Type 2 (non-insulin-dependent) diabetes — An epidemiological overview
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Summary
Despite the use of a wide range of different methodologies and diagnostic criteria, epidemiological studies have shown that Type 2 (non-insulindependent) diabetes has a global distribution and its prevalence varies from country to country, in different ethnic groups in the same country, and between the same ethnic group undergoing internal or external migration. Rural-urban and migration studies indicate that change towards a ‘Westernized’ lifestyle is associated with a dramatic increase in the prevalence rates for Type 2 diabetes. Between populations, comparisons are confounded by a wide range of different ascertainment rates, survey methodologies, and diagnostic criteria for diabetes. However, low prevalence rates for Type 2 diabetes are seen in Eskimos and populations of the Far East, while the highest are seen in American Indians, urbanized Pacific Island populations, and migrant Asian Indians. Available evidence suggests that these latter groups have a genetic susceptibility to Type 2 diabetes (‘diabetes genotype’) and that the disease is unmasked by environmental factors. There appears to be a spectrum of interaction between genetic and environmental factors — in certain populations the genetic role may be more important than environmental, or vice versa. Epidemiological studies, apart from their value in population screenings and case-finding, have contributed to the new classification and diagnostic criteria for diabetes and our understanding of risk factors and host characteristics in the aetiology of Type 2 diabetes.
Key words
Type 2 diabetes epidemiology genetics environmental factors ethnic groups migrants rural urban comparisonsReferences
- 1.Bennett PH, Le Compte PM, Miller M, Rushforth NB (1976) Epidemiological studies of diabetes in the Pima Indians. Recent Prog Horm Res 32:333–376Google Scholar
- 2.Zimmet P, Guinea A, Guthrie W, Taft P, Thoma K (1977) The high prevalence of diabetes mellitus on a Central Pacific island. Diabetologia 13:111–115Google Scholar
- 3.Zimmet P, Arblaster M, Thoma K (1978) The effect of westernization on native populations. Studies on a Micronesian community with a high diabetes prevalence. Aust NZ J Med 8: 141–146Google Scholar
- 4.West KM (1978) Epidemiology of diabetes and its vascular complications. Elsevier, New YorkGoogle Scholar
- 5.Gamble D (1980) The epidemiology of insulin dependent diabetes with particular reference to the relationship of virus infection to its etiology. Epidemiologic Reviews 2:49–70Google Scholar
- 6.National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28:1039–1057Google Scholar
- 7.World Health Organization Expert Committee on Diabetes Mellitus, Second Report (1980), Technical Report Series 646, WHO GenevaGoogle Scholar
- 8.Neel JV (1976) Diabetes mellitus: A geneticist's nightmare. In: Creutzfeld W, Koberling J, Neel J (eds) The genetics of diabetes mellitus. Springer, New York, pp 1–11Google Scholar
- 9.Zimmet P (1980) When is diabetes? — A new look at diagnostic criteria for diabetes mellitus. Aust NZ J Med 10:346–350Google Scholar
- 10.West KM (1974) Diabetes in American Indians and other native populations of the New World. Diabetes 23: 841–855Google Scholar
- 11.Zimmet P (1979) Epidemiology of diabetes and its macrovascular complications in Pacific populations: The medical effects of social progress. Diabetes Care 2:144–153Google Scholar
- 12.Taylor R, Zimmet P (in press) The epidemiology of diabetes — migrant studies. In: Mann J, Pyorala K, Teuscher A (eds) Diabetes — a clinical perspective. Churchill Livingstone, EdinburghGoogle Scholar
