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Diabetes and its drivers: The largest epidemic in human history?

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The “Diabesity” epidemic (obesity and type 2 diabetes) is likely to be the biggest epidemic in human history. Diabetes has been seriously underrated as a global public health issue and the world can no longer ignore “the rise and rise” of type 2 diabetes. Currently, most of the national and global diabetes estimates come from the IDF Atlas. These estimates have significant limitations from a public health perspective. It is apparent that the IDF have consistently underestimated the global burden. More reliable estimates of the future burden of diabetes are urgently needed. To prevent type 2 diabetes, a better understanding of the drivers of the epidemic is needed. While for years, there has been comprehensive attention to the “traditional” risk factors for type 2 diabetes i.e., genes, lifestyle and behavioral change, the spotlight is turning to the impact of the intra-uterine environment and epigenetics on future risk in adult life. It highlights the urgency for discovering novel approaches to prevention focusing on maternal and child health. Diabetes risk through epigenetic changes can be transmitted inter-generationally thus creating a vicious cycle that will continue to feed the diabetes epidemic. History provides important lessons and there are lessons to learn from major catastrophic events such as the Dutch Winter Hunger and Chinese famines. The Chinese famine may have been the trigger for what may be viewed as a diabetes “avalanche” many decades later. The drivers of the epidemic are indeed genes and environment but they are now joined by deleterious early life events. Looking to the future there is the potential scenario of future new “hot spots” for type 2 diabetes in regions e.g., the Horn of Africa, now experiencing droughts and famine. This is likely to occur should improved economic and living conditions occur over the next few decades. Type 2 diabetes will remain one of the greatest challenges to human health for many years to come.
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C O M M E N T A R Y Open Access
Diabetes and its drivers: the largest
epidemic in human history?
Paul Z. Zimmet
Abstract
The Diabesityepidemic (obesity and type 2 diabetes) is likely to be the biggest epidemic in human history.
Diabetes has been seriously underrated as a global public health issue and the world can no longer ignore the rise
and riseof type 2 diabetes. Currently, most of the national and global diabetes estimates come from the IDF Atlas.
These estimates have significant limitations from a public health perspective. It is apparent that the IDF have
consistently underestimated the global burden. More reliable estimates of the future burden of diabetes are
urgently needed.
To prevent type 2 diabetes, a better understanding of the drivers of the epidemic is needed. While for years, there has
been comprehensive attention to the traditionalrisk factors for type 2 diabetes i.e., genes, lifestyle and behavioral
change, the spotlight is turning to the impact of the intra-uterine environment and epigenetics on future risk in adult
life. It highlights the urgency for discovering novel approaches to prevention focusing on maternal and child health.
Diabetes risk through epigenetic changes can be transmitted inter-generationally thus creating a vicious cycle that will
continue to feed the diabetes epidemic. History provides important lessons and there are lessons to learn from major
catastrophic events such as the Dutch Winter Hunger and Chinese famines. The Chinese famine may have been the
trigger for what may be viewed as a diabetes avalanchemany decades later. The drivers of the epidemic are indeed
genes and environment but they are now joined by deleterious early life events. Looking to the future there is the
potential scenario of future new hot spotsfor type 2 diabetes in regions e.g., the Horn of Africa, now experiencing
droughts and famine. This is likely to occur should improved economic and living conditions occur over the next few
decades. Type 2 diabetes will remain one of the greatest challenges to human health for many years to come.
Keywords: Global diabetes epidemic, Drivers for diabetes, Epigenetics and diabetes
Background
In this lecture honoring Professor Stefan S. Fajans of the
University of Michigan, I am going to address four major
topics related to diabetes:
[a]Statistics about the global diabetes epidemic : facts
and fallacies;
[b]Epidemiological data about the diabetes epidemic:
secular rises and falls;
[c]The drivers of the type 2 diabetes epidemic; and
[d]Epigenetics and early life exposure of the fetus that
may influence the risk of diabetes in adult life.
The Black Death was one of the most devastating pan-
demics in human history, killing as much as 20% of the
worlds population in the 14th century [1]. But that was
then. In the 21st century, the question may be asked, is
type 2 diabetes the biggest epidemic in history? I believe
it is a much bigger epidemic than the Black Death and
in this talk I will try to prove it to you.
Statistics about the global diabetes epidemic: facts and
fallacies
The International Diabetes Federation (IDF) has asked a
very simple question, if you look at the worlds most
populous countries, where would diabetes fit? Numeric-
ally diabetes, if it were a nation, would surpass the
United States as the third most populated country in the
world. While there are approximately 320 million people
in the U.S., there are now 415 million people in the
Correspondence: Paul.Zimmet@bakeridi.edu.au
Monash University & Baker IDI Heart and Diabetes Institute, Melbourne, VIC,
Australia
© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Zimmet Clinical Diabetes and Endocrinology (2017) 3:1
DOI 10.1186/s40842-016-0039-3
world with diabetes according to the IDF [2]. This is
clear evidence to suggest that we have a major global
problem with type 2 diabetes.
