THE GLOBAL BURDEN OF DIABETES

World Health Organization Geneva Switzerland

Values for diagnosis of diabetes mellitus and other categories of hyperglycaemia (WHO, 1999)
Venous plasma glucose concentration, mmol/l
Diabetes mellitus: Fasting or 2-h post 75g glucose load Impaired Glucose Tolerance (IGT): Fasting (if measured) and 2-h post 75g glucose load Impaired Fasting Glycaemia (IFG): Fasting and (if measured) 2-h post 75 glucose load

>= 7.0 (126 mg/dl) >= 11.1 (200 mg/dl)

< 7.0 (126 mg/dl) >= 7.8 and < 11.1 (140 mg/dl and 200 mg/dl)

>= 6.1 and < 7.0 (110 mg/dl and 126 mg/dl) < 7.8 (140 mg/dl)

Differences in diagnostic criteria of glucose intolerance

American Diabetes Association 1997 Only fasting glucose IFG replaces IGT World Health Organization 1999 Retains OGTT IFG & IGT are two distinct categories Whole blood and plasma glucose

Plasma glucose

HOW MANY PERSONS WITH DIABETES ARE THERE?

 Number of people with diabetes in 2000: ~171

million

Two thirds of all persons with diabetes live in the developing world In these countries, most of those who have diabetes are in economically active age groups.
Source: Wild et al, 2004

Global diabetes prevalence by age and sex

16

14

12 Pr ev ale 10 nc e of dia 8 be tes (% ) 6

Males Females

0 0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-70 70-74 75-79 80+

%
Es tm

10

6 4

Fo rm er so ce cE ur ia In d La tA me r ic a& Ca r ib re he ha rA bSa ra si a nA & fr ic sc I sl a st C Ea lei na dd Ot Su Ch Mi n co te

ar ke

Prevalence of diabetes in adults 20+ (%)

2030

2000

Number of persons with diabetes (millions)

400 350 300 250 200 150 100 50 0 Developed Developing World

2000

2030

Number of persons with diabetes (millions)

90 80 70 60 50 40 30 20 10 0
Est market Former ec soc.ec Eur India China Latin Amer&Car

2000 2030

Middle East

Other Asia&Isl

SubSaharan Afr

Number of persons with diabetes by age group, year and region

Developed countries
140 120 100 80 60 40 20 0

millions

2000 2030

20-44

45-64 age group (years)

65+

160 140 120 100 80 60 40 20 0 20-44

Developing countries
2000 2030

45-64

65+

Increase in the number of persons with diabetes in the world, 1995-2030 400 300
millions
366

171

200 100 0

135

1995

2000

2030

Highest numbers of estimated cases of diabetes for 2000 and 2030

Ranking 2000 Country 2030 Country

People with diabetes (millions)

1 2 3

India China United States of America Indonesia Japan Pakistan Russian Federation Brazil Italy Bangladesh

4 5 6 7 8 9 10

31.7 India 20.8 China United States of 17.7 America 8.4 Indonesia 6.8 Pakistan 5.2 Brazil 4.6 4.6 4.3 3.2 Bangladesh Japan Philippines Egypt

People with diabetes (millions) 79.4 42.3

30.3 21.3 13.9 11.3 11.1 8.9 7.8 6.7

% 10 12 0
ile

Ch Ch Cu E t yp t h io pia In I n dia do ne M si a ala T a y si a nz an T u ia rk Ur ey ug V i ua y et Na m Eg ba in a

Prevalence of diabetes in adults 20+ (%)

2000

2030

Number of persons with diabetes (millions Country

Chile China Cuba Egypt Ethiopia India Indonesia Malaysia Tanzania Turkey

Proxy
Brazil own data Brazil Jordan Sudan own data Singapore Singapore own data own data

2000
0.5 20.1 0.2 2.6 0.8 31.7 8.4 0.9 0.2 2.9

2030
1 42.3 0.5 6.7 1.8 79.4 21.2 2.5 0.6 6.4

WHY THE INCREASE IN DIABETES PREVALENCE?

