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2. Epidemiology of Type 2 Diabetes Dr Ghadiri

3. Diabetes Primary Goal for 2010 Through prevention programs, reduce the disease incidence, its complications and its economic impact, in addition, to improve quality of life for all those persons that had diabetes or that are at risk to develop the disease. Through prevention programs, reduce the disease incidence, its complications and its economic impact, in addition, to improve quality of life for all those persons that had diabetes or that are at risk to develop the disease. Reference: U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. 3

4. Epidemiology The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 30 million cases in 1985 to 285 million in 2010. International Diabetes Federation projects that 438 million individuals will have diabetes by the year 2030. Prevalence of both type 1 and type 2 DM is increasing worldwide, the prevalence of type 2 DM is rising much more rapidly, presumably because of increasing obesity, reduced activity levels as countries become more industrialized, and the aging of the population. 4

5.  The magnitude of the healthcare problem of type 2 diabetes results not just from the disease itself but also from its association with obesity and cardiovascular risk factors, particularly dyslipidaemia and hypertension.  Type 2 diabetes has now been recognized as one manifestation of the “metabolic syndrome”, a condition characterized by insulin resistance and associated with a range of cardiovascular risk factors. 5

6.  Various cardiovascular risk factors, including hypertension and dyslipidaemia become progressively worse with progression from normal glucose tolerance to IGT/IFG to diabetes. 6

7.  While there is good evidence for a strong genetic contribution to both obesity and diabetes, the increase in these conditions in both developed and developing countries appears to be due to a changing balance between energy intake and energy expenditure through physical activity.  Physical activity levels have probably diminished by half. 7

8.  The tendency for the increased prevalence of type 2 diabetes to be concentrated in lower socioeconomic groups in developed countries and higher socioeconomic groups in developing countries probably reflects the adoption of a “healthier” lifestyle by better educated people in developed countries, while it is generally the affluent in developing countries who enjoy a high calorie intake and low level of physical activity. 8

9. Approximately 1.6 million individuals (>20 years) were newly diagnosed with diabetes in 2010. DM increases with aging. In 2010, the prevalence of DM in the United Sates was estimated to be 0.2% in individuals aged 20 years. In individuals aged >65 years, the prevalence of DM was 26.9%. The prevalence is similar in men and women throughout most age ranges (11.8% and 10.8%, respectively, in individuals aged >20 years). 9

10. In Asia, the prevalence of diabetes is increasing rapidly and the diabetes phenotype appears to be different from that in the United States and Europe—onset at a lower BMI and younger age, greater visceral adiposity, and reduced insulin secretory capacity. 10

11. Diabetes is a major cause of mortality, but several studies indicate that diabetes is likely underreported as a cause of death. In the United States, diabetes was listed as the seventh leading cause of death in 2007; a recent estimate suggested that diabetes was the fifth leading cause of death worldwide and was responsible for almost 4 million deaths in 2010. 11

12. Global Prevalence of Diabetes 12

13. Global Prevalence Estimates, 2000 and 2030 4.4 % 2.8 % Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.

14. Diabetes in the World millions India 31.7 China 20.8 USA 17.7 Indonesia8.4 Japan 6.8 Year 2000 Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053. 14

15. Diabetes in the World millions India 79.4 China 42.3 USA 30.3 Indonesia21.3 Japan 8.9 Year 2030 Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053. 15

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17. Prevalence of Diabetes in Adults United States, BRFSS * 1998 - 2003 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services. 17

18. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. Prevalence of Diabetes in Adults United States, BRFSS 1990 No Data 10% 18

19. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 1991-92 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 19

20. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 1993-94 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 20

21. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 1995-96 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 21

22. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 1995 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 22

23. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 1997-98 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 23

24. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 1999 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 24

25. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 2000 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 25

26. Reference: Mokdad et al., Diabetes Care 2000;23:1278-83. 2001 No Data 10% Prevalence of Diabetes in Adults United States, BRFSS 26

27. Prevalence of Diabetes in Adults, United States and territories, BRFSS * 2002 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services. 27

28. Prevalence of Diabetes by Sex and Year, Puerto Rico BRFSS * 1997, 2001 - 2003 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1997-2003. Atlanta, GA: United States, Department of Health and Human Services. 28

29. Overall Non-Hispanic Whites Non-Hispanic Blacks Mexican- Americans Cowie et al., 2008; Prevalence of Total Diabetes (diagnosed and undiagnosed diabetes) in the U.S. Adult Population, age ≥ 20, 1988-1994 to 2005-2006

31. Problem Statement Iceberg Disease Increased prevalence in newly industrialized and developing countries. Disease acquired in the most productive period of their life. Iceberg Disease Increased prevalence in newly industrialized and developing countries. Disease acquired in the most productive period of their life.

