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Epidemiology of Type II Diabetes

An International Perspective

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Summary

Non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) is present in nearly all of the countries of the world, and represents a significant disease burden in most developed countries. Type II diabetes is fairly common among Caucasoid populations in the United States and Europe and, more importantly, among Native Americans, Pacific Island populations, persons of Asian Indian origin, Hispanics and African Americans. Our current understanding is that type II diabetes probably results from an interaction of genetic and environmental factors. While a genetic link is most likely a precursor to type II diabetes, a number of lifestyle behaviours, including obesity, lack of physical activity, and diet, also influence the development of the disease. Lifestyle changes and westernisation that accompany economic development in developing countries have been followed in the past by substantial increases in the prevalence of type II diabetes. Thus, further increases in type II diabetes might be expected in the Third World as the economic advancement of these countries continues.

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References

  1. Simanis JG. Health care expenditures: international comparisons, 1970–80. Soc Sec Bull 1987; 50: 19–24

    CAS  Google Scholar 

  2. Simanis JG, Coleman JR. Health care expenditures in nine industrialized countries, 1960–76. Soc Secur Bull 1980; 43: 3–8

    PubMed  CAS  Google Scholar 

  3. Organization for Economic Cooperation and Development. Health care systems in transition; the search for efficiency. OECD Social Policy Studies No.7. Paris, 1990: 129–35

  4. WHO Study Group on Prevention of Diabetes Mellitus. Prevention of diabetes mellitus [WHO Technical Report Series no. 844]. Geneva: World Health Organization, 1994

    Google Scholar 

  5. Bennett PH, Bogardus C, Tuomilehto J, et al. Epidemiology andnatural history of NIDDM: non-obese and obese. In: Alberti KGMM, DeFronzo RA, Keen H, et al., editors. Internationaltextbook of diabetes mellitus. London: John Wiley & Sons Ltd, 1992: 147–76

    Google Scholar 

  6. WHO Study Group on Diabetes Mellitus. Diabetes mellitus [WHO Technical Report Series no. 727]. Geneva: World Health Organization, 1985

    Google Scholar 

  7. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28: 1039–57

    Google Scholar 

  8. Harris MI, Zimmet P. Classification of diabetes mellitus and other categories of glucose intolerance. In: Alberti KGMM, DeFronzo RA, Keen H, et al., editors. International textbook of diabetes mellitus. London: John Wiley & Sons Ltd, 1992: 3–18

    Google Scholar 

  9. Zimmet P. Non-insulin-dependent (type 2) diabetes mellitus — does it really exist? Diabet Med 1989; 6: 728–35

    Article  PubMed  CAS  Google Scholar 

  10. Zimmet PZ, Shaten BJ, Kuller LH, et al. Antibodies to glutamic acid decarboxylase and diabetes mellitus in the Multiple Risk Factor Intervention Trial. Am J Epidemiol 1994; 140 (8): 683–90

    PubMed  CAS  Google Scholar 

  11. Zimmet PZ, King HOM, Bjorntorp SPA. Obesity, hypertension, carbohydrate disorders and risk of chronic diseases. Is thereany epidemiological evidence for integrated prevention programmes? Med J Aust 1986; 45: 256–9

    Google Scholar 

  12. Zimmet P, Baba S. Central obesity, glucose intolerance, and other cardiovascular disease risk factors. An old syndrome, rediscovered. In: Baba S, Zimmet P, editors. World data book of obesity. Diabetes Res Clin Pract 1990; 10 Suppl. 1: S167–71

    Article  Google Scholar 

  13. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607

    Article  PubMed  CAS  Google Scholar 

  14. Bennett PH, Burch TA, Miller M. Diabetes mellitus in American (Pima) Indians. Lancet 1971; 2: 125–8

    Article  PubMed  CAS  Google Scholar 

  15. Knowler WC, Bennett PH, Hamman RF, et al. Diabetes incidence and prevalence in Pima Indians: a 19-fold greater incidence than in Rochester, Minnesota. Am J Epidemiol 1978; 108: 497–505

    PubMed  CAS  Google Scholar 

  16. Zimmet P, Taft P, Guinea A, et al. The high prevalence of diabetes mellitus on a central Pacific island. Diabetologia 1978; 13: 111–5

    Article  Google Scholar 

  17. Zimmet P, King H, Taylor R, et al. The high prevalence of diabetes mellitus, impaired glucose tolerance and diabetic retinopathy in Nauru — the 1982 survey. Diabetes Res 1984; 1: 13–8

