Diabetologia

, Volume 22, Issue 6, pp 399–411 | Cite as

Type 2 (non-insulin-dependent) diabetes — An epidemiological overview

  • P. Zimmet

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 comparisons 

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References

  1. 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. 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. 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. 4.
    West KM (1978) Epidemiology of diabetes and its vascular complications. Elsevier, New YorkGoogle Scholar
  5. 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. 6.
    National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28:1039–1057Google Scholar
  7. 7.
    World Health Organization Expert Committee on Diabetes Mellitus, Second Report (1980), Technical Report Series 646, WHO GenevaGoogle Scholar
  8. 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. 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. 10.
    West KM (1974) Diabetes in American Indians and other native populations of the New World. Diabetes 23: 841–855Google Scholar
  11. 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. 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. 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. 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. 15.
    Irvine WJ (1980) Autoimmunity in diabetes. In: Waldhäusl W (ed) Diabetes 1979. Excerpta Medica, Amsterdam, pp 353–366Google Scholar
  16. 16.
    Editorial (1977) The epidemiological transition. Lancet 2: 670Google Scholar
  17. 17.
    Mouratoff GJ, Carroll NV, Scott EM (1967) Diabetes mellitus in Eskimos. JAMA 199:107–112Google Scholar
  18. 18.
    Mouratoff GJ, Carroll NV, Scott EM (1969) Diabetes mellitus in Athabaskan Indians in Alaska. Diabetes 18:29–32Google Scholar
  19. 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. 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. 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. 22.
    Shanghai Diabetes Research Cooperative Group (1980) Diabetes mellitus survey in Shanghai. Chinese Med J 93: 663–672Google Scholar
  23. 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. 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. 25.
    Henry RE, Bennett PH, Burch TA, Miller M (1969) Diabetes in the Cocopah Indians. Diabetes 18:33–37Google Scholar
  26. 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. 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. 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. 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. 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. 31.
    West KM, Kalbfleisch JM (1966) Glucose intolerance in Uruguay, Venezuela, Malaya and East Pakistan. Diabetes 15:9–18Google Scholar
  32. 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. 33.
    Zammit Maempel JV (1965) Diabetes in Malta. A pilot survey. Lancet 2:1197–1200Google Scholar
  34. 34.
    Sanchez-Medina M (1979) Special needs of Latin America. Diabetologia Croatica VIII (Suppl) 1:135–141Google Scholar
  35. 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. 36.
    Bose RKC (1907) Comments on diabetes in the tropics. B med J 2:1053–1054Google Scholar
  37. 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. 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. 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. 40.
    Poon-King T, Henry MV, Rampersad F (1968) Prevalence and natural history of diabetes in Trinidad. Lancet 1:155–160Google Scholar
  41. 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. 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. 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. 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. 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. 46.
    West KM, Kalbfleisch JM (1970) Diabetes in Central America. Diabetes 19:656–663Google Scholar
  47. 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. 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. 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. 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. 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. 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. 53.
    Zimmet P, Whitehouse S (1978) Bimodality of fasting and twohour glucose tolerance distributions in a Micronesian population. Diabetes 27:793–800Google Scholar
  54. 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. 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. 56.
    Cudworth AG, Woodrow JC (1975) Evidence for HL-A-Linked genes in “juvenile” diabetes mellitus. B med J 3:133–135Google Scholar
  57. 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. 58.
    Pyke DA (1979) The genetic connection. Diabetologia 17: 333–343Google Scholar
  59. 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. 60.
    Owerbach D, Nerup J (1981) Restriction fragment length polymorphism of the insulin gene in diabetic individuals. Diabetologia 21:311 (Abstract)Google Scholar
  61. 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. 62.
    Neel JV (1962) Diabetes mellitus: a thrifty genotype rendered detrimental by ‘progress’? Am J Hum Genet 14:353–362Google Scholar
  63. 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. 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. 65.
    Zimmet P, Kiss J, Whitehouse S (1979) Ethnic variability in insulin secretion. Diabetes 28:624–628Google Scholar
  66. 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. 67.
    Kobberling J, Bengseh N, Bruggeboes B, Schwarch K, Tillil H, Weber B (1980) The chlorpropamide alcohol flush. Diabetologia 19:359–363Google Scholar
  68. 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. 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. 70.
    Cudworth AG (1978) Type 1 diabetes mellitus. Diabetologia 14:281–291Google Scholar
  71. 71.
    Rotter JI, Rimoin DL (1979) Diabetes mellitus: the search for genetic markers. Diabetes Care 2:215–226Google Scholar
  72. 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. 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. 74.
    De Fronzo RA (1981) Glucose intolerance and ageing. Diabetes Care 4:493–501Google Scholar
  75. 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. 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. 77.
    Ahuja M (1976) Vicissitudes of epidemiological studies of diabetes mellitus. J All India Inst Med Sci 2: 5–13Google Scholar
  78. 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. 79.
    Campbell GD, Batchelor EL, Goldberg MD (1967) Sugar intake and diabetes. Diabetes 16:62–63Google Scholar
  80. 80.
    Yudkin J (1964) Dietary fat and dietary sugar in relation to ischemic heart disease and diabetes. Lancet 2:4–5Google Scholar
  81. 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. 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. 83.
    Trowell H (1975) Dietary-fiber hypothesis of the etiology of diabetes mellitus. Diabetes 24:762–765Google Scholar
  84. 84.
    Cleave TL (1974) The saccharine disease. Wright, Bristol, UKGoogle Scholar
  85. 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. 86.
    Helgason T, Jonasson MR (1981) Evidence for a food additive as a cause of ketosis-prone diabetes. Lancet 2:716–720Google Scholar
  87. 87.
    McMillan DE, Geevarghese PJ (1979) Dietary cyanide and tropical malnutrition diabetes. Diabetes Care 2:202–208Google Scholar
  88. 88.
    West KM, Kalbfleisch JM (1971) Influence of nutritional factors on prevalence of diabetes. Diabetes 20:99–108Google Scholar
  89. 89.
    Pyke DA (1956) Parity and the incidence of diabetes. Lancet 1: 818–821Google Scholar
  90. 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. 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. 92.
    Middleton GD, Caird FI (1968) Parity and diabetes mellitus. Br J Prev Soc Med 22:100–104Google Scholar
  93. 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. 94.
    Porte D Jr, Berthoud HR, Jeanrenaud B, Woods SC (1981) Diabetes and the nervous system. Diabetologia 20 (Suppl): 245 (Editorial)Google Scholar
  95. 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. 96.
    Porte D Jr, Woods SC (1981) Regulation of food intake and body weight by insulin. Diabetologia 20 (Suppl): 274–280Google Scholar
  97. 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

Copyright information

© Springer-Verlag 1982

Authors and Affiliations

  • P. Zimmet
    • 1
  1. 1.WHO Collaborating Centre for the Epidemiology of Diabetes MellitusRoyal Southern Memorial HospitalMelbourneAustralia

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