The IDF has attempted to create awareness of the im-
portance of type 2 diabetes. In the year 2000, IDF esti-
mated there were 151 million people with diabetes
globally and predicted that by 2030, there would be 324
million people in the world with diabetes [3]. The World
Health Organization (WHO) also estimated the global
prevalence of diabetes in 2000 and 2030171 million
people with diabetes in 2000 and 366 million by 2030 [4].
They were terribly wrong, because by 2015 there were
already 415 million people with diabetes, far above what
was predicted in 2000 for 30 years later. And the situation
may even be worse than that. To perform its global pro-
jections, the IDF estimates how many people have dia-
betes in each country. If a country does not have data
about diabetes prevalence, the IDF extrapolates from an-
other country using regional data [3] or match geography,
World Bank income, ethnicity and language [2]. These ex-
trapolations are less reliable. If anything, the current IDF
estimates are still a quite serious underestimate.
This issue is of more than academic interest because
young researchers in epidemiology may think the IDF and
WHO data are gospel. Unfortunately, they may represent a
quick grab of data that go out for public relations purposes
and not necessarily for public health benefit and planning.
In 1978, a Kroc Foundation International Conference
on Epidemiology of Diabetes and Its Macrovascular Com-
plications was held in Santa Ynez Valley, California.
Attendees included Kelly West, Peter Bennett, Harry Keen
and other legendary figures in diabetes epidemiology. I
was also there, though as a buddingepidemiologist! The
Santa Ynez Valley meeting produced a classification of dia-
betes, diagnostic criteria, and proper protocols for diabetes
epidemiology studies [5], so if a study was done in Japan,
it would be comparable to one performed in the United
States. This heritage of consensus and standardization has
been lost of late because of the practice of the IDF and
WHO and indeed the Global Burden of Disease Group [6]
and others to publish data which underestimate the bur-
den of diabetes and, if used for public health purposes,
probably underestimate the resources required to attack
the epidemic. So we have issued a word of caution and
hopefully the word will get out [6].
The WHO is at least, in part, at fault in this, as they
support the STEPS program which diagnoses diabetes
based on the fasting glucose level alone [7]. Notably,
Stefan Fajans and Jerome Conn did not even include the
fasting glucose in their criteria for the oral glucose toler-
ance test [8]. Whether they were wise or it was an over-
sight on their part, I cannot say, but we know the
measurement of fasting glucose alone underestimates the
prevalence of diabetes by 2025% [9].
If epidemiologists of policy makers use country-
specific estimates provided by IDF or WHO for their
planning, they should carefully examine the appropriate-
ness of any extrapolation of data from one country to
another and evaluate the criteria used to diagnose dia-
betes. Inappropriate extrapolations and reliance on fast-
ing glucose alone may substantially bias country-specific
estimates and adversely impact planning.
Another issue demonstrates the problems researchers
have in getting access to primary data sources, especially
from the WHO [10]. WHO has historically not released
key information related to diabetes and other non-com-
municable diseases that are vital for public health. We need
a lot more transparency from major organizations in help-
ing both researchers and decision makers to understand the
true burden of diabetes, and that involves access to the pri-
mary data. These are the barriers that we are trying to ad-
dress now. We should not be using the data put out by
WHO or the IDF or even the Global Burden of Disease
Research Group [6, 11] uncritically when it comes to public
health planning in any country, even the United States.
Epidemiological data about the diabetes epidemic:
secular rises and falls
So what about this epidemic of diabetes? I started my dia-
betes epidemiology activities in the Pacific [12] and, later
on, the Indian Ocean island of Mauritius [13]. The inspir-
ation for me to get into diabetes research came from the
early studies of Ian Prior, a famous cardiovascular epi-
demiologist who, in the mid-1960s, published information
about high rates of diabetes in Polynesians living in New
Zealand and the Pacific islands [14]. In 1975, I was in
London training at Guys Hospital and it was Christmas. It
was snowing and cold and no one came to work. I was
sitting there by myself and I picked up an old British Med-
ical Journal and read about Ian Priors research showing
high rates of diabetes in Polynesians. Subsequently Peter
Bennett showed that Pima Indians living in Arizona had
the highest prevalence of diabetes in any community in the
world [15]. There was also a study in Australia showing
how indigenous people have high rates of diabetes [16]. So
when I returned to Australia from London, I decided to in-
vestigate the issue of diabetes in Pacific Island populations.
