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Diabetes Mellitus Introduction to Diabetes Epidemiology

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Diabetes MellitusIntroduction to Diabetes Epidemiology STAR-initiative Knut Borch-Johnsen

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2 Diabetes Mellitus Definition A metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both Associated with a risk of developing late diabetic complications including Microvascular (retinopathy, nephropathy) Macrovascular (atherosclerosis) Neuropathy

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3 Increasing mortality from diabetes mellitus J. Olefsky, JAMA 2001:285:628-632

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4 Diabetes Epidemiology Type 1 diabetes Type 2 diabetes Other specific types Impaired glucose regulation (IFG & IGT) Insulin Resistance & Metabolic Syndrome

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5 Type 1 diabetes epidemiology Very big variation in incidence and prevalence Variation in growth-rate Disease process relatively well described Genetic markers known Weak risk factors

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6 Incidence of type 1 diabetesAge 0-14 years IDF Diabetes Atlas 2003

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7 Type 1 diabetesIncrease in incidence/year

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8 Type 1 diabetes epidemiology Very big variation in incidence and prevalence Variation in growth-rate Disease process relatively well described Genetic markers known Weak risk factors

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9 2 minutes

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10 Diabetes Epidemiology Type 1 diabetes Type 2 diabetes Other specific types Impaired glucose regulation Insulin Resistance & Metabolic Syndrome

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11 Type 2 diabetes epidemiology Some variation in incidence and prevalence Variation in growth-rate Disease process partly understood Some and often weak genetic markers known Strong risk factors

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12 Prevalence of DM and IGTage 35-64 years

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13 Diabetes in Denmark 1974-96 Drivsholm et al.Diabetic Medicine 201

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14 Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1990, 1995 and 2001 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

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15 World wide epidemic Zimmet, Nature 2001 India: 2000:32 mill 2020: 81 mill

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16 1995 2025 19 million 57 million DIABETES Top Three Countries in the world King et al, Diabetes Care, 1998

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17 Type 2 DM - global epidemic - why ? Prevalence depends on: Age Residence(urban/rural) Obesity Physical activity Ethnicity

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18 Type 2 DM - global epidemic - why ? Prevalence depends on: Age Residence (urban/rural) Obesity Physical activity Ethnicity

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19 Age standardized prevalence of Type 2 DM(native and migrant Asian Indian populations)

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20 Urban-Rural ratio

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21 2 minutes

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22 Type 2 DM - global epidemic - why ? Prevalence depends on: Age Residence(urban/rural) Obesity Physical activity Ethnicity

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23 Non-pharmacological, observational Obesity RR risk of DM in females (ref. BMI < 22) 22-23 3.0 24-25 5.0 > 31 40 (Colditz & al, Ann Int Med, 1995, 122; 481-6)

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24 Obesity (BMI>30) in USA1960-2000 (males) Flegal & al, JAMA 2002, 288, 1723-7

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25 Obesity children in USA 1960-2000BMI >95-centile (boys) Ogden & al, JAMA 2002, 288, 1728-32

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26 Obesity* Trends Among U.S. Adults BRFSS, 1991, 1995 and 2000 (*BMI ³ 30, or ~ 30 lbs overweight for 5’4” person) Source: Mokdad A H, et al. JAMA 1999;282:16, 2001;286:10. No Data <10% 10%-14% 15-19% ³20%

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27 Obesity Trends* Among U.S. AdultsBRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

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28 Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1990, 1995 and 2001 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

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29 Type 2 DM - global epidemic - why ? Prevalence depends on: Age Residence (urban/rural) Obesity Physical activity Ethnicity

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30 Non-pharmacological, observational Exercise Vigorous exercise > 1/week, 25% risk reduction (Manson & al, Lancet 1991, 338; 774-8., JAMA, 1992, 268,63-7) Looking TV 2-10 hours per week: RR 1.66 of having DM compared with 0-1 hour per week ( HU et al; Arch Intern Med 2001;161: 1542-1548)

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34 Type 2 DM - global epidemic - why ? Prevalence depends on: Age Residence(urban/rural) Obesity Physical activity Ethnicity

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35 Prevalence of DM in 60 years old Men Decoda:Nakagami; Diabetologia 2003

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36 Prevalence of DM in 60 years old Women Decoda:Nakagami; Diabetologia 2003

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