acid between surveys as well as a reduction in the prevalence of smoking. This is the first study using standardized methods to show a dramatic increase in the prevalence of NIDDM in a developing Pacific island population, and it indicates the importance of maintaining and expanding preventive programs for NIDDM and related lifestyle diseases in these populations.
Article
To determine the prevalence of diabetes and its relationship to age and obesity in an urban community in Colombia. A cluster sample of 670 adults > or = 30 yr of age was selected from the city of Santafé de Bogotá. Classification of diabetes and IGT was according to WHO criteria. Response to the survey, conducted in 1988-1989, was 71% for men and 84% for women. Prevalence of diabetes was 7% in both sexes. Prevalence of IGT was 5% in men and 7% in women. Age-standardized prevalence of diabetes in the 30- to 64-yr age range was comparable with that reported in urban Brazilians and rural Hispanics in the U.S.. Prevalence was higher than in the white population of the U.S. but lower than in several urban U.S. Hispanic communities. Some 40% of men and 30% of women with diabetes were unaware of their condition before the survey, but all those < 50 yr of age were diagnosed previously. Glucose intolerance was associated with high BMI in men and with advancing age in both sexes. Glucose intolerance is common in this community and will likely increase in frequency in Colombians with further urbanization and population aging.