Our group sweptthrough the Pacific and found
some of the highest rates of diabetes that had ever been
reported [12]. This was a warning to me that we were
going to face a diabetes epidemic. Indeed when we did
our first Pacific survey in Nauru in 1975, we found a
high rate of diabetes 34.4% in individuals >15 years
old [17]. Peter Bennett had reported that >50% of the
adult Pima Indian population over the age of 35 years had
diabetes [15]. There was clearly a warning there, and
indeed, our Melbourne daily newspaper, The Age, pub-
lished a warning about diabetes as The Western Killer in
Zimmet Clinical Diabetes and Endocrinology (2017) 3:1 Page 2 of 8
Paradise.Unfortunately, they put my photograph under
the headline and it almost killed the point of the story!
After our group showed very high rates of diabetes in
the Pacific, the WHO asked me to go to Mauritius to have
a look at the diabetes problem there as there were some
indications that diabetes was becoming a problem on that
beautiful and idyllic Indian Ocean Island. It was important
to understand diabetes in Mauritius because although it
had a relatively small population of 1.2 million, the popu-
lation represented three major ethnic groups: Asian
Indians from India, Creole- South African Black popula-
tion, and Chinese people [13]. Together, these three ethnic
groups represent approximately two-thirds of the worlds
population. Whatever was happening in Mauritius could
be extrapolated to other countries where there were
Indian, Chinese and Creole or Black populations.
With a team including Sir George Alberti, a great bio-
chemist; Jaakko Tuomilehto, whose name is synonymous
with the prevention of type 2 diabetes; my colleagues
from Australia, Jonathan Shaw and Dianna Magliano;
and Sudhirsen Kowlessur from Mauritius, we have sur-
veyed the population of Mauritius every 5 years or so
from 1987 to 2015. Figure 1 shows data from Mauritius
from the first study in 1987 to the most recent published
study from 2009 [18, 19]. As you can see, the prevalence
of diabetes went from 14.6 to 23.6%, a 62% increase over
20 years (Fig. 1a). The pattern was very similar in each
ethnic group. Based on these data, we concluded that we
were facing a global epidemic of type 2 diabetes, especially
in countries such as China and India.
This has now been borne out. In India there has been
an increase of nearly 5% (absolute) in diabetes prevalence
between the years 2000 and 2006 [20] (Fig. 1b). India now
has 8090 million people with diabetes. In India and in
many middle and low-income countries, there are simply
not the resources to manage diabetes. In 1980, less than
1% of Chinese population had diabetes. In Beijing, the
McDonalds restaurant in Tiananmen Square was one of
the busiest McDonald franchise in the world (Fig. 2). Now
the estimate of diabetes prevalence in China is 9.7% [21]
(Fig. 1c). A study from Turkey has also documented an in-
credible 90% increase in diabetes prevalence over 11 years
from 2002 to 2013 [22].
Indigenous populations are disproportionately affected
by diabetes and its complications. In Australia, Indigenous
populations residing in the Northern Territory have one
of the highest rates of diabetes in the world and certainly
among Indigenous communities [23]. Indigenous people
in Australia have a 4-fold higher diabetes prevalence com-
pared to the general Australian, mainly European popula-
tion. They also have the one of the highest rates of end-
stage renal disease in the world [24]. Alice Springs, in the
center of Australia and the home to a large Indigenous
population, has the largest kidney dialysis unit in the
southern hemisphere per capita, another reflection of the
impact of diabetes [25]. Diabetes also impacts survival.
The prevalence of diabetes falls off in the Indigenous
population over 64 years of age, not because there is a de-
crease in the incidence of diabetes, but because of higher
mortality in those with diabetes in that age category. [26].
The drivers of the type 2 diabetes epidemic (Table 1)
In indigenous communities in Australia, as in the US
and Canada, it is very important to understand the atti-
tudes of affected people before trying to prevent or manage
diabetes. We have a westernview that diabetes is caused
by bad behavior, too much sugary drinks, and eating too
much. Obesity and not enough exercise are the culprits. In
contrast, the Indigenous people of Australia have lost their
Fig. 1 The Increase in Diabetes Prevalence in aMauritius Adapted from
[18, 19], bIndia Adapted from [20], and cChina Adapted from [21]
Zimmet Clinical Diabetes and Endocrinology (2017) 3:1 Page 3 of 8
lands, are in disharmony with other communities, suffer
from poverty and other external pressures (Table 2). Rec-
ognizing and addressing these issues is one of the greatest
challenges we have in trying to prevent diabetes in the
communities of Australia that have the highest rates.