    PubMed  CAS  Google Scholar 

  18. Zimmet P, Taylor R, Ram P, et al. Prevalence of diabetes and impaired glucose tolerance in the biracial (Melanesian and Indian) population of Fiji: a rural-urban comparison. Am J Epidemiol 1983; 118: 673–88

    PubMed  CAS  Google Scholar 

  19. Omar MAK, Seedat MA, Dyer RB, et al. The prevalence of diabetes mellitus in a large group of South African Indians. S Afr Med J 1985; 67: 924–6

    PubMed  CAS  Google Scholar 

  20. Dowse GK, Gareeboo H, Zimmet PZ, et al. The high prevalence of glucose intolerance in Indian, Creole, and Chinese Mauritians. Diabetes 1990; 39: 390–6

    Article  PubMed  CAS  Google Scholar 

  21. Flegal KM, Ezzati TM, Harris MI, et al. Prevalence of diabetes in Mexican-Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey 1982–1984. Diabetes Care 1991; 14 Suppl. 3: 628–38

    Article  PubMed  CAS  Google Scholar 

  22. Gardner LI, Stern MP, Haffner SM, et al. Prevalence of diabetes in Mexican-Americans — relationship to percent of gene pool derived from Native American sources. Diabetes 1984; 33: 86–92

    Article  PubMed  Google Scholar 

  23. Harris MI, Hadden WC, Knowler WC, et al. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in US population aged 20–74 years. Diabetes 1987; 36: 523–34

    Article  PubMed  CAS  Google Scholar 

  24. King H, Rewers M. Diabetes mellitus in third world adults. Bull World Health Organ 1991; 69 (6): 643–8

    PubMed  CAS  Google Scholar 

  25. King H, Zimmet P. Trends in prevalence and incidence of diabetes; non-insulin-dependent diabetes mellitus. World Health StatQ 1988; 41: 190–6

    CAS  Google Scholar 

  26. Harris MI. Screening for undiagnosed non-insulin-dependent diabetes. In: Alberti KGMM, Mazze R, editors. Frontiers of diabetes research: current trends in non-insulin-dependent diabetes mellitus. Amsterdam: Elsevier, 1989

    Google Scholar 

  27. McCarty D, Zimmet P. Diabetes 1994 to 2010: Global estimates and projections. Melbourne: International Diabetes Institute, 1994

    Google Scholar 

  28. Everhart J, Knowler WC, Bennett PH. Incidence and risk factors for non-insulin-dependent diabetes. In: Diabetes in America, diabetes data compiled 1984. NIH Pub. No. 85–1468. Bethesda, MD: National Diabetes Data Group, 1985

    Google Scholar 

  29. Bender AP, Sprafka JM, Jagger HG, etal. Incidence, prevalence, and mortality of diabetes mellitus in Wadena, Marshall, and Grand Rapids, Minnesota: the three-city study. Diabetes Care 1986; 9: 343–50

    Article  PubMed  CAS  Google Scholar 

  30. Balkau B, King H, Zimmet P, et al. Factors associated with the development of diabetes in the Micronesian population of Nauru. Am J Epidemiol 1985; 122: 594–605

    PubMed  CAS  Google Scholar 

  31. Haffner SM, Hazuda HP, Mitchell BD, et al. Increased incidence of type II diabetes mellitus in Mexican Americans. Diabetes Care 1991; 14 (2): 102–8

    Article  PubMed  CAS  Google Scholar 

  32. Dowse GK, Spark RA, Mavo B, et al. Extraordinary high prevalence of non-insulin-dependent diabetes mellitus and bimodal plasma glucose distribution in the Wanigela people of Papua New Guinea. Med J Aust 1994; 160 (12): 767–74

    PubMed  CAS  Google Scholar 

  33. Zimmet PZ. Kelly West Lecture 1991: Challenges in diabetes epidemiology — from west to the rest. Diabetes Care 1992; 15 (2): 232–52

    PubMed  CAS  Google Scholar 

  34. Newman B, Selby JV, King MC, et al. Concordance for type 2 (non-insulin-dependent) diabetes mellitus in male twins. Diabetologia 1987; 30: 763–8

    Article  PubMed  CAS  Google Scholar 

  35. Barnett AH, Eff C, Leslie RDG, et al. Diabetes in identical twins: a study of 200 pairs. Diabetologia 1981; 20: 87–93

    Article  PubMed  CAS  Google Scholar 

  36. Gottlieb MS, Root HE. Diabetes mellitus in twins. Diabetes 1968; l7: 693–704

    Google Scholar 

  37. Serjeantson S, Zimmet P. Diabetes in the Pacific: evidence of amajor gene. In: Baba S, Gould MK, Zimmet P, editors. Diabetes mellitus: recent knowledge on aetiology, complications, and treatment. Sydney: Academic Press, 1984

