The global burden of diabetes and its complications: an emerging pandemic

The number of patients with type 2 diabetes is increasing rapidly in both developed and developing countries around the world. The emerging pandemic is driven by the combined effects of population ageing, rising levels of obesity and inactivity, and greater longevity among patients with diabetes that is attributable to improved management. The vascular complications of type 2 diabetes account for the majority of the social and economic burden among patients and society more broadly. This review summarizes the burden of type 2 diabetes, impaired glucose tolerance, and their vascular complications. It is projected that by 2025 there will be 380 million people with type 2 diabetes and 418 million people with impaired glucose tolerance. Diabetes is a major global cause of premature mortality that is widely underestimated, because only a minority of persons with diabetes dies from a cause uniquely related to the condition. Approximately one half of patients with type 2 diabetes die prematurely of a cardiovascular cause and approximately 10% die of renal failure. Global excess mortality attributable to diabetes in adults was estimated to be 3.8 million deaths. Eur J Cardiovasc Prev Rehabil 17 (Suppl 1):S3-S8 © 2010 The European Society of Cardiology

[1]  Darren K Mcguire,et al.  Impaired glucose tolerance and impaired fasting glucose — a review of diagnosis, clinical implications and management , 2005, Diabetes & vascular disease research.

[2]  Plamen Nikolov,et al.  Economic Costs of Diabetes in the U.S. in 2002 , 2003, Diabetes care.

[3]  N. Ray,et al.  Economic Consequences of Diabetes Mellitus in the U.S. in 1997 , 1998, Diabetes Care.

[4]  N. Chaturvedi The burden of diabetes and its complications: trends and implications for intervention. , 2007, Diabetes research and clinical practice.

[5]  C. Millett,et al.  Diabetes retinopathy screening: audit of equity in participation and selected outcomes in South East London , 2006, Journal of medical screening.

[6]  P. Bennett,et al.  Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes , 2001, Diabetologia.

[7]  R. Stolk,et al.  Low yield of population-based screening for Type 2 diabetes in the Netherlands: the ADDITION Netherlands study. , 2007, Family practice.

[8]  A Sekikawa,et al.  Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. , 1999, Diabetes care.

[9]  J. Stewart,et al.  Trends in incidence of treated end‐stage renal disease, overall and by primary renal disease, in persons aged 20–64 years in Europe, Canada and the Asia‐Pacific region, 1998–2002 , 2007, Nephrology.

[10]  V. Mohan,et al.  Prevalence and risk factors for diabetic neuropathy in an urban south Indian population: the Chennai Urban Rural Epidemiology Study (CURES‐55) , 2008, Diabetic medicine : a journal of the British Diabetic Association.

[11]  G. Nichols,et al.  The impact of cardiovascular disease on medical care costs in subjects with and without type 2 diabetes. , 2002, Diabetes care.

[12]  H. King,et al.  Global Burden of Diabetes, 1995–2025: Prevalence, numerical estimates, and projections , 1998, Diabetes Care.

[13]  Rajiv Raman,et al.  Prevalence of diabetic retinopathy in India: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study report 2. , 2009, Ophthalmology.

[14]  B. Lundman,et al.  Diabetes and it's complications in a Swedish county. , 1998, Diabetes research and clinical practice.

[15]  R. Klein,et al.  Onset of NIDDM occurs at Least 4–7 yr Before Clinical Diagnosis , 1992, Diabetes Care.

[16]  P. Bennett,et al.  The incidence of visual impairment and its determinants in the WHO multinational study of vascular disease in diabetes , 2001, Diabetologia.

[17]  A. M. Adelstein,et al.  Diabetes mortality: New light on an underestimated public health problem , 1983, Diabetologia.

[18]  J. L. Wall,et al.  Total and Component Health Care Costs in a Non-Medicare HMO Population of Patients With and Without Type 2 Diabetes and With and Without Macrovascular Disease , 2006, Journal of managed care pharmacy : JMCP.

[19]  Prevalence of visual impairment and selected eye diseases among persons aged >/=50 years with and without diabetes--United States, 2002. , 2004, MMWR. Morbidity and mortality weekly report.

[20]  E. Ferrannini,et al.  Plasma glucose levels as predictors of diabetes: the Mexico City diabetes study , 2009, Diabetologia.

[21]  S. Resnikoff,et al.  Global data on visual impairment in the year 2002. , 2004, Bulletin of the World Health Organization.

[22]  J. Tuomilehto,et al.  Predictive properties of impaired glucose tolerance for cardiovascular risk are not explained by the development of overt diabetes during follow-up. , 2003, Diabetes care.

[23]  S. Harding,et al.  Incidence of sight‐threatening retinopathy in Type 1 diabetes in a systematic screening programme , 2003, Diabetic medicine : a journal of the British Diabetic Association.