There are clear links among lifestyle, inactivity, ageing, obes-
ity, and modernization, that contribute to diabetes. Between
1980, when the first diabetes study was done in Australia, and
2000, the prevalence of obesity almost tripled and the preva-
lence of diabetes increased from 2.4 to 7.2% [27] (Fig. 3). If
Fig. 2 Coca-colonizationin China and India. aMcDonald's in China bCoca-cola in India
Table 1 Reported drivers of diabetes
Lifestyle
Inactivity
Caloric excess
Obesity
Ageing
Modernization
Fetal Programming
Table 2 Indigenous communities: drivers of type 2 diabetes
Westernview Indigenous view
Bad behaviors Dispossession of lands
Bad choices Disharmony/Imbalance
Lazy Poverty
Obesity Socio-cultural change
Toxicexternal pressures
Transgenerational trauma
With permission from Professor Alex Brown
Zimmet Clinical Diabetes and Endocrinology (2017) 3:1 Page 4 of 8
you look at the incidence of diabetes in the Australian
cohort from the year 2000, there was a 4-fold difference
in risk of developing diabetes between people who were
obese and those who were of normal weight [28].
Almost two-thirds of the Australian population in 2000
was overweight or obese, close to the rates of over-
weight and obesity in Americans.
So far, Ive given you all the bad news about the epidemic
of diabetes. The question is, are there any studies that show
that the prevalence of diabetes is actually falling? Some re-
cent data from the United States now suggest there might
be a leveling off of obesity and diabetes [29]. Theressome
debate as to why this may be happening; whether it is due
to improved public awareness or whether everyone who is
going to get diabetes already has it. In Nauru in 1994, the
prevalence of diabetes was approximately 50%. In a subse-
quent study about 10 years later, the rate had fallen [30].
Over the same time period, Nauru went from being the
wealthiest country in the world per capita (due to rich
phosphate deposits) to one of the poorest countries in the
world. So the decline in prevalence could have been an
effect of the economic collapse. Another study reported in
the British Medical Journal found that during an economic
crisis in Cuba, there was a decrease in obesity and a de-
crease in diabetes incidence and deaths from diabetes [31].
So theressomeevidencethateconomichardshipmaybe
the best way to prevent diabetes!
The prevention of type 2 diabetes is a major global
public health challenge that we now face. Over 20 years
ago, a study by the late Hilary King, an adventurous
young epidemiologist, found a 4% diabetes prevalence
on a small Island off of the coast of Papua New Guinea
[32]. This was quite high for Papua New Guinea. We
considered doing a prevention study there, but an earth-
quake occurred and the whole island disappeared. I did
not think it was a good way to prevent diabetes, but it
solved the problem there!
In 1982, Kerin ODea, one of our very well-known
Australian diabetes investigators, took a group of Indigen-
ous bush people for 7 weeks to live using traditional foods,
such as crocodile, kangaroo and native plants [33]. They
lost weight and their glucose tolerance, insulin sensitivity,
blood lipids, and blood pressure all improved (Table 3).
This was one of the first demonstrations that if you return
to a traditional lifestyle, you can reverse not just diabetes
but other components of the metabolic syndrome. These
results were extended by others including the classic study
of Jaakko Tuomilehto, the Finnish Diabetes Prevention
Study [34]. He observed a reduction of 58% in the risk of
progression to type 2 diabetes; this now seems to be an
accepted outcome now among persons at high-risk people
of diabetes.
Epigenetics and risk for diabetes
Although I have always been a strong believer in the
CocaColonizationstory, a term suggested by Arthur
Koestler [35], that changes of lifestyle in rural and trad-
itional island populations have caused the epidemics of
obesity and diabetes, I think there are emerging data that
Fig. 3 Prevalence of Diabetes and Obesity in Australia 1980/81 and 1999/2000 Adapted from [27, 28]
Table 3 Impact of 7 weeks of Back to Traditional Hunter
Gatherer Lifestyle Change in Australian Aborigines on type 2
diabetes
Weight loss
Striking improvement in glucose tolerance
Improved insulin response
Normalization of blood lipids
Reduction in blood pressure
Adapted from [33]
Zimmet Clinical Diabetes and Endocrinology (2017) 3:1 Page 5 of 8
suggest we need to rethink the story and consider the im-
pact of epigenetics. In 1990, David J. P. Barker first pro-
posed that in utero metabolic adaptation defines a
trajectory of growth that prepares the fetus for its likely
adult environment [36]. What happens in utero to the
fetus depends on the mothers and the fathersbehaviors
before conception and the mothers during pregnancy.
The story goes back to the Dutch winter famine [37]. At
the end of World War 2, there was a famine during the
Nazi Germany occupation of Holland. Women who were
pregnant were on very poor diets. Some 30 years later,
researchers looked to see what happened to the children
who were born at that time. They found high rates of
diabetes, obesity, hypertension, and indeed some mental
disorders like schizophrenia in the offspring of women
who were undernourished during early pregnancy. This
raised the issue of the famine and what happened many
years later when these children became adults. Their risks
of chronic diseases were increased.
Another example occurred during the Chinese famine
of 19581962 [38]. There was virtually minimal diabetes
in China before 1980 [39]. Some 3040 years after that
famine, there are now over 120 million Chinese with
diabetes [40]. Again, this raises a question of the role of
a famine and the effect of the famine on children ex-
posed to intrauterine undernutrition. In very simple
terms, epigenetics reflects not a change in the genes of
the fetus, but a change in the DNA around the genes.