    Google Scholar 

  38. Knowler WC, Pettitt DJ, Bennett PH, et al. Diabetes mellitus in the Pima Indians: genetic and evolutionary considerations. Am J Phys Anthropol 1983; 62: 107–14

    Article  PubMed  CAS  Google Scholar 

  39. Rimm EB, Chan J, Stampfer MJ, et al. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ 1995; 310: 555–9

    Article  PubMed  CAS  Google Scholar 

  40. Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Mem Fund Q 1971; 49 (4): 509–38

    Article  PubMed  CAS  Google Scholar 

  41. Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the case of delayed degenerative diseases. Milbank Q 1986; 64: 355–91

    Article  PubMed  CAS  Google Scholar 

  42. Mosley WH, Jamison DT, Henderson DA. The health sector in developing countries: problems for the 1990s and beyond. Annu Rev Public Health 1990; 11: 335–58

    Article  PubMed  CAS  Google Scholar 

  43. King H, Taylor R, Zimmet P, et al. Non-insulin-dependent diabetes (NIDDM) in a newly independent Pacific nation: the Republic of Kiribati. Diabetes Care 1984; 7: 409–15

    Article  PubMed  CAS  Google Scholar 

  44. Taylor R, Lewis ND, Levy S. Societies in transition: mortality patterns in Pacific Island populations. Int J Epidemiol 1989; 18: 634–46

    Article  PubMed  CAS  Google Scholar 

  45. Dowse GK, Zimmet PZ, Gareeboo H, et al. Abdominal obesity and physical inactivity as risk factors for NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Diabetes Care 1991; 14: 271–82

    Article  PubMed  CAS  Google Scholar 

  46. Glatthaar C, Welborn TA, Stenhouse NS, et al. Diabetes and impaired glucose tolerance: a prevalence estimate based on the Busselton 1981 survey. Med J Aust 1985; 143: 436–40

    PubMed  CAS  Google Scholar 

  47. French LR, Boen JR, Martinez AM, et al. Population-based study of impaired glucose tolerance and type II diabetes in Wadena, Minnesota. Diabetes 1990; 39: 1131–7

    Article  PubMed  CAS  Google Scholar 

  48. Eriksson KF, Lindgarde E Impaired glucose tolerance in a middle-aged male urban population: a new approach for identifying high risk populations. Diabetologia 1990; 33: 526–31

    CAS  Google Scholar 

  49. Nabarro J. Diabetes in the United Kingdom, some facts and figures. Diabetic Med 1988; 5: 816–20

    Article  PubMed  CAS  Google Scholar 

  50. Gurney M, Gorstein J. The global prevalence of obesity - an initial overview of available data. World Health Stat Q 1988; 41: 251–4

    PubMed  CAS  Google Scholar 

  51. Zimmet P, Dowse G, Kriska A, et al. Recent developments in the epidemiology of non-insulin-dependent diabetes. Diabetes Nutr Metab 1990; 3 Suppl. 1: 3–8

    Google Scholar 

  52. Swai ABM, McLarty DG, Sherrif F, et al. Diabetes and impaired glucose tolerance in an Asian community in Tanzania. Diabetes Res C1in Pract 1990; 8: 227–34

    Article  CAS  Google Scholar 

  53. Shanghai Diabetes Research Cooperative Group. Diabetes mellitus survey in Shanghai. Chin Med 1980; 93: 663–5

    Google Scholar 

  54. Coventry J, King H, Zimmet P, et al. Impaired glucose tolerance in the biethnic (Melanesian and Indian) populations of Fiji. Diabetes Res 1986; 3: 427–32

    PubMed  CAS  Google Scholar 

  55. Schaad JDG, Terpstra J, Dernrawsingh I, et al. Diabetes prevalence in the three main ethnic groups in Surinam (South America): a population survey. Netherlands Med J 1986; 28: 17–27

    Google Scholar 

  56. Klein R, Klein BEK, Moss SE. The epidemiology of ocular problems in diabetes mellitus. In: Feman SS, editor. Ocular problems in diabetes mellitus. Boston: Blackwell, 1992

    Google Scholar 

  57. Klein R, Klein BEK, Moss SE. Epidemiology of proliferative diabetic retinopathy. Diabetes Care 1992; 15 (12): 1875–91

    Article  PubMed  CAS  Google Scholar 

  58. Klein R, Klein BEK. Vision disorders in diabetes. In: Diabetes in America, diabetes data compiled 1984; NIH Pub. No. 85- 1468. Bethesda, MD: National Diabetes Data Group, 1985; XIII: 1–36