- 13.Prior IAM, Davidson F (1966) The epidemiology of diabetes in Polynesians and Europeans in New Zealand and the Pacific. NZ Med J 65:375–383Google Scholar
- 14.Zimmet P, Ainuu S, De Boer W, Faaiuso J, Whitehouse S (1981) The prevalence of diabetes in the rural and urban Polynesian population of Western Samoa. Diabetes 30:45–51Google Scholar
- 15.Irvine WJ (1980) Autoimmunity in diabetes. In: Waldhäusl W (ed) Diabetes 1979. Excerpta Medica, Amsterdam, pp 353–366Google Scholar
- 16.Editorial (1977) The epidemiological transition. Lancet 2: 670Google Scholar
- 17.Mouratoff GJ, Carroll NV, Scott EM (1967) Diabetes mellitus in Eskimos. JAMA 199:107–112Google Scholar
- 18.Mouratoff GJ, Carroll NV, Scott EM (1969) Diabetes mellitus in Athabaskan Indians in Alaska. Diabetes 18:29–32Google Scholar
- 19.Gupta OP, Dave SH, Joshi MH (1978) Prevalence of diabetes in India. In: Levine R, Luft R (eds) Advances in metabolic disorders, vol 9. Academic Press, New York, pp 13–28Google Scholar
- 20.Toyota T, Goto Y, Komatsu K, Kudo M, Taya S (1976) Prevalence of diabetes in rural and urban Japan. In: Baba S, Fukui S, Goto Y (eds) Diabetes mellitus in Asia. Excerpta Medica, Amsterdam, pp 35–40Google Scholar
- 21.Djokomoeljanto R, Boedhi-Darmojo R, Hamardji Soetardjo (1976) A community study of diabetes mellitus in an urban population in Semarang, Indonesia. In: Baba S, Fukui S, Goto Y (eds) Diabetes mellitus in Asia. Excerpta Medica, Amsterdam, pp 45–50Google Scholar
- 22.Shanghai Diabetes Research Cooperative Group (1980) Diabetes mellitus survey in Shanghai. Chinese Med J 93: 663–672Google Scholar
- 23.Cheah JS, Tan BY (1979) Diabetes among different races in a similar environment. In: Waldhäusl W (ed) Diabetes 1979. Excerpta Medica, Amsterdam, pp 512–516Google Scholar
- 24.Welborn TA, Cullen KJ, Curnow DH, McCali MG, Stenhouse NS, Wearne JT (1968) Diabetes detected by blood sugar measurement after a glucose load: Report from the Busselton survey, 1966. Med J Aust 2:778–783Google Scholar
- 25.Henry RE, Bennett PH, Burch TA, Miller M (1969) Diabetes in the Cocopah Indians. Diabetes 18:33–37Google Scholar
- 26.Stein JH, McDonald GW, Robey JM, Tirador DF, West KM (1965) The high prevalence of abnormal glucose tolerance in Cherokee Indians of North Carolina. Arch Intern Med 116: 842–846Google Scholar
- 27.Prior IAM, Beaglehole R, Davidson F, Salmond CE (1978) The relationship of diabetes, blood lipids, and uric acid levels in Polynesians. In: Levine R, Luft R (eds) Advances in metabolic disorders, vol 9. Academic Press, New York, pp 242–260Google Scholar
- 28.Wise PH, Craig R, Edwards FM, Elliot RB, Hatcher L, Thomas DW (1970) Hyperglycaemia in the urbanized aboriginal. The Davenport survey. Med J Aust 2:1001–1006Google Scholar
- 29.Martin FIR, Griew AR, Haurahelia M, Higginbotham L, Wyatt GB (1980) Diabetes mellitus in urban und rural communities in Papua New Guinea. Studies of prevalence and plasma insulin. Diabetologia 18:369–374Google Scholar
- 30.Zimmet P, Kirk RL, Serjeantson S, Taylor R, Whitehouse S (in press) Diabetes in Pacific populations — genetic and environmental interaction in diabetes mellitus. In: Baba S, Melish J (eds) Diabetes in Asia and Oceania. Excerpta Medica, AmsterdamGoogle Scholar
- 31.West KM, Kalbfleisch JM (1966) Glucose intolerance in Uruguay, Venezuela, Malaya and East Pakistan. Diabetes 15:9–18Google Scholar
- 32.Marine N, Edelstein O, Jackson WPU, Vinik AI (1969) Diabetes hyperglycaemia and glycosuria among Indians, Malays and Africans (Bantu) in Cape Town, South Africa. Diabetes 18:840–857Google Scholar