That DNA influences how the gene reacts with potential
environmental risk factors including those noted in the
figure (Fig. 4). This can also happen to children born
during a famine so that 2030 years later, when they
come into an obesogenic environment, they get diabetes.
This is just an example of some of the risk factors that
can influence in utero this process and its been well
demonstrated in animal studies that this happens. All of
the data so far in humans is retrospective, but there is
now a prospective study in Singapore led by Professor
Sir Peter Gluckman, to assess the impact of epigenetics
at a human level [41]. What is also interesting is that
diabetes itself is one of the many factors that can cause
epigenetic changes. We know that mothers with pre-ges-
tational diabetes and mothers with gestational diabetes are
more likely to have offspring who are either obese or have
diabetes. And the epigenetic effect appears to be
intergenerational. It means you could have a vicious cycle
perpetuating the diabetes epidemic. Gluckman and
Hansen have authored a book, Mismatch [42], suggest-
ing that a baby born in a famine situation expects to
come out into the famine, but may arrive into an obeso-
genic environment. I have tried to make this phenomenon
a little clearer by pointing out that with undernutrition in
pregnancy, the adaptation is to expect a scarce resource
Fig. 4 Developmental plasticity, fetal programming and
intergenerational risk
Fig. 5 Mismatch: The relevance for prevention of type 2 diabetes
Zimmet Clinical Diabetes and Endocrinology (2017) 3:1 Page 6 of 8
environment. If the expectation is not met because the
baby arrives to an obesogenic environment, we may see
both early changes in the child, and an increased risk of
obesity, diabetes, and heart disease in adult life (Fig. 5).
I think this is a real story. Higher rates of diabetes also
may be linked to famine situations that occurred in the
Ukraine (19321933) [43] and in Cambodia (197579)
[44, 45]. We now have a famine in the Horn of Africa.
This raises very important issues as to how the United
Nations (UN), the WHO, and the UN Development
Program and other NGOs handle food relief during and
after a famine. These may be very important aspects of
preventing diabetes in communities many, many years
hence. So finally the message is out to be very wary of
national and international predictions of this diabetes
epidemic. We need to be looking more closely at mater-
nal and child health, and the whole issue of early devel-
opment in utero to reduce the risk to future generations.
The next epidemic may occur in countries in the Horn
of Africa if we do not pay attention to the correct way of
handling the nutritional and social issues particularly
with aid and food supplies.
Conclusion
The Diabesityepidemic (obesity and type 2 diabetes) is
likely to be the biggest epidemic in human history.
Diabetes has been seriously underrated as a global public
health issue and the world can no longer ignore the rise
and riseof type 2 diabetes. Currently, most of the
national and global diabetes estimates come from the
IDF Atlas. These estimates have significant limitations
from a public health perspective. It is apparent that the
IDF have consistently underestimated the global burden.
More reliable estimates of the future burden of diabetes
are urgently needed. To prevent type 2 diabetes, a better
understanding of the drivers of the epidemic is needed.
While for years, there has been comprehensive attention
to the traditionalrisk factors for type 2 diabetes i.e.,
genes, lifestyle and behavioral change, the spotlight is
turning to the impact of the intra-uterine environment
and epigenetics on future risk in adult life. It highlights
the urgency for discovering novel approaches to preven-
tion focusing on maternal and child health. Diabetes risk
through epigenetic changes can be transmitted inter-
generationally thus creating a vicious cycle that will con-
tinue to feed the diabetes epidemic. Yes, diabetes is the
greatest epidemic in human history. It has affected the
greatest numbers, it has had the greatest cost [46], and it
is not over yet.
Abbreviations
IDF: International Diabetes Federation; STEPS: STEPwise approach to
Surveillance; UN: United Nations; US: United States; WHO: World Health
Organization
Acknowledgements
I want to acknowledge collaborators who we have worked with on these
projects: [1] Baker IDI and key collaborators include Jonathan Shaw, Sir
George Alberti, Jaako Tuomilehto, Dianna Magliano, David Dunstan, Stefan
Soderberg, Merlin Thomas and William Herman. [2] Mauritius collaborators
include Sudhir Kowlessur, Pierrot Chitson, N Gopee and V Pauvaday.
I also wish to acknowledge my wife Vivien, my biggest supporter through all
these years dedicated to the cause of diabetes. I would also like to
acknowledge the support of our two sons, Hendrik and Marcel, who now
are contributing so much in medicine- in Heart Failure Cardiology and Fetal
Alcohol Syndrome Disorders, respectively.
This paper is adapted from the Stefan S Fajans Lecture delivered at
University of Michigan, Ann Arbor, on May 13, 2016 by Professor Zimmet.
