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Data gathered throughout the years has labeled Diabetes as one of the top leading causes of human suffering and pain. Statistics show how instead of decreasing in prevalence it is becoming a burden worldwide. A major reason for this is that it is related to many risk factors therefore it is important to target those the most vulnerable and make sure that accurate information is made accessible to them.

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Informing the population about these risk factor is an important step to help reduce or to prevent this condition.

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As depicted in this image prevalence of diabetes will continue to escalate globally. Therefore, it is important to take immediate action.

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Obesity is one of the most important factors that increases your risk of diabetes.

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Kai McKeever Bullard, PhD, ¹ Catherine C. Cowie, PhD, ² Sarah E. Lessem, PhD, ³ Sharon H. Saydah, PhD, ¹ Andy Menke, PhD, ⁴ Linda S. Geiss, MA, ¹ Trevor J. Orchard, MD, ⁵ Deborah B. Rolka, MS, ¹ and Giuseppina Imperatore, MD, PhD ¹

Currently 23 million U.S. adults have been diagnosed with diabetes (). The two most common forms of diabetes are type 1 and type 2. Type 1 diabetes results from the autoimmune destruction of the pancreas's beta cells, which produce insulin. Persons with type 1 diabetes require insulin for survival; insulin may be given as a daily shot or continuously with an insulin pump (). Type 2 diabetes is mainly caused by a combination of insulin resistance and relative insulin deficiency (). A small proportion of diabetes cases might be types other than type 1 or type 2, such as maturity-onset diabetes of the young or latent autoimmune diabetes in adults (). Although the majority of prevalent cases of type 1 and type 2 diabetes are in adults, national data on the prevalence of type 1 and type 2 in the U.S. adult population are sparse, in part because of the previous difficulty in classifying diabetes by type in surveys (,,). In 2016, supplemental questions to help distinguish diabetes type were added to the National Health Interview Survey (NHIS) (). This study used NHIS data from 2016 to estimate the prevalence of diagnosed diabetes among adults by primary type. Overall, based on self-reported type and current insulin use, 0.55% of U.S. adults had diagnosed type 1 diabetes, representing 1.3 million adults; 8.6% had diagnosed type 2 diabetes, representing 21.0 million adults. Of all diagnosed cases, 5.8% were type 1 diabetes, and 90.9% were type 2 diabetes; the remaining 3.3% of cases were other types of diabetes. Understanding the prevalence of diagnosed diabetes by type is important for monitoring trends, planning public health responses, assessing the burden of disease for education and management programs, and prioritizing national plans for future type-specific health services.

NHIS is an annual, cross-sectional household interview survey conducted by CDC that gathers health-related data in a nationally representative sample of the civilian, noninstitutionalized U.S. population (). The 2016 NHIS Sample Adult Core consisted of 33,028 adults aged ≥18 years, with a final response rate of 54.3%. Each respondent was randomly selected among all adults aged ≥18 years in each household. During face-to-face interviews, respondents were asked whether a doctor or health care professional had ever told them that they had diabetes, other than during pregnancy. Among those who said they had diabetes, questions were asked regarding age at diagnosis and insulin and oral hypoglycemic medication use. In 2016, respondents were also asked to report whether they had type 1, type 2, or another type of diabetes. Virtually all patients with type 1 diabetes require insulin to survive, and very few persons who use insulin do not report using it (). Previous studies have found that self-reported diabetes type alone is not a valid method for classifying diabetes type in surveys because some patients are not aware of their diabetes type (,). Therefore, for this analysis, type 1 diabetes was defined as current insulin use and self-report of type 1 diabetes. Adults who reported having type 1 diabetes but reported not using insulin were classified as having type 2 diabetes, as were persons who reported type 2 diabetes, unknown diabetes type, or who would not report diabetes type. Respondents who reported having another diabetes type were classified as having "other type."

Crude prevalence estimates of diagnosed diabetes by type and 95% confidence intervals (CIs) were calculated for the overall population and by selected sociodemographic characteristics. P values were calculated from chi-squared tests and were considered significant at <0.05. Final survey weights were applied to the data to adjust for various probabilities of selection and household nonresponse. Statistical software was used to account for NHIS's complex sampling design.