- 33.Zammit Maempel JV (1965) Diabetes in Malta. A pilot survey. Lancet 2:1197–1200Google Scholar
- 34.Sanchez-Medina M (1979) Special needs of Latin America. Diabetologia Croatica VIII (Suppl) 1:135–141Google Scholar
- 35.Stern MP, Allen CR Jr, Garza V, Gonzales JL, Parten Gaskill S, Waldrop RH (1981) Cardiovascular risk factors in Mexican Indians in Laredo, Texas. 1. Prevalence of overweight and diabetes and distribution of serum lipids. Am J Epidemiol 113: 546–555Google Scholar
- 36.Bose RKC (1907) Comments on diabetes in the tropics. B med J 2:1053–1054Google Scholar
- 37.Jackson WPU (1978) Diabetes in South Africa. In: Levine R, Luft R (eds) Advances in metabolic disorders, vol 9. Academic Press, New York, pp 111–146Google Scholar
- 38.Williams E, Williams P (1981) Uganda West Nile district. In: Trowell HC, Burkitt DP (eds) Western diseases: their emergence and prevention. Edward Arnold, London, pp 188–193Google Scholar
- 39.Trowell HC (1981) Hypertension, obesity, diabetes mellitus and coronary heart disease. In: Trowell HC, Burkitt DP (eds) Western diseases: their emergence and prevention. Edward Arnold, London, pp 3–32Google Scholar
- 40.Poon-King T, Henry MV, Rampersad F (1968) Prevalence and natural history of diabetes in Trinidad. Lancet 1:155–160Google Scholar
- 41.Prior I, Tasman-Jones C (1981) New Zealand Maori and Pacific Polynesians. In: Trowell HC, Burkitt DP (eds) Western diseases: their emergence and prevention. Edward Arnold, London, pp 227–267Google Scholar
- 42.Cohen AM, Bavly S, Poznanski R (1961) Change of diet in relation to diabetes and ischaemic heart disease. Lancet 2: 1399–1401Google Scholar
- 43.Cohen AM, Chen B, Eisenberg S, Fidel J, Furst A (1979) Diabetes, blood lipids, lipoproteins and change of environment. Restudy of the ‘new immigrant Yemenites’ in Israel. Metabolism 28:716–728Google Scholar
- 44.Kawate R, Nishimoto Y, Yamakido M (1980) Migrant studies among the Japanese in Hiroshima and Hawaii. In: Waldhäusl WK (ed) Diabetes 1979. Excerpta Medica, Amsterdam, pp 526–531Google Scholar
- 45.Bennett PH, Knowler WC (1980) Increasing prevalence of diabetes in the Pima (American). Indians over a ten year period. In: Waldhäusl WK (ed) Diabetes 1979. Excerpta Medica, Amsterdam, pp 507–511Google Scholar
- 46.West KM, Kalbfleisch JM (1970) Diabetes in Central America. Diabetes 19:656–663Google Scholar
- 47.Harris M (1982) The prevalence of diagnosed diabetes, undiagnosed diabetes and impaired glucose tolerance in the United States. In: Melish JS, Hanna J, Baba S (eds) Genetic environmental interaction in diabetes mellitus. Excerpta Medica, Amsterdam, pp 70–76Google Scholar
- 48.Hamman RF, Bennett PH, Miller M (1978) Incidence of diabetes among the Pima Indians. In: Levine R, Luft R (eds) Advances in Metabolic Disorders, vol 9, Academic Press, New York, pp 49–63Google Scholar
- 49.Knowler WC, Bennett PH, Hamman RF, Miller M (1978) Diabetes incidence and prevalence in Pima Indians: A 19-fold greater incidence than in Rochester, Minnesota. Am J Epidemiol 108:497–504Google Scholar
- 50.Palumbo PJ, Labarthe DR (1978) The incidence of diabetes mellitus in Rochester, Minnesota, 1945–1969. In: Levine R, Luft R (eds) Advances in metabolic disorders, vol 9. Academic Press, New York, pp 13–20Google Scholar
- 51.Zimmet P, Pinkstone G, Thoma K, Whitehouse S (1982) The high incidence of diabetes mellitus in the Micronesian population of Nauru. Acta Diabetologica Latina (in press)Google Scholar
- 52.Rushforth NB, Bennett PH, Burch TA, Miller M, Steinberg AG (1971) Diabetes in the Pima Indians. Evidence of bimodality in glucose tolerance distributions. Diabetes 20:756–764Google Scholar