Funding
N/A.
Availability of data and materials
N/A.
Authorscontributions
PZ prepared and delivered the 2016 Fajans lecture after which he adapted it
into a paper. PZ read and approved the final manuscript.
Authorsinformation
Professor Zimmet is Professor of Diabetes at Monash University, and former
Emeritus Director of Baker IDI Heart and Diabetes Institute in Melbourne,
Australia. He is an Honorary President of the International Diabetes
Federation.
Competing interests
None.
Consent for publication
N/A.
Ethics approval and consent to participate
N/A.
Received: 13 September 2016 Accepted: 30 November 2016
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Zimmet Clinical Diabetes and Endocrinology (2017) 3:1 Page 8 of 8
... These recent developments have resulted in diabetes being listed as one of the top four noncommunicable diseases of the twenty-first century. 1 Being the most common type of diabetes, type 2 diabetes mellitus currently accounts for over 90% of all diabetes cases worldwide. [3][4][5] Though commonly associated with ageing and older adults, the disease is gradually becoming pervasive among young adults and adolescents, 5,6 which, according to Aranda 7 and Arnett et al., 8 is as a result of physical inactivity, poor eating habits and obesity. Even though the health disorder is a global phenomenon, Thomas et al. 9 noted that it is gradually becoming predominant in developing countries, particularly those in Africa and Asia. ...
... 2 Given that, in 2019, only US$ 9 billion was allocated to combating the disease on the African continent (which is equivalent to just 1% of the total health expenditure for the 2019 financial year), the scientific community foresees a gloomy future for the disease in Africa. 4,[11][12][13] It has therefore become imperative that unprecedented actions are taken by member countries and the international community, to ensure that the continent is freed from the burden of this deadly disease. According to the IDF, 5 a victory over the surge of type 2 diabetes on the African continent will be a great milestone towards achieving sustainable development goal (SDG) 3 by end-of-year 2030. ...
... A significant rise in the incidence of metabolic syndrome, i.e. obesity, insulin resistance and dyslipidemia, has amounted to the presumption of epidemic proportions for type 2 or insulin resistant diabetes mellitus. Diabetes mellitus (DM), now emerges as one of the biggest threats in the 21st century affecting approximately 400 million people round the globe [1]. It is the world's most prevalent non-communicable disease and is placed to be the leading cause of death in developed countries [2]. ...
Article
Full-text available
Aim: To study the independent effect of insulin resistance on LVM in the elderly normotensive population. Methods: The study included 50 subjects excluding patients with myocardial infarction, heart failure, systemic hypertension and aortic stenosis. Group I included 30 patients with glucose intolerance, insulin resistance, or type 2 DM while Group II included 20 control subjects of matched age and sex. Participants involved in the study underwent clinical examination, laboratory investigation (including 75-g oral glucose tolerance test, HbA1c, Plasma insulin level, calculated HOMA-IR, Fasting Lipid profile, Serum albumin/creatinine ratio) and echocardiography. Results: LV mass index was significantly different between the 2 group being higher (142.07±53.34) in the study group compared to (92.05±9.42) in the control group, (P=0.000). Waist circumference, HOMA-IR, FBS, HbA1c and systolic BP have significant positive correlations with LV mass index. However, only HOMA-IR has a significant independent positive correlation with LV mass index. Conclusion: It is inferred from the present study that insulin resistance is associated with increased cardiac mass in normotensive elderly people.
... The number of people with DM will increase from ∼415 million today up to 550 million by 2030, but the situation may get even worse [399]. Despite significant advantages in the management strategies that lessen atherosclerotic CVD risk factors, CVD has remained the leading cause of morbidity and mortality in patients with T2DM. ...
... Far too many people continue to smoke, even when they have established cardiovascular disease. The incidence of obesity, metabolic syndrome, and diabetes continue to rise throughout the world [14]. Despite the availability of antiglycemic medications that impact risk for atherosclerotic cardiovascular disease related events, heart failure admission to hospital, and cardiovascular mortality, these medications have very limited penetration in clinical practice and their benefits are largely unknown or unappreciated by most clinicians. ...
... For instance, in the United States, 10.5% of the population was diabetic in 2018 (5). The rapid growth of diabetic cases across the world has made them an epidemic, levying heavy social and medical burdens (6). ...
