Diabetes Mellitus-Epidemiology

Epidemiology

Who Is Most Affected

  • persons with obesity3
  • mean age at diagnosis of type 2 diabetes in the United States decreased from 52 years in 1988-1994 to 46 years in 1999-2000 (Ann Fam Med 2005 Jan-Feb;3(1):60full-text)
  • diabetes prevalence similar in men and women globally, but slightly higher in men < 60 years old and in women at older ages (Diabetes Care 2004 May;27(5):1047)
  • American Indians/Alaska Natives (AI/ANs) have a higher prevalence of diabetes
    • from 1994 to 2002, the age-adjusted prevalence of diabetes among United States adults increased from 4.8% to 7.3%, but among AI/AN adults, from 11.5% to 15.3% (MMWR Morb Mortal Wkly Rep 2003 Aug 1;52(30):702full-text)
    • from 1994 to 2004, the age-adjusted prevalence of diagnosed diabetes in AI/ANs < 35 years old increased from 0.85% to 1.71%; prevalence in 2004 increased with age from 0.22% at age < 15 years to 4.68% at ages 25-34 years.

Incidence/Prevalence

  • about 415 million people worldwide were estimated to have diabetes in 2015, and diabetes mellitus type 2 reported to account for > 90% of that cases
  • STUDY SUMMARY
    worldwide prevalence of diabetes in adults 9% in men and 7.9% in women in 2014
    INDIVIDUAL PATIENT DATA META-ANALYSIS: Lancet 2016 Apr 9;387(10027):1513 
     
  • the estimated prevalence of diabetes in adults in the United States
    • STUDY SUMMARY
      8.5% prevalence of diabetes mellitus type 2 in adults in the United States in 2016-2017
      CROSS-SECTIONAL STUDY: BMJ 2018 Sep 4;362:k1497 
       

Risk Factors

  • metabolic conditions
    • prediabetes – American Diabetes Association (ADA) and World Health Organization (WHO) criteria for diagnosing prediabetes includes any of
      • impaired fasting glucose – plasma glucose 110-125 mg/dL (6.1-6.9 mmol/L) using WHO criteria, or 100-125 mg/dL (5.6-6.9 mmol/L) using ADA criteria
      • impaired glucose tolerance – 2-hour plasma glucose 140-199 mg/dL (7.8-11 mmol/L) during 75 g oral glucose tolerance test (WHO and ADA criteria)
      • HbA1c 5.7%-6.4% (ADA criteria)
    • obesity
    • metabolic syndrome
    • polycystic ovary syndrome
    • gestational diabetes mellitus (GDM)
  • modifiable lifestyle factors
    • poor diet or Western-pattern diet, increased processed meat consumption, sweetened beverage consumption, high dietary glycemic index, low cereal fiber intake, and low magnesium intake
    • lack of exercise and sedentary behaviors
    • smoking
  • demographic factors
    • African Americans and Hispanics in the United States, and Aborigines in Australia
    • lower socioeconomic status
  • see Risk Factors for Diabetes Mellitus Type 2 for details
  • other medical conditions
    • hemochromatosis carrier state (C282Y mutation)
    • chronic hepatitis C infection
    • depression
    • cancer (survivors of childhood cancer with abdominal radiation)
  • medications
    • atypical antipsychotics, such as olanzapine
    • thiazide diuretics and beta-blockers
    • glucocorticoids
    • progestin-only contraceptives
    • antiretroviral therapy
    • concomitant selective serotonin reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) use
    • statins
  • environmental toxins
    • pesticide exposure
    • polychlorinated biphenyl (PCB) exposure
    • arsenic
    • organochlorine pollutants in serum
  • genotype
    • TCF7L2 polymorphism
    • single-nucleotide polymorphisms
  • other possible risk factors
    • retinal arteriolar narrowing
    • low birth weight
    • short or long sleep duration, or difficulty sleeping
    • history of lithotripsy
    • low body mass index (in older Japanese adults)
  • serum biomarkers associated with diabetes
    • elevated C-reactive protein (CRP)
    • elevated liver enzymes (gamma-glutamyltransferase [GGT] and alanine aminotransferase [ALT])
    • low potassium levels
    • increased iron stores
    • low ghrelin levels
    • markers of endothelial dysfunction (elevated E-selectin and intracellular adhesion molecule 1 [ICAM-1])
    • low endogenous sex hormone levels (testosterone, estradiol, sex-hormone-binding globulin)
    • elevated fetuin-A (hepatic protein) levels
    • low serum vitamin C levels
    • elevated serum uric acid levels

Other Associated Conditions

  • other conditions associated with type 2 diabetes include1
    • nonalcoholic fatty liver disease
    • HIV
    • pancreatitis
    • periodontal disease
    • hearing impairment
    • psychosocial/emotional disorders
      • anxiety disorders
      • depression
      • disordered eating behavior
      • serious mental illness including schizophrenia and other thought disorders