- 53.Zimmet P, Whitehouse S (1978) Bimodality of fasting and twohour glucose tolerance distributions in a Micronesian population. Diabetes 27:793–800Google Scholar
- 54.Rushforth NB, Bennett PH, Miller M (1979) Fasting and twohour post-glucose levels for the diagnosis of diabetes. The relationship between glucose levels and complications of diabetes in the Pima Indians. Diabetologia 16:373–379Google Scholar
- 55.Hayner NS, Epstein FH, Francis T, Kjelsberg MD (1965) Carbohydrate tolerance and diabetes in a total community: Tecumseh, Michigan. Diabetes 14:413–423Google Scholar
- 56.Cudworth AG, Woodrow JC (1975) Evidence for HL-A-Linked genes in “juvenile” diabetes mellitus. B med J 3:133–135Google Scholar
- 57.Christy M, Christau B, Green A, Kromann H, Nerup J, Platz P, Ryder L, Svejgaard A, Thomsen M (1979) Studies of the HLA system and insulin-dependent diabetes mellitus. Diabetes Care 2:209–214Google Scholar
- 58.Pyke DA (1979) The genetic connection. Diabetologia 17: 333–343Google Scholar
- 59.Serjeantson S, Court J, Dry PJ, Kirk RL, Ryan DP, Stepanas AV, Zimmet P (1980) HLA studies in Australian multiple-case families of juvenile onset diabetes mellitus. Med J Aust 1: 107–109Google Scholar
- 60.Owerbach D, Nerup J (1981) Restriction fragment length polymorphism of the insulin gene in diabetic individuals. Diabetologia 21:311 (Abstract)Google Scholar
- 61.Cruz-Vidal M, Costas R, Garcia-Palmieri MR, Hertsmark E, Sorlie PD (1979) Factors related to diabetes mellitus in Puerto Rican men. Diabetes 28:300–307Google Scholar
- 62.Neel JV (1962) Diabetes mellitus: a thrifty genotype rendered detrimental by ‘progress’? Am J Hum Genet 14:353–362Google Scholar
- 63.Neel JV (in press) The thrifty genotype revisited In: Kobberling J, Tattersal R (eds) The genetics of diabetes mellitus. Proc Serono Symposium. Academic Press, LondonGoogle Scholar
- 64.Wise PH (1977) Significance of anomalous thermo-regulation in the pre-diabetic spiny mouse (Acomys Cahirinus): Cold tolerance: Blood glucose and food consumption responses to environmental heat. Aust J Exper Biol Med Sci 55:475–484Google Scholar
- 65.Zimmet P, Kiss J, Whitehouse S (1979) Ethnic variability in insulin secretion. Diabetes 28:624–628Google Scholar
- 66.Wise PH, Craig RJ, Edwards FM, Evans B, Murchland JB, Sutherland B, Thomas DW (1976) Diabetes and associated variables in the South Australian aboriginal. Aust NZ J Med 6: 191–196Google Scholar
- 67.Kobberling J, Bengseh N, Bruggeboes B, Schwarch K, Tillil H, Weber B (1980) The chlorpropamide alcohol flush. Diabetologia 19:359–363Google Scholar
- 68.Briggs BR, Botha MC, Jackson WPU, Du Toit ED (1980) The histocompatibility (HLA) antigen distribution in South African blacks (Xhosa). Diabetes 29:68–70Google Scholar
- 69.Williams RC, Bennett PH, Butler WJ, Johnson AH, Knowler WC, Lisse JR, Mann DL, Pettit DJ, Teraski PI (1981) HLA-A2 and Type 2 (insulin independent) diabetes mellitus in Pima Indians: An association of allele frequency with age. Diabetologia 21:460–463Google Scholar
- 70.Cudworth AG (1978) Type 1 diabetes mellitus. Diabetologia 14:281–291Google Scholar
- 71.Rotter JI, Rimoin DL (1979) Diabetes mellitus: the search for genetic markers. Diabetes Care 2:215–226Google Scholar
- 72.Knowler WC, Bennett PH, Pettit PJ, Savage PJ (1981) Diabetes incidence in Pima Indians: Contributions of obesity and parental diabetes. Am J Epidemiol 113:144–156Google Scholar
- 73.Zimmet P, Whitehouse S (1979) The effect of age on glucose tolerance. Studies in a Micronesian population with a high prevalence of diabetes. Diabetes 28:617–623Google Scholar
- 74.De Fronzo RA (1981) Glucose intolerance and ageing. Diabetes Care 4:493–501Google Scholar