[24]  J. Tuomilehto,et al.  Sex differences in cardiovascular and total mortality among diabetic and non-diabetic individuals with or without history of myocardial infarction , 2005, Diabetologia.

[25]  A. Hughes,et al.  Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: a randomised controlled trial , 2009, Diabetologia.

[26]  Michael M. Engelgau,et al.  Prevalence of Diabetes and Impaired Fasting Glucose in Adults in the U.S. Population , 2006, Diabetes Care.

[27]  P. Romero-Aroca,et al.  Changes in the diabetic retinopathy epidemiology after 14 years in a population of Type 1 and 2 diabetic patients after the new diabetes mellitus diagnosis criteria and a more strict control of the patients. , 2009, Journal of diabetes and its complications.

[28]  R. Holman,et al.  Risk factors for stroke in type 2 diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS) 29. , 1999, Archives of internal medicine.

[29]  A. Kocer,et al.  Prevalence of peripheral neuropathy in type 2 diabetic patients attending a diabetes center in Turkey. , 2004, Endocrine journal.

[30]  K. Reddy,et al.  The Prevalence and Management of Diabetes in Rural India , 2006, Diabetes Care.

[31]  A. Avogaro,et al.  Incidence of Coronary Heart Disease in Type 2 Diabetic Men and Women , 2007, Diabetes Care.

[32]  A. Avogaro,et al.  Incidence and Risk Factors for Stroke in Type 2 Diabetic Patients: The DAI Study , 2007, Stroke.

[33]  K. Ajlouni,et al.  Prevalence of Blindness and Visual Impairment among Jordanian Diabetics , 2005, European journal of ophthalmology.

[34]  A. T. N. Group,et al.  Risk factors for cardiovascular mortality and morbidity: The WHO multinational study of vascular disease in diabetes. , 2001, Diabetologia.

[35]  R. Klein,et al.  Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005-2050. , 2008, Archives of ophthalmology.

[36]  J. Bottomley,et al.  Economic costs of diabetes in the US in 2007 — Implications for Europe , 2008 .

[37]  B. Klein,et al.  Overview of epidemiologic studies of diabetic retinopathy. , 2007, Ophthalmic epidemiology.

[38]  M. C. Leske,et al.  Nine-year incidence of visual impairment in the Barbados Eye Studies. , 2009, Ophthalmology.

[39]  H. Valkenburg,et al.  Prevalence and Determinants of Glucose Intolerance in a Dutch Caucasian Population: The Hoorn Study , 1995, Diabetes Care.

[40]  F. Dekker,et al.  Trends in the incidence of renal replacement therapy for end-stage renal disease in Europe, 1990-1999. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[41]  P. Bennett,et al.  The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes , 2001, Diabetologia.

[42]  R. Holman,et al.  U.K. Prospective Diabetes Study 22: Effect of age at diagnosis on diabetic tissue damage during the first 6 years of NIDDM , 1997, Diabetes Care.

[43]  J. Caro,et al.  Economic Outcomes Associated with Microvascular Complications of Type 2 Diabetes Mellitus , 2012, PharmacoEconomics.

[44]  B V Howard,et al.  Diabetes and cardiovascular disease. , 2002, Annual review of medicine.

[45]  M. Martinell,et al.  Prevalence and incidence of Type 2 diabetes and its complications 1996–2003—estimates from a Swedish population‐based study , 2008, Diabetic medicine : a journal of the British Diabetic Association.

[46]  D. Belsky,et al.  Changes in incidence of diabetes mellitus-related eye disease among US elderly persons, 1994-2005. , 2008, Archives of ophthalmology.

[47]  G. Gallus,et al.  Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. , 2003, Diabetes care.

[48]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[49]  J. Park,et al.  Islet cell autoimmunity and mitochondrial DNA mutation in Korean subjects with typical and atypical Type I diabetes , 2001, Diabetologia.

[50]  Beverley Balkau,et al.  Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. , 2003, Diabetes care.

[51]  Colin Mathers,et al.  The burden of mortality attributable to diabetes: realistic estimates for the year 2000. , 2005, Diabetes care.

[52]  S. Wild,et al.  Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. , 2004, Diabetes care.

[53]  D L McGee,et al.  Diabetes and Cardiovascular Risk Factors: The Framingham Study , 1979, Circulation.

[54]  A. Idil,et al.  The Prevalence of Blindness and Low Vision in Older Onset Diabetes Mellitus and Associated Factors: A Community-Based Study , 2004, European journal of ophthalmology.

[55]  H. Yokoyama,et al.  Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: the Japan Diabetes Clinical Data Management study (JDDM15). , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[56]  H. Keen,et al.  Mortality and causes of death in the WHO multinational study of vascular disease in diabetes , 2001, Diabetologia.

[57]  F. Al-Mahroos,et al.  Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in bahrain: a nationwide primary care diabetes clinic-based study , 2007, Annals of Saudi medicine.