A total of 3,519 respondents aged ≥18 years reported having diabetes, including 211 classified as having type 1; 3,210 classified as having type 2 (including 182 who reported having type 1, but not taking insulin; 2,897 who reported having type 2; one who reported an unknown type; and one refusal); and 98 classified as having "other" type. In 2016, the overall crude prevalence of diagnosed diabetes among U.S. adults was 9.44% (95% CI = 9.01-9.88). The prevalences of type 1 diabetes, type 2 diabetes, and other diabetes types were 0.55%, 8.58%, and 0.31%, respectively (). The weighted percentages of all diagnosed diabetes cases that were type 1 and type 2 were 5.8% and 90.9%, respectively; the remaining were other types. Based on the weighted NHIS population, the estimated numbers of adults with type 1, type 2, and other diabetes types were 1.3 million, 21.0 million, and 0.8 million, respectively.

TABLE

Estimated crude prevalence of type 1 diabetes among U.S. adults did not significantly vary by age group (p = 0.54) or education (p = 0.14) (). The prevalence of type 1 diabetes was higher among men (0.64%) than among women (0.46%) (p<0.05) and higher among non-Hispanic whites (whites) (0.67%) than among Hispanics (0.22%) (p<0.01). By age group, the prevalence of type 2 diabetes was highest among adults aged ≥65 years and lowest among adults aged 18-29 years (p<0.001), and by race/ethnicity, was higher among non-Hispanic blacks (11.52%) than among non-Hispanic Asians (6.89%), whites (7.99%), and Hispanics (9.07%) (p<0.001) (). The prevalence of type 2 diabetes decreased with higher levels of educational attainment (p<0.001).

Discussion

In 2016, the estimated prevalences of diagnosed type 1 and type 2 diabetes were 0.55% (corresponding to 1.3 million U.S. adults) and 8.6% (corresponding to 21.0 million U.S. adults), respectively. Type 1 and type 2 diabetes accounted for approximately 6% and 91% of all cases of diagnosed diabetes, respectively. Because the prevalence of type 2 diabetes is so much higher than that of type 1, current diabetes surveillance data that do not distinguish diabetes type are more reflective of persons with type 2 diabetes. Recent analysis of diagnosed diabetes prevalence indicates a plateauing among adults aged 20-79 years (), but it is not known whether this trend might differ for type 1 diabetes. Because the etiology, treatment, and outcomes of diabetes vary by type, it is important to distinguish between them.

There is no reference standard for classifying prevalent type 1 diabetes or type 2 diabetes cases in public health surveillance. The presence of autoantibodies against the beta cells of the pancreas and the lack of endogenous insulin secretion are biologic markers of type 1 diabetes. However, beta cell autoantibodies disappear with time and might even be absent at the time of type 1 diabetes diagnosis (). Insulin secretion tests are difficult to perform and interpret, making these tests unsuitable for use in cross-sectional surveys. In administrative health databases and electronic medical records, adults with diabetes frequently have International Classification of Diseases codes for both type 1 and type 2 diabetes. For this reason, disease coding has been combined with other information (e.g., current prescriptions for insulin or oral hypoglycemic medication) when estimating diabetes type in these data (,). Using type 1 diabetes self-report and current insulin use to classify diabetes type, the percentage of all diabetes cases that were type 1 diabetes fell reasonably within the range of results from other studies (approximately 5%-10%) (-,).

The findings in this report are subject to at least three limitations. First, the data were self-reported and underestimate the total number of adults with diabetes. Second, data were not validated, which could have led to misclassification of diabetes type. Adults with self-reported type 1 diabetes who did not report insulin use were reclassified as having type 2 diabetes, which might have resulted in misclassification if they actually used insulin but did not report use. However, self-reported use of insulin is highly specific: <0.02% of persons who reported insulin in a medication log failed to report using it when asked (). Some insulin users with type 2 diabetes might have incorrectly reported type 1 diabetes, assuming that taking insulin meant they had type 1 diabetes (). In addition, because self-reported cases of unknown type were reclassified as type 2 diabetes, the prevalence of type 2 diabetes might have been overestimated. However, according to a Canadian survey-based algorithm to distinguish diabetes types, 99% of adults who self-reported unknown type would have been classified as type 2 diabetes (). Finally, the small sample size of some subgroups limited precision.

Despite these limitations, this first study to estimate the prevalence of diagnosed type 1 and type 2 diabetes based on self-report and current insulin use among U.S. adults provides information to track prevalence of diabetes by type to monitor trends and assess the burden of disease for education and prevention programs. Knowledge about national prevalences of type 1 and type 2 diabetes might facilitate assessment of the long-term cost-effectiveness of public health interventions and policies aimed at improving diabetes management and help to prioritize national plans for future type-specific health services.

What is already known about this topic?

The two most common forms of diabetes are type 1 and type 2. Previous national diabetes prevalence estimates did not distinguish between types among U.S. adults.

What is added by this report?