- 75.Medalie JH, Goldbourt U, Herman JB, Papier CM (1978) Variations in the incidence of diabetes among 10,000 adult Israeli males and factors related to their development. In: Levine R, Luft R (eds) Advances in metabolic disorders, vol 9. Academic Press, New York, pp 94–110Google Scholar
- 76.Taylor R, Whitehouse S, Zimmet P (1982) Is the role of obesity as a risk factor for diabetes overstated? Studies in rural and urban Polynesians (Western Samoa). In: Melish JS, Hanna J, Baba S (eds) Genetic environmental interaction in diabetes mellitus. Excerpta Medica, Amsterdam, pp 179–183Google Scholar
- 77.Ahuja M (1976) Vicissitudes of epidemiological studies of diabetes mellitus. J All India Inst Med Sci 2: 5–13Google Scholar
- 78.Barnett AH, Eff C, Leslie RDG, Pyke DA (1981) Diabetes in identical twins. A study in 200 pairs. Diabetologia 20:87–93Google Scholar
- 79.Campbell GD, Batchelor EL, Goldberg MD (1967) Sugar intake and diabetes. Diabetes 16:62–63Google Scholar
- 80.Yudkin J (1964) Dietary fat and dietary sugar in relation to ischemic heart disease and diabetes. Lancet 2:4–5Google Scholar
- 81.Cohen AM, Teitelbaum A (1966) Effect of different levels of protein in “sucrose” and “starch” diets on the glucose tolerance and growth. Metabolism 15:1034–1038Google Scholar
- 82.Keen H (1974) Diabetes and sugar consumption. In Hillebrand SS (ed) Proc 8th Symposium of International Sugar Research Federation, Bethesda, Maryland, USA, pp 14–17Google Scholar
- 83.Trowell H (1975) Dietary-fiber hypothesis of the etiology of diabetes mellitus. Diabetes 24:762–765Google Scholar
- 84.Cleave TL (1974) The saccharine disease. Wright, Bristol, UKGoogle Scholar
- 85.Rossini AA, Appel MC, Like AA, Mordes JP, Williams RM (1980) Animal models of insulin dependent diabetes. In: Waldhäusl WK (ed) Diabetes 1979, Excerpta Medica, Amsterdam, pp 367–372Google Scholar
- 86.Helgason T, Jonasson MR (1981) Evidence for a food additive as a cause of ketosis-prone diabetes. Lancet 2:716–720Google Scholar
- 87.McMillan DE, Geevarghese PJ (1979) Dietary cyanide and tropical malnutrition diabetes. Diabetes Care 2:202–208Google Scholar
- 88.West KM, Kalbfleisch JM (1971) Influence of nutritional factors on prevalence of diabetes. Diabetes 20:99–108Google Scholar
- 89.Pyke DA (1956) Parity and the incidence of diabetes. Lancet 1: 818–821Google Scholar
- 90.Fitzgerald MG, Malins JM, O'Sullivan DJ, Wall M (1961 a) The effect of sex and parity on the incidence of diabetes mellitus. J Med 30:57Google Scholar
- 91.Zimmet P, Collins J, Currie P, DeBoer W, Seluka A, Wicking J (1977) Diabetes mellitus in an urbanized isolated Polynesian population. The Funafuti Survey. Diabetes 26:1101–1108Google Scholar
- 92.Middleton GD, Caird FI (1968) Parity and diabetes mellitus. Br J Prev Soc Med 22:100–104Google Scholar
- 93.Steffens AB (1981) The modulatory effect of the hypothalamus on glucagon and insulin secretion in the rat. Diabetologia 20 (Suppl) 411–416Google Scholar
- 94.Porte D Jr, Berthoud HR, Jeanrenaud B, Woods SC (1981) Diabetes and the nervous system. Diabetologia 20 (Suppl): 245 (Editorial)Google Scholar
- 95.Woods SC, Kenney NJ, Lotter EC, McKay LD, Porte D Jr, Porte SG, Stein LJ, West DB (1981) Peptides and the control of meal size. Diabetologia 20 (Suppl): 305–313Google Scholar
- 96.Porte D Jr, Woods SC (1981) Regulation of food intake and body weight by insulin. Diabetologia 20 (Suppl): 274–280Google Scholar
- 97.Savage PJ, Bennion LJ, Bennett PH (1979) Normalization of insulin and glucagon secretion in ketosis-resistant diabetes mellitus with prolonged diet therapy. J Clin Endocrinol Metab 49: 830–833Google Scholar