Article
Full-text available
Background Diabetes is one of the most common comorbidities in COVID-19 patients that pertains to disease severity, but the causal mechanism regarding its negative impact on COVID-19 outcome has yet been uncovered. Methods We retrospectively analyzed 459 COVID-19 patients admitted in early 2020 and 336 COVID-19 patients admitted in August 2021, with their demographic information, medical history, vaccination status (if applied), and laboratory data reported. Results Among COVID-19 patients, compared to the non-diabetic group, the diabetic group exhibited elder age, higher proportion of patients with other major comorbidities, more severe dysfunction of innate immune cells, more refractory blood coagulopathy and more detrimental organ damage. For the wild-type SARS-CoV-2 infection, diabetic comorbidity was associated with COVID-19 severity but not mortality, and the glycemic levels in the non-diabetic group upon infection experienced high and analogous to those in the diabetic group. Besides, infected by the delta variant of SARS-CoV-2, the non-diabetic patients did not demonstrate hyperglycemia, and despite different vaccination statuses, the diabetic patients exhibited comparable antibody responses to non-diabetic, showing the robustness of acquired immunity. Conclusions SARS-CoV-2 infection may superimpose the deterioration of innate immune systems in diabetic patients, which contributes to their worsened disease outcome, but timely COVID-19 immunization could provide adequate protection in diabetic population that leads to favored prognosis.
... For more than a century, since the discovery of insulin in 1921, the treatment of T1D has relied on ensuring an external supply of this hormone to maintain a balanced glycemic level [3]. Since the late 20th century, there has been an upward trend in the number of new cases of T1D diagnosed in children and adolescents [4]. ...
Article
Full-text available
Type 1 diabetes mellitus (T1D) is, next to obesity and asthma, the most common chronic disease in children in Poland. The results of T1D treatment strongly depend on the patient’s compliance with therapeutic recommendations, which entails the use of necessary health services. Based on a retrospective analysis of the data on health services provided in 2016–2020 to over 15.5 thousand patients with T1D in Poland, we assessed the compliance of the actual model of treatment of T1D in children with the current guidelines. It was found that only about 50% of patients received the number of diabetes consultations corresponding to the recognized standards, with about 15% of children with T1D remaining outside the public healthcare system. In the case of many outpatient services (ophthalmological, neurological, mental health), the number of consultations was extremely low—one order of magnitude lower than in general population and dropped even lower in 2020. This shows that the health needs of children with T1D are not being met within the public healthcare system. The COVID-19 pandemic caused significant limitations in access to healthcare in Poland. Compared to the pre-pandemic period there was a significant decrease (−27% compared to 2019) in the number of hospitalizations, and a substantial increase (+22% compared to 2019) in the number of diabetic ketoacidoses (DKA) cases. The proportion of hospitalizations caused by DKA rose to 8.9% compared to 7.3% in 2019.
... Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both (American Diabetes Association, 2010). The global prevalence of diabetes is very high as there were nearly 415 million people were affected with diabetes in 2015 (Zimmet, 2017). Diabetes patients have an enhanced incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease along with hypertension and abnormalities of lipoprotein metabolism. ...
Article
The interim results of the large, multinational trials on coronavirus disease 2019 (COVID‐19) using a combination of antiviral drugs appear to have little to no effect on the 28‐day mortality or the in‐hospital course. Therefore, there is a still vivid interest in finding alternate re‐purposed drugs and nutrition supplements, which can halt or slow the disease severity. We review here the multiple preclinical studies, partially supported by clinical evidence showing the quercetin's possible therapeutic/prophylaxis efficacy against severe acute respiratory syndrome coronavirus (SARS‐CoV) as well as comorbidities like chronic obstructive pulmonary disease (COPD), diabetes mellitus, obesity, coagulopathy, and hypertension. Currently, 14 interventional clinical trials are underway assessing the efficacy of quercetin along with other antiviral drugs/nutritional supplements as prophylaxis/treatment option against COVID‐19. The present review is tempting to suggest that, based on circumstantial scientific evidence and preliminary clinical data, the flavonoid quercetin can ameliorate COVID‐19 infection and symptoms acting in concert on two parallel and independent paths: inhibiting key factors responsible for SARS‐CoV‐2 infections and mitigating the clinical manifestations of the disease in patients with comorbid conditions. Despite the broad therapeutic properties of quercetin, further high power randomized clinical trials are needed to firmly establish its clinical efficacy against COVID‐19.
... Diabetes is a global public health issue (1). According to published results, 1 in 11 adults had diabetes worldwide in 2015, and the diabetic population will increase to 642 million by 2040 (2)(3)(4). ...
Article
Full-text available
Diabetic retinopathy (DR) is an important complication with a high incidence of 34.6% in the diabetic populations. DR could finally lead to vision impairment without effective interventions, during which, diabetic macular edema (DME) is a key phase causing visual loss. Up to date, antivascular endothelial growth factor (anti-VEGF) therapy is the first-line treatment for DME which has achieved relatively better clinical outcomes than traditional treatments. However, there are several kinds of anti-VEGF medicines, and patients are sensitive to different anti-VEGF treatments. In addition, its effectiveness is unstable. Considering the patients’ need to accept continual anti-VEGF treatments and its price is comparatively high, it is clinically important to predict the prognosis after different anti-VEGF treatments. In our research, we used the demographic and clinical data of 254 DME patients and 2,763 optical coherence tomography (OCT) images from three countries to predict the fundus structural and functional parameters and treatment plan in 6 months after different anti-VEGF treatments. Eight baseline features combined with 11 models were applied to conduct seven prediction tasks. Accuracy (ACC), the area under curve (AUC), mean absolute error (MAE), and mean square error (MSE) were respectively used to evaluate the classification and regression tasks. The ACC and AUC of structural predictions of retinal pigment epithelial detachment were close to 1.000. The MAE and MSE of visual acuity predictions were nearly 0.3 to 0.4 logMAR. The ACC of treatment plan regarding continuous injection was approaching 70%. Our research has achieved great performance in the predictions of fundus structural and functional parameters as well as treatment plan, which can help ophthalmologists improve the treatment compliance of DME patients.