    Google Scholar 

  59. Herman WH, Teutsch SM. Kidney diseases associated with diabetes. In: Diabetes in America, diabetes data compiled 1984; NIH Pub. No. 85–1468. Bethesda, MD: National Diabetes Data Group, 1985; XIV: 1–31

    Google Scholar 

  60. Viberti GC, Walker JD, Pinto JD. Diabetes nephropathy. In: Alberti KGMM, DeFronzo RA, Keen H, et al., editors. International textbook of diabetes mellitus. London: John Wiley & Sons Ltd, 1992: 1267–1328

    Google Scholar 

  61. Franklin GM. Sensory neuropathy in non-insulin-dependent diabetes mellitus: the San Luis Valley Diabetes Study. Am J Epidemiol 1990; 131: 633–43

    PubMed  CAS  Google Scholar 

  62. Palumbo PJ, Elveback LR, Whisnant JP. Neurologic complications of diabetes mellitus: transient ischaemic attack, stroke, and peripheral neuropathy. In: Schoenberg BS, editor. Neurological epidemiology: principles and clinical applications. New York: Raven Press, 1978: 593–601

    Google Scholar 

  63. Sussman KE, Reiber G, Albert SF. The diabetic foot problema failed system for health care? Diabetes Res Clin Pract 1992; 17: 1–8

    Article  PubMed  CAS  Google Scholar 

  64. Barrett-Connor E, Orchard T. Diabetes and heart disease. In: Diabetes in America, diabetes data compiled 1984; NIH Pub. no. 85–1468. Bethesda, MD: National Diabetes Data Group, 1985; XVI: 1–41

    Google Scholar 

  65. The World Health Organization Multinational Study of Vascular Disease in Diabetics (MNSVDD). Prevalence of small vessel disease in diabetic patients from 14 centers. Diabetologia 1985; 28 Suppl. 1: 615–40

    Google Scholar 

  66. Garcia MJ, McNamara PM, Gordon T, et al. Morbidity and mortality in diabetics in the Framingham population. Diabetes 1974; 23: 105–11

    PubMed  CAS  Google Scholar 

  67. Dowse GK, Zimmet PZ, Gareeboo H, et al. Abdominal obesity and physical inactivity as risk factors for NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Diabetes Care 1991; 14 (4): 271–82

    Article  PubMed  CAS  Google Scholar 

  68. Reiber GE, King H. Guidelines for the development of a national programme for diabetes mellitus. Geneva: World Health Organization, 1991

    Google Scholar 

  69. Harris MI, Entmacher P. Mortality from diabetes. In: Diabetes in America, diabetes data compiled 1984; NIH Pub. no. 85- 1468. Bethesda, MD: National Diabetes Data Group, 1985; XXIX: 1–48

    Google Scholar 

  70. Fuller JH, Elford J, Goldblatt P, et al. Diabetes mortality: new light on an underestimated public health problem. Diabetologia 1983; 24: 336–41

    Article  PubMed  CAS  Google Scholar 

  71. Whittal DE, Glatthaar C, Knuiman MW, et al. Deaths from diabetes are under-reported in national mortality statistics. Med J Aust 1990; 152: 598–600

    Google Scholar 

  72. Stern MP. Kelly West Lecture: primary prevention of type II diabetes mellitus. Diabetes Care 1991; 14: 399–410

    Article  PubMed  CAS  Google Scholar 

  73. King H, Dowd IE. Primary prevention of type 2 (non-insulindependent) diabetes mellitus. Diabetologia 1990; 33: 3–8

    Article  PubMed  CAS  Google Scholar 

  74. Zimmet PZ. Primary prevention of diabetes mellitus. Diabetes Care 1988; 11: 258–62

    Article  PubMed  CAS  Google Scholar 

  75. Tuomilehto J. Strategies for primary prevention of NIDDM. Adv Exp Med Biol 1988; 246: 403–11

    Article  PubMed  CAS  Google Scholar 

  76. Last JM. A dictionary of epidemiology. 2nd ed. New York: Oxford University Press, 1988

    Google Scholar 

  77. Eriksson KF, Lindgarde F. Prevention of type 2 (non-insulindependent) diabetes mellitus by diet and physical exercise. Diabetologia 1991; 34: 891–8

    Article  PubMed  CAS  Google Scholar 

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Songer, T.J., Zimmet, P.Z. Epidemiology of Type II Diabetes. Pharmacoeconomics 8 (Suppl 1), 1–11 (1995). https://doi.org/10.2165/00019053-199500081-00003

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