New data allowed estimation of diagnosed diabetes by type. In 2016, the prevalence of diagnosed type 1 diabetes was 0.55%, representing 1.3 million U.S. adults; the prevalence of diagnosed type 2 diabetes was 8.6%, representing 21.0 million U.S. adults. Non-Hispanic white adults had a higher prevalence of diagnosed type 1 diabetes than did Hispanic adults. Non-Hispanic blacks had the highest prevalence of diagnosed type 2 diabetes. Diagnosed type 2 diabetes prevalence estimates increased with age and decreased with increasing levels of educational attainment.

What are the implications for public health practice?

Knowledge about national prevalence of diagnosed diabetes by type might be helpful in monitoring trends, assessing the burden of disease for education and management programs, and guiding and prioritizing national plans for future type-specific health services.

Notes

Conflict of Interest: No conflicts of interest were reported.

References

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3. American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care 2017;40(Suppl 1):S11-24. [[ PubMed] Google Scholar]

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10. Klompas M, Eggleston E, McVetta J, Lazarus R, Li L, Platt R. Automated detection and classification of type 1 versus type 2 diabetes using electronic health record data. Diabetes Care 2013;36:914-21. 10.2337/dc12-0964 [[ PubMed] [ CrossRef] PMC free article] [ Google Scholar]

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Prevalence of Diagnosed Diabetes in Adults by Diabetes Type - United States, 2016

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Kai McKeever Bullard, PhD, 1 Catherine C. Cowie, PhD, 2 Sarah E. Lessem, PhD, 3 Sharon H. Saydah, PhD, 1 Andy Menke, PhD, 4 Linda S. Geiss, MA, 1 Trevor J. Orchard, MD, 5 Deborah B. Rolka, MS, 1 and Giuseppina Imperatore, MD, PhD 1 Currently 23 million U.S.

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The uprise of type 2 diabetes has become a major concern in the healthcare system. China, India and the US continue to hold top spots as countries with the most affected individuals for this condition.

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Abstract

The rising burden of type 2 diabetes is a major concern in healthcare worldwide. This research aimed to analyze the global epidemiology of type 2 diabetes. We analyzed the incidence, prevalence, and burden of suffering of diabetes mellitus based on epidemiological data from the Global Burden of Disease (GBD) current dataset from the Institute of Health Metrics, Seattle. Global and regional trends from 1990 to 2017 of type 2 diabetes for all ages were compiled. Forecast estimates were obtained using the SPSS Time Series Modeler. In 2017, approximately 462 million individuals were affected by type 2 diabetes corresponding to 6.28% of the world's population (4.4% of those aged 15-49 years, 15% of those aged 50-69, and 22% of those aged 70+), or a prevalence rate of 6059 cases per 100,000. Over 1 million deaths per year can be attributed to diabetes alone, making it the ninth leading cause of mortality. The burden of diabetes mellitus is rising globally, and at a much faster rate in developed regions, such as Western Europe. The gender distribution is equal, and the incidence peaks at around 55 years of age. Global prevalence of type 2 diabetes is projected to increase to 7079 individuals per 100,000 by 2030, reflecting a continued rise across all regions of the world. There are concerning trends of rising prevalence in lower-income countries. Urgent public health and clinical preventive measures are warranted.

Keywords: Diabetes mellitus type 2, epidemiology, disease pattern, prevalence

1. INTRODUCTION

Type 2 diabetes is recognized as a serious public health concern with a considerable impact on human life and health expenditures. Rapid economic development and urbanization have led to a rising burden of diabetes in many parts of the world [ 1]. Diabetes affects individuals' functional capacities and quality of life, leading to significant morbidity and premature mortality [ 2]. Recently, concerns have been raised that more than one-third of the diabetes-related deaths occur in people under the age of 60 [ 3]. Increased consumption of unhealthy diets and sedentary lifestyles, resulting in elevated Body Mass Index (BMI) and fasting plasma glucose, have been blamed for these trends [ 4]. In particular, persons with higher BMI are more likely to have type 2 diabetes [ 5]. The aging of the human population is another contributor, as diabetes tends to affect older individuals [ 6]. The cost of diabetes care is at least 3.2 times greater than the average per capita healthcare expenditure, rising to 9.4 times in presence of complications [ 7]. Control of blood glucose, blood pressure, and other targets remains suboptimal for many patients [ 8]. This has been partly attributed to the lack of awareness and health promotion needed for diabetes control [ 9].

Unfortunately, the global epidemiology of diabetes has not been re-evaluated since the availability of recent high-quality data [ 10]. We found no studies providing global forecasts for the intermediate future, which would be a critical piece of information for health policymakers.