... This means honey in the urine. Madhumeha was declared an ancient Ayurvedic scholar, KastaSadi (unwieldy), and even Asadija (unbearable) [7]. They have explained that all types of prameha (diabetes), if left or partially treated, convert into Kashtasadhya Madhumeha [difficult to treat diabetes, that is type 2 diabetes mellitus (T2DM)], and later on, if not treated properly, a period comes when it converts to Asadhya Madhumeha (incurable diabetes), i.e., type 1 diabetes mellitus (T1DM). ...
Chapter
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There has been a great interest of researchers in Vedic knowledge using the symbol of OM, and this word Om is considered to be the beginning and end of the past and future. Mr. Slogan's motive is a subtle understanding of the human body, mind, and the world of reality. Emotions, Thoughts and Beliefs in our lives are important characteristics. In accordance with the Indian philosophy, OM which is a spiritual symbol is also called Atman Brahman (reality, God, supreme soul, truth, cosmic principles, world, and knowledge). The research is a symbol of Global OM. The main aim of this research was to calculate the effects of Gayatri Mantra and Ohm readings on human health. The Gayatri Mantra is a very potential mantra mentioned in Rigveda. This research was performed on some patients (male = 4) and (female = 7) in the age range 44 to 70 years. All the patients were trained to read the Gayatri Mantra for 3 days. We used basic data. Participants at the Mantra Gayatri Meeting and Om Conference attended for approximately 15 minutes on two consecutive days. The order of meetings was randomly assigned to participants. This previous study showed that both Gayatri's mantra and comfort are of interest, as measured by Stormwork. However, Mantra Gayatri's work was much more numerous than Om's reading. The manuscript also provides an analysis of the well‐being index before and after the Yaina process and radiation analysis of various devices.
Preprint
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Individuals with prediabetes and type 2 diabetes mellitus (T2DM) have poor ability to adapt to diet-triggered perturbations. We investigated global metabolic responses to a mixed meal test (MMT) in morbidly obese individuals with different diabetic status by performing plasma metabolomic profiling. Abnormal metabolism of carbohydrates, (branched-chain) amino acids, fatty acids and acylcholines in individuals with (pre)diabetes was observed. Moreover, differences in metabolic responses were associated with altered fecal metagenomics and transcriptomes of liver, jejunum and adipose tissues, which revealed a modified gut microbiome and multi-tissue metabolism in individuals having insulin resistance. Finally, using integrative machine learning models, we built a predictive model based on metabolomics data after 2h MMT, and identified possible new biomarkers for glycemic control including N−acetylaspartate and phenylalanine-derived metabolites that may be useful for diagnosis, intervention and prevention of T2DM.
Book
We have built a world that no longer fits our bodies. Our genes - selected through our evolution - and the many processes by which our development is tuned within the womb, limit our capacity to adapt to the modern urban lifestyle. There is a mismatch. We are seeing the impact of this mismatch in the explosion of diabetes, heart disease and obesity. But it also has consequences in earlier puberty and old age. Bringing together the latest scientific research in evolutionary biology, development, medicine, anthropology and ecology, Peter Gluckman and Mark Hanson, argue that many of our problems as modern-day humans can be understood in terms of this fundamental and growing mismatch. It is an insight that we ignore at our peril.
Article
Diabetes mellitus is one of the most important public health challenges of the twenty-first century. Until the past decade, it has been seriously underrated as a global health threat. Major gaps exist in efforts to comprehend the burden nationally and globally, especially in developing nations, due to a lack of accurate data for monitoring and surveillance. Early attempts to obtain accurate data, discussed in this article, seem to have been cast aside so, at present, these needs remain unmet. Existing international efforts to assemble information fall far short of requirements. Current estimates are imprecise, only providing a rough picture, and probably underestimate the disease burden. The methodologies that are currently used, and that are discussed in this Perspectives article, are inadequate for providing a complete and accurate assessment of the prevalence of diabetes mellitus. International consensus on uniform standards and criteria for reporting national data on diabetes mellitus prevalence as well as for common complications of diabetes mellitus and mortality need to be developed.