WHY ARE WE CONCERNED ABOUT WHY ARE WE CONCERNED ABOUT DIABETES AND ITS LONG TERM DIABETES AND ITS LONG TERM COMPLICATIONS? COMPLICATIONS? BAD NEWS! BAD NEWS! Global Projections for the Diabetes Global Projections for the Diabetes Epidemic: 2003- -2025 2025 Epidemic: 2003 NA EUR 23.0 M 48.4 M EMME WP 36.2 M 58.6 M ↑ 57.0% 19.2 M SEA ↑ 21% 43.0 M 39.4 M 75.8 M 39.3 M ↑ 105% ↑ 79% 81.6 M ↑ 108% AFR SACA 7.1M World 14.2 M 15.0 M 2003 = 194 M ↑ 111% 26.2 M ↑ 85% 2025 = 333 M ↑ 72% 2003 2025 M = million, AFR = Africa, NA = North America, EUR = Europe, SACA = South and Central America, EMME = Eastern Mediterranean and Middle East, SEA = South-East Asia, WP = Western Pacific Diabetes Atlas Committee. Diabetes Atlas 2 nd Edition: IDF 2003 . 1
Diabetes in the World in the World Diabetes ( ( 20 20- -79 79 age age group ) group ) 2007:246.000.000 2007:246.000.000 2025 :380.000.000* 2025 :380.000.000* *7.1% of the Adult *7.1% of the Adult Population Population 80% In Developing 80% In Developing Countries Countries Impaired Glucose Glucose Tolerance Tolerance Impaired in the World in the World 2007 :308.000.000 2007 :308.000.000 2025: 418.000.000* 2025: 418.000.000* *8.1% of the World *8.1% of the World Population Population 80% in Developing Developing Countries Countries 80% in 2
Diabetes + IGT In the World in + IGT In the World in Diabetes 2007 2007 ~550.000.000 ~550.000.000 ~13% of the ~13% of the Adult Population Population Adult Diabetes + IGT in the World in + IGT in the World in Diabetes 2025 2025 ~800.000.000 ~800.000.000 >15% Adult Adult >15% Population Population 3
Diabetes Mellitus in the United States: Diabetes Mellitus in the United States: Overview Overview Prevalence Prevalence 22 million Americans (5.9% of the population) 22 million Americans (5.9% of the population) – 14.5 million diagnosed 14.5 million diagnosed – – 7.5 million not diagnosed 7.5 million not diagnosed – Incidence Incidence 1000,000 new cases diagnosed yearly 1000,000 new cases diagnosed yearly Leading cause of Leading cause of – blindness in adults blindness in adults – – end end- -stage renal disease stage renal disease – – – nontraumatic amputations nontraumatic amputations Healthcare costs: $174 billion 2001 Healthcare costs: $174 billion 2001 90% to 95% of cases are type 2 diabetes ADA. Diabetes Care . 1998;21:296-309. NIDDK. Diabetes Statistics. NIH Publication No. 98-3926; November 1997 (updated February 1998). US Diabetes Prevalence US Diabetes Prevalence by Ethnic Group by Ethnic Group Men and Women, Age 45-74 Years 50 % with diabetes 40 30 20 10 0 Pima European Cuban Japanese African Mexican Puerto American American American American Rican Harris et al. Diabetes. 1987;36:523. Flegal et al. Diabetes Care. 1991;14(suppl 3):628. Knowler et al. Diabetes Care. 1993;16(suppl 1):216. Fujimoto et al. Diabetes Res Clin Pract . 1991;13:119. Fujimoto et al. Diabetes. 1987;36:721. 4
Obesity and Diabetes Trends in the US Obesity and Diabetes Trends in the US Obesity 1991 2001 ≥ 25% No Data < 10% 10% -14% 15% -19% 20% -24% Diabetes 1991 2001 No Data < 4% 4% -6% 7% -8% 9% -10% > 10% Mokdad et al. Mokdad et al. JAMA. JAMA. 2003;289:76 2003;289:76- -79. 79. Diabetes Trends Among Adults in the Diabetes Trends Among Adults in the U.S U.S 1990 1995 2000 2010 No Data Less than 4% 4% to 6% Above 6% Above 10% Mokdad et al. Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286(10). www.diabetes.org. 5
Obesity Trends Among US Adults* Obesity Trends Among US Adults* BRFSS, 2000 BRFSS, 2000 No Data < 10% 10%-14% 15%-19% ≥ 20% *BMI ≥ 30, or ~30 lb overweight for 5'4" woman. Mokdad et al. J Am Med Assoc. 2000;284:13. Obesity Trends* Among US Obesity Trends* Among US Adults, BRFSS 2001 Adults, BRFSS 2001 No Data <10% 10%-14% 15%-19% 20-24% ≥ 25% *BMI ≥ 30, or ~30 lbs overweight for 5’4” woman. Mokdad AH et al. J Am Med Assoc. 2003;289:76-79. 6
Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults BRFSS, 2005 BRFSS, 2005 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥ 30% Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults BRFSS, 2006 BRFSS, 2006 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥ 30% 7
Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults BRFSS, 2007 BRFSS, 2007 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥ 30% Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults BRFSS, 2008 BRFSS, 2008 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥ 30% 8
