Overview: Diabetes is the most common endocrine disease affecting more than one million people in the UK and causing three million deaths globally each year. It is defined by high blood glucose: fasting plasma glucose (FPG) below 5.6 millimoles per litre (mmol/L) is considered normal, above 7 mmol/L is diagnostic of diabetes and an FPG level between 5.6 and 7 is considered pre-diabetes.
Treating diabetes accounts for approximately 10% of NHS spend. This is largely due to its associated complications which include coronary, cerebrovascular, ophthalmological and renal disease.
New evidence: A global study into diabetes prevalence (Danaei, G et al, The Lancet, 378, (9785) 31-40) shows the number of cases has more than doubled over the past 3 decades, with an estimated 347 million people now living with the condition worldwide.
The researchers analysed fasting plasma glucose (FPG) data from 2.7 million participants aged 25 and over across the world. They found that the number of adults with diabetes increased from 153 million in 1980 to 347 million in 2008. This is considerably higher than the 285 million that a 2009 study estimated (Shaw JE et al, Diabetes Res Clin Pract. 2010 Jan;87(1):4-14).
While 70% of this rise was due to population ageing (ageing increases the risk of diabetes), the other 30% was due to a higher prevalence across different age groups, caused by increases in risk factors such as obesity. The percentage of male adults with diabetes worldwide rose from 8.3% to 9.8% (an 18% rise) across the three decade period, with adult female prevalence increasing from 7.5% to 9.2% (a 23% increase).
The authors noted a strong correlation between the increasing prevalence of diabetes and rising body-mass index worldwide, this correlation being stronger for women than for men. However, despite increasing levels of obesity in the UK, diabetes prevalence was lower than in most other high-income countries.
The researchers conclude that because preventative measures such as weight control and physical activity are difficult to implement, health systems will have to develop programmes to improve detection and management of diabetes to slow progression to microvascular and macrovascular complications.
Commentary: “Notwithstanding some reservations about this study’s methodology the global rise in diabetes is a very real phenomenon with genuinely alarming implications for health systems management and funding. The National Diabetes Audit (NDA) documents show that diagnosed diabetes inEngland has been growing at 4% per year for the past 5 years while the actual prevalence is estimated to be up to 30% higher than the diagnosed prevalence. Also, although increasing longevity is an important driver, 25% of people with diabetes are under the age of 55 and increasingly they have type 2 diabetes due to population changes in obesity and exercise.
“Of the total cost of diabetes 75-80% is incurred in the treatment of complications associated with poor preventive care and long duration. The NDA shows that younger people are less likely to engage fully in annual preventive diabetes care and less often achieve preventive treatment targets (Diabetes NICE Pathway and The NDA 2009-2010 Paediatric Report).” –
Dr Bob Young CBE, consultant diabetologist at Salford Royal Hospital and clinical lead for The National Diabetes Information Service.