This research project examines the latest dataset of the Global Burden of Disease (GBD) to assess the burden of type 2 diabetes worldwide. The aim is to study the current global epidemiology of diabetes and highlight the current distribution of disease and emerging epidemiologic trends.

2. MATERIALS AND METHODS

We analyzed descriptive epidemiological data from the GBD dataset managed by the Institute of Health Metrics and Evaluation at the University of Washington, Seattle [ 11]. The GBD dataset is actively maintained and updated based on research data, epidemiology studies, and governmental publications from more than 100,000 sources. As a systematic public health project, it carefully builds models and statistical estimates for health loss due to illness, injury, and risk factors based on empirical data. GBD produces annual estimates of disease measures, such as prevalence, incidence, deaths, and Disability-Adjusted Life Years (DALYs). DALYs combine years of life lost due to premature death and years lived with disability, and are a more accurate reflection of human suffering resulting from a disease than prevalence or mortality alone.

We used the latest data refresh from GBD (the 2017 update). This dataset includes annual figures from 1990 to 2017 for type 2 diabetes in all countries and regions. We selected four world regions (Asia, Europe, America, and Africa) instead of other classification schemes based on economic development. All data were directly retrieved from GBD without any adjustments. Estimates were not age adjusted for differences in underlying population age distributions. Thus, the rates for different countries represent the actual burden on their respective health systems.

2.1. Statistical Data Analysis

Forecasting was conducted using IBM SPSS version 25 (IBM Corp., Armonk, NY, USA). The Time Series Modeler was used to develop a forecast model using the Expert Modeler option without any events. None of the observed values were marked as outliers.

3. RESULTS

Globally, an estimated 462 million individuals are affected by type 2 diabetes, corresponding to 6.28% of the world's population (). More than 1 million deaths were attributed to this condition in 2017 alone, ranking it as the ninth leading cause of mortality. This is an alarming rise when compared with 1990, when type 2 diabetes was ranked as the eighteenth leading cause of deaths. In terms of human suffering (DALYs), diabetes ranks as the seventh leading disease.

Table 1

The prevalence of type 2 diabetes shows a distribution pattern that matches socio-economic development (). Developed regions, such as Western Europe, show considerably higher prevalence rates that continue to rise despite public health measures (). The rate of increase does not appear to be slowing down.

Remarkably, certain regions, such as Pacific Ocean island nations, are sustaining the highest prevalence of disease. These countries include Fiji (20,277 per 100,000), Mauritius (18,545), American Samoa (18,312), and Kiribati (17,432). Southeast Asian countries, such as Indonesia, Malaysia, Thailand, and Vietnam, have moved up the ranks in the last two decades. Owing to their large population sizes, China (88.5 million individuals with type 2 diabetes), India (65.9 million), and the US (28.9 million) retain the top spots as the countries with the greatest total number of individuals with this condition.

Males show a slightly higher prevalence than females (6219 compared with 5898 cases per 100,000), although this difference is within the margin of uncertainty. The age of onset of new diagnosis is also somewhat earlier among males and shows expected patterns of rising prevalence with increasing age, whereas the incidence peaks at 55-59 years (). There appears to be no major shift in the age distribution from 1990 to 2017.

Even though it afflicts individuals later in life, type 2 diabetes ranks seventh among the leading causes of disability and years of life lost (DALYs). It has jumped ranks from nineteenth position in 1990, indicating a global transition in disease patterns toward noncommunicable diseases.

Statistical forecasting using a model based on the 1990-2017 data showed that global diabetes prevalence could increase to 7079 per 100,000 by 2030 and 7862 by 2040. This estimate for 2040 is flanked by an upper confidence limit of 9904 and a lower limit of 5821 per 100,000.

4. DISCUSSION

This study reports on the current trends in the global burden of diabetes with emphasis on the burden of human suffering. The high prevalence of type 2 diabetes worldwide continues to rise, and there are no signs of it stabilizing. A concerning finding is the rapidly rising burden in lower-income countries. These findings have implications for health policy planners, physicians, healthcare professionals, and the public.

The burden of suffering due to diabetes, as measured by DALYs, is increasing despite significant investment in clinical care and pharmaceutical research. This increase is in excess of population growth and aging. Notably, Western Europe has a rate of increase greater than that of global and Asian averages. Even with the high levels of clinical and public health expenditure, this region is losing the battle against diabetes. One explanation might be non-modifiable risk factors, such as age and family history [ 12]. However, factors like a highly processed, calorie-dense western diet and a sedentary lifestyle may also be contributing. Developed countries like Italy and the US endure the highest burdens of human suffering (DALYs) due to diabetes. Advanced economies in Asia, such as South Korea and Taiwan, are joining the ranks of these countries, based on GBD data. Thus, our findings support the correlation between diabetes and economic development [ 13]. We speculate that our current approach to diabetes management, which focuses on expensive oral medications and insulin, is not working. Lowering blood glucose levels is perhaps not sufficient by itself nor effective in reducing all-cause mortality among these patients.