IMPROVED SURVIVAL OF PERSONS WITH DIABETES?

Stvring et al, Lancet 2003

THE WORLD IS GETTING OLD

The world population is ageing

Population Pyramid in 1995 and 2025
Age
80+ 70-74 60-64 50-54 40-44 30-34 20-24 10-14 00-04

MALE

FEMALE

300

200

100

Millions

100

200

300

UN Population Division, 1998 Revision

Life expectancy at birth is increasing in all regions

90

Japan
80

70

Y ears

60

50

Sierra Leone

40

30 1950-55
Africa

1970-75
Asia
Europe

1990-95

2010-15

2030-35
Northern America

Latin America and Caribbean

Source: UN Population Division, 1998 Revision

The population in developing countries is fast increasing - particularly the aged

Population (in billion) Total More developed countries Less developed countries 65+ More developed countries Less developed countries 2000 6.0 1.2 4.7 0.4 0.2 0.2 2025 7.8 1.2 6.6 0.8 0.3 0.5 2050 8.9 1.2 7.8 1.5 0.3 1.2

THE WORLD IS GETTING FAT

Per capita food consumption (kcal per capita per day)

4000 kcal/capita/day 3500 3000 2500 2000 1500 196466 197476 198486 199799 2015 2030
World Developing countries Industrialized countries Transition i

Year
Adapted from Diet, Nutrition and the prevention of Chronic Diseases, WHO TRS 916, Geneva 2003

Trends in Obesity (BMI>30) Brazil 1974 -1996 20

18

Prevalence (%)

16 14 12 10 8 6 4 2 0
8.0 3.7 3.2 0.8

Urban, M Rural, M Urban, F Rural, F

12.9

13.0 10.1

7.3 5.7

8.1

1.2

2.6

1974

1989

1996
Source: WHO Global NCD Infobase

Prevalence of overweight overweight and obesity in Prevalence of and obesity in 10-year old girls and boys Prevalence of overweight and obesity in 10-year old girls and boys in selected countries. in and boys in selected countries. 10-year old girls selected countries.
Malta Italy USA Chile Australia Germany Venezuela Japan Singapore France UK Hungary Slovakia China Hong Kong Sweden Brazil Netherlands
40

Overweight girls Overweight boys

30

20

10

10

20

30

40

Africa & Middle East: 4 year olds Africa & Middle East: 4 year olds
Morocco Egypt Niger Nigeria Burkina Faso Cameroon Zambia
<5% 5-9.9% 10-14.9% 15-19.9% >25%

Senegal

Yemen
Uganda Kenya Rwanda Tanzania Madagascar Zimbabwe

Namibia

IOTF unpublished data

Odds ratios for diabetes with increasing weight (Must et al, 1999)
20 18 16 14 12 10 8 6 4 2 0

NHANES III, USA men

<55 years >=55 years

Odds ratio

25-29.9

30-34.9 35-39-9 Body mass index

40+

Duration of obesity and risk of Type 2 diabetes (Everhart al, 1992)

Annual incidence of diabetes 7 6 5 4 3 2 1 0 <5 years 5-10 years Duration of BMI>=30.0 >10 years

THE EARTH DOES NOT MOVE!

Physical inactivity in selected countries

50 45
46 36 28 Male Female 33

Age standardized (%)

40 35 30 25 20 15 10 5 0

30

12 6

10

Chile

Canada

India

Mauritius
Source: WHO Global NCD Infobase

Relative risk of Type 2 diabetes by different levels of occupational physical activity (from Hu et al, Diabetologia 2003)
Physical activity
LIGHT MODERATE ACTIVE P- value for trend

Relative risk (95% CI)*

1.00 (reference category) 0.70 (0.52-0.96) 0.74 (0.57-0.95) 0.02

* adjusted for age, sex, BMI, systolic BP, smoking, education, other physical activity (n= 6898 Men+7392 women, 35-64 years old)

In the year 2000 there were 3.2 million deaths attributable to diabetes