Prevalence of Overweight and Prevalence of Overweight and Obesity Among US Adults, Age 20- Obesity Among US Adults, Age 20 - 74 Years* 74 Years* Overweight or obese Overweight Obese 80 (BMI ≥ 25.0) (BMI ≥ 30.0) (BMI 25.0-29.9) 61 60 56 Percent 47 40 34 33 32 27 23 20 15 0 NHANES II NHANES III NHANES 1976-80 1988-94 1999 (n=11,207) (n=14,468) (n=1446) BMI = body mass index. *Age-adjusted by the direct method to the year 2000 US Bureau of the Census estimates using the age groups 20-34, 35-44, 45-54, 55-64, and 65-74 years. Prevalence of Overweight Among Prevalence of Overweight Among US Children and Adolescents US Children and Adolescents NHANES III (1988-1994) NHANES (1999-2000) 15.5 16 15.3 14 12 11.3 10.5 10.4 10 8 7.2 % % 6 4 2 0 Age 2-5 Age 6-11 Age 12-19 NHANES=National Health and Nutrition Examination Survey. Ogden CL et al. JAMA . 2002;288:1728-1732. 9
Ethnic Distribution of Diabetes in Ethnic Distribution of Diabetes in Children Children 100 Type 2 Type 1 diabetes 90 diabetes 80 82% % of diabetes in children 70 African-American 74% White 60 Other 50 40 30 20 24% 2% 18% 10 0% 0 Scott et al. Pediatrics. 1997;100:84. The fear for our children is The fear for our children is the epidemic of longterm longterm the epidemic of diabetic complications in diabetic complications in rd decade of life in the the 3 rd decade of life in the the 3 youths with diabetes youths with diabetes 10
Estimated Prevalence of Diabetes by Age Group, Estimated Prevalence of Diabetes by Age Group, Race and Male Gender, with Odds Ratios (OR), Race and Male Gender, Ohio 2005 1 1 . . Ohio 2005 40 36.0 35 27.4 30 Percent (%) 25 16.4 20 White Male Black Male 11.3 15 6.8 10 6.2 3.4 5 1.2 O.R. = 0.5 O.R. = 3.2 O.R. = 1.7 0 O.R. = 5.7 18-34 35-49 50-64 65+ Age Group (Years) 1 Source: Behavioral Risk Factor Surveillance System; Chronic Disease and Behavioral Epidemiology; Surveillance – Prevention; Ohio Department of Health, 2006. Estimated Prevalence of Diabetes by Age Group, Estimated Prevalence of Diabetes by Age Group, Race and Female Gender, with Odds Ratios (OR), Race and Female Gender, Ohio 2005 1 1 . . Ohio 2005 30 24.3 23.2 25 20 Percent (%) 16.1 15 12.2 White Female 10.3 Black Female 10 3.5 5 1.0 0.6 O.R. = 3.5 O.R. = 2.4 O.R. = 1.4 0 O.R. = 1.7 18-34 35-49 50-64 65+ Age Group (Years) 1 Source: Behavioral Risk Factor Surveillance System; Chronic Disease and Behavioral Epidemiology; Surveillance – Prevention; Ohio Department of Health, 2006. 11
Estimated Prevalence of Diabetes by Age Estimated Prevalence of Diabetes by Age Ohio 2005 1 1 Group, with Odds Ratios (OR), Ohio 2005 Group, 16.6 18 16 12.2 14 12 ) Percent (% 10 8 5.3 6 4 1.1 2 O.R. = 4.8 O.R. = 11.1 O.R. = 15.1 0 18-34 35-49 50-64 65+ Age Group (Years) 1 Source: Behavioral Risk Factor Surveillance System; Chronic Disease and Behavioral Epidemiology; Surveillance – Prevention; Ohio Department of Health, 2006. Estimated Prevalence of Diabetes by Age Group Estimated Prevalence of Diabetes by Age Group Ohio 2005 1 1 . and Race, and Race, with Odds Ratios (OR), Ohio 2005 . 28.4 30 24.7 25 20 Percent (%) 16.2 15 10.8 White Black 8.3 10 4.9 3.1 5 0.9 O.R. = 1.7 O.R. = 2.6 O.R. = 1.5 O.R. = 3.4 0 18-34 35-49 50-64 65+ Age Group (Years) 1 Source: Behavioral Risk Factor Surveillance System; Chronic Disease and Behavioral Epidemiology; Surveillance – Prevention; Ohio Department of Health, 2006. 12
Estimated Prevalence of Diabetes by Estimated Prevalence of Diabetes by Race / Ethnicity, Ohio 2005 1 1 . Race / Ethnicity, Ohio 2005 . 14.0 12.6 12.1 12.0 10.0 Percent (%) 7.2 7.1 8.0 6.0 4.0 2.0 0.0 White Black Hispanic/Latino Other 1 Source: Behavioral Risk Factor Surveillance System; Chronic Disease and Behavioral Epidemiology; Surveillance – Prevention; Ohio Department of Health, 2006. Estimated Prevalence of Diabetes by Race and Estimated Prevalence of Diabetes by Race and 1 . Ohio 2005 1 Gender, Gender, with Odds Ratios (OR), Ohio 2005 . 16.0 13.9 14.0 11.8 12.0 Percent (%) 10.0 7.4 7.0 8.0 6.0 4.0 2.0 O.R. = 1.9 O.R. = 1.7 0.0 White Male Black Male White Female Black Female 1 Source: Behavioral Risk Factor Surveillance System; Chronic Disease and Behavioral Epidemiology; Surveillance – Prevention; Ohio Department of Health, 2006. 13
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