Prevention of new cases of diabetes appears to be not working as well based on our findings from global data. Although research is ongoing to reduce the progression from metabolic syndrome and prediabetes to diabetes, most interventions being tried seem to be unsuccessful in affecting the incidence. According to our data, there is no evidence of a decrease in incidence. Alarmingly high incidence rates recorded in island nations in the Pacific region are an indication of the interaction between genetic predisposition and the effect of rapid nutritional change on these indigenous populations. Meanwhile, the sheer number of individuals with diabetes is testing health systems in China, India, and the US to the limit. Rapid urbanization and its effects on diet and lifestyle has been implicated [ 14]. These findings have direct implications for health systems planning and resource allocation. Clearly, hospital-based management and subspecialist care are not sustainable strategies. Resource allocation in healthcare budgets for prevention of diabetes needs to be comparable to expenditures on treatment. Strengthening of primary care and community restructuring for active lifestyles and healthy nutrition are perhaps more likely to be cost effective [ 15]. Sadly, the rising tide of type 2 diabetes is out pacing preventive efforts by a wide margin [ 16].

The rising incidence of type 2 diabetes at earlier ages warrants closer attention. Previous clinic-based studies have reported a high number of young adults being diagnosed with type 2 diabetes, most of whom are obese [ 17]. There appears to be an age gradient with early-onset type 2 diabetes patients (those younger than 45) showing more obesity, dyslipidemia, smoking, sedentary lifestyles, and low-grade inflammation [ 18]. In our study, although the incidence of diabetes in young adults has increased over the past decades, the rise is across all ages. Thus, there appears to be no clear indication that the age of onset of type 2 diabetes has shifted to younger age groups. In any case, rising life expectancy in many countries will lead to a substantially greater burden of diabetes in the elderly.

The main limitations of our study include reliance on secondary data, which in turn is affected by the accuracy of measurement, changes in case definition, and heterogeneity in study designs. Yet as GBD evolves and matures, its estimation techniques have become more accurate and reliable. These statistical estimates provide a more complete and continuous picture of disease epidemiology than relying on raw data from isolated studies [ 11]. Ultimately, the goal is to guide decision making in clinical care and public health policy.

5. CONCLUSION

Type 2 diabetes continues to increase in prevalence, incidence, and as a leading cause of human suffering and deaths. Despite significant investments in clinical care, research, and public health interventions, there appears to be no sign of reduction in the rate of increase. Certain regions of the world, such as Western Europe and island states in the Pacific, are experiencing a disproportionately high burden. This epidemic will require an urgent and unwavering commitment to aggressive solutions at national levels with public policies, public health funding, and economic incentives for local communities to start diabetes prevention programs. Healthy eating options need to be subsidized, and unhealthy foods need to be taxed or otherwise disincentivized. Healthcare organizations and individual healthcare providers from multiple disciplines (doctors, nurses, pharmacists, dieticians, and diabetes educators) must be given time and resources to collaborate as they educate and care for individual and groups of patients. Unless urgent measures are instituted to reduce unhealthy eating, sedentary lifestyles, rapid urbanization, and other factors related to economic development, the burden of diabetes is expected to continue rising.

ACKNOWLEDGMENT

We would like to thank the Institute of Health Metrics, Seattle for compiling global epidemiological statistics and allowing access to data.

CONFLICTS OF INTEREST

The authors declare they have no conflicts of interest.

AUTHORS' CONTRIBUTION

MK contributed to writing the manuscript including the literature review. MJH designed the study/basic concept, wrote sections of the manuscript, analyzed the data, and provided overall supervision of the study. JK wrote parts of the manuscripts, proofread, and provided insights into the interpretation. RDG revised the manuscript and provided additional interpretation of results. HM compiled data and wrote the table. JAK revised and proofread the manuscript and provided additional interpretation of results.

FUNDING

This study did not receive any external grants from government, private or commercial sources.

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Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends

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The rising burden of type 2 diabetes is a major concern in healthcare worldwide. This research aimed to analyze the global epidemiology of type 2 diabetes. We analyzed the incidence, prevalence, and burden of suffering of diabetes mellitus based on epidemiological ...