32. Undiagnosed or inadequately treated patients develop multiple chronic complications. Lack of awareness about interventions for prevention and management of complications. Undiagnosed or inadequately treated patients develop multiple chronic complications. Lack of awareness about interventions for prevention and management of complications.

33. Age Distribution of Diabetes Mellitus 33

34. Age Distribution of Diabetes Mellitus 34

35. Prevalence of diabetes in the WHO South-East Asia Region 35

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38. Eastern Mediterranean Health Journal, Vol. 15, No. 3, 2009 591 ٢٠٠٩ ، المجلة الصحية لشرق المتوسط، منظمة الصحة العالمية، المجلد الخامس عشر، العدد ٣ Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis A.A Haghdoost, 1,2 M. Rezazadeh-Kermani, 1 B. Sadghirad 3 and H.R. Baradaran 4 38

39. Between 1996 and 2004. In those > 40 years the prevalence was 24% and it increased by 0.4% with each year after 20 years of age. The risk of type 2 diabetes was1.7% greater in women than men Between 1996 and 2004. In those > 40 years the prevalence was 24% and it increased by 0.4% with each year after 20 years of age. The risk of type 2 diabetes was1.7% greater in women than men 39

40. Province Prevalence Province Prevalence Bushehr 12.62 (7.62–17.63) Bushehr 12.62 (7.62–17.63) Qazvin 13.09 (7.93–18.25) Qazvin 13.09 (7.93–18.25) Gilan 5.45 (1.78–9.13) Gilan 5.45 (1.78–9.13) Isfahan 8.20 (5.23–11.17) Isfahan 8.20 (5.23–11.17) Kerman 13.16 (7.55–18.77) Kerman 13.16 (7.55–18.77) Khorasan 9.09 (2.28–15.89) Khorasan 9.09 (2.28–15.89) Kordestan 3.35 (0–7.36) Kordestan 3.35 (0–7.36) Tehran 7.43 (4.04–10.81) Tehran 7.43 (4.04–10.81) Yazd 14.01 (10.75–17.27) Yazd 14.01 (10.75–17.27) 40

41. Prevalence of diabetes in I.R.IRAN Year 2000 2030 Diabetic patients 2,103,000 6,421,000 Prevalence of diabetes in Yazd Province Year 2000 2030 Diabetic patients 145,000 442,722 41

42. Prevalence of Type 2 Diabetes Complications in Yazd Province In this study 1000 type 2 diabetic patients (457 male, 543 female) were studied. male, 543 female) were studied. Nephropathy : 285 (28.5%) Nephropathy : 285 (28.5%) Retinopathy : 519 (51.9%) Retinopathy : 519 (51.9%) CAD : 251 (25.1%) CAD : 251 (25.1%) PVD : 143 (14.3%) PVD : 143 (14.3%) CVA :109 (10.9%) CVA :109 (10.9%) Foot ulcer : 84 (8.4%) Foot ulcer : 84 (8.4%) 42

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47. Estado Libre Asociado de Puerto Rico Estado Libre Asociado de Puerto Rico 47

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50. There is considerable geographic variation in the incidence of both type 1 and type 2 DM. Scandinavia has the highest incidence of type 1 DM (Finland, the incidence is 57.4/100,000 per year). Japan and China has a much lower rate of type 1 DM (0.6–2.4/100,000 per year); Northern Europe and the United States have an intermediate rate (8–20/100,000 per year). 50

51. Much of the increased risk of type 1 DM is believed to reflect the frequency of high-risk human leukocyte antigen (HLA) alleles among ethnic groups